Choosing between a thulium laser vs holmium laser is one of the main platform decisions a urology department faces. Both are used for stone treatment and for prostate enucleation, but they differ in wavelength, emission, power supply, fibres, size and running costs. This article compares the two technologies using the published specifications of Richard Wolf's MegaPulse 70+ holmium:YAG and Pulvis 60+ thulium fibre lasers and suggests how to decide for your service.
How the two laser types work
A holmium:YAG laser is a solid-state laser that emits at 2100 nm in pulses. MegaPulse 70+ delivers up to 70 W with a pulse energy of 0.2 to 5 J at 3 to 60 Hz, and its Expert mode allows the pulse width to be set from 50 to 1100 µs. Holmium is well established, with a long record in lithotripsy and soft-tissue work.
A thulium fibre laser generates light in a doped optical fibre at about 1920 to 1960 nm, a wavelength strongly absorbed by water. Pulvis 60+ delivers up to 60 W with a pulse energy of 0.020 to 6 J and frequencies up to 2,500 Hz, in continuous and pulsed emission. The high frequency range is what makes fine dusting settings possible.
Stone treatment: dusting, fragmentation and retropulsion
Holmium is the long-standing standard for laser lithotripsy and offers fragmentation and dusting with a choice of pulse settings. Thulium laser lithotripsy with Pulvis 60+ is presented by the manufacturer as suited to dusting, popcorning and fragmentation with low retropulsion, using disposable and reusable fibres from 150 to 1,000 µm.
Fibre diameters matter in flexible ureteroscopy, where a small fibre improves irrigation and scope deflection. Ask both manufacturers for their available fibre sizes and which scopes they pair with. Clinical performance claims should be checked against published evidence and your surgeons' experience, not against marketing statements. See our guides on holmium laser settings and thulium laser.
Enucleation and soft-tissue work: holmium vs thulium laser for BPH
Both platforms are used for anatomical endoscopic enucleation of the prostate. MegaPulse 70+ is designed for holmium laser enucleation (HoLEP), while Pulvis 60+ is described for thulium fibre laser enucleation (ThuFLEP) as an alternative to HoLEP, and for TUR-B and en bloc resection of bladder tumours. A morcellator such as PIRANHA completes an enucleation set.
Decide with your surgeons which procedures you want to offer, what training they have and what the case volume will be. Power alone does not decide the choice; the delivery system, the fibres and the surgical technique matter. For the enucleation workflow see HoLEP equipment and HoLEP vs BPH technologies.
Practical differences: power supply, size and operation
Pulvis 60+ runs on a standard wall outlet with no high-voltage supply and is a compact tower on castors, 47 x 94 x 81 cm and about 100 kg. MegaPulse 70+ measures 595 x 1200 x 1074 mm and weighs 200 kg, with a foldable 12-inch touch screen, a double-pedal footswitch, RFID detection of the sterile fibre and its diameter, and a blast shield.
Check electrical requirements, cooling, theatre space, the need to move the laser between rooms and the integration with your tower. Laser safety is a core requirement for both: eyewear matched to the wavelength, controlled-area signage and a trained laser safety officer, in line with IEC 60825-1 and your hospital policy.
Running costs, support and how to decide
Compare fibre costs and lifetimes, service contracts, expected downtime and training. A single platform for stones and enucleation reduces the number of devices, but the two technologies are not interchangeable in every respect, and some departments hold both. Ask each supplier for a reference list of consumables and service terms.
Beckfinity distributes Richard Wolf urology systems and can arrange demonstrations of both lasers. Contact our specialists to discuss your case mix and request a quotation.
Frequently asked questions
Which is better, thulium or holmium?
Neither is better for every department. Holmium has the longest track record; thulium fibre offers high frequencies and a compact design. Decide on procedures, fibres, space and costs.
Can both lasers be used for BPH?
Yes, both are used for endoscopic enucleation. MegaPulse 70+ is intended for HoLEP and Pulvis 60+ for ThuFLEP.
Does a thulium laser need special power?
Pulvis 60+ is stated to run on a standard wall outlet with no high-voltage supply.
What fibre sizes are available?
Pulvis 60+ uses disposable and reusable fibres from 150 to 1,000 µm. Ask Beckfinity about fibre options for MegaPulse 70+.
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