Endoscopic treatment of renal and ureteral stones using the new Cyber Ho generator with Magneto technology: the first clinical experience from a multicenter study

Purpose: A novel Ho: YAG laser generator incorporating Magneto pulse modulation technology has been developed to enhance lithotripsy performance. This study evaluates the safety and effectiveness of the Holmium: YAG Cyber Ho generator with Magneto technology (Quanta System®) for the endoscopic treatment of renal and ureteral stones. Materials and methods: An observational multicentric study was conducted on 55 prospectively enrolled patients with ureteral and renal stones who underwent endoscopic lithotripsy using the new Ho: YAG laser with Magneto pulse modulation technology. Recorded parameters included stone volume, density, laser-on time (LOT), and laser settings optimized for Magneto use. Outcome metrics included ablation speed (mm³/s) and energy consumption (J/mm³), while the stone-free rate (SFR) and complication rate were also assessed. The perceived effectiveness of lithotripsy and retropulsion were evaluated using a 5-point Likert scale. Results: Included patients had a median age of 57 years (IQR 48–65). The median stone volume was 948 mm³ (IQR 107–3091), and the median stone density was 900 HU (IQR 750–1105). Stones were located in the ureter in 21 cases (38%), in the lower calyx in 13 cases (24%), and in the upper/mid calyx in 21 cases (38%). The median laser-on time was 16 min (IQR 5–17). Laser settings showed consistent performance, with a median energy of 0.8 J (IQR 0.8–0.8), a frequency of 10 Hz (IQR 10–10), and an average power of 8 W (IQR 8–10). Lithotripsy performance was reflected by a median energy consumption of 14.8 J/mm³ (IQR 11.9–24.3) and an ablation speed of 0.6 mm³/s (IQR 0.4–0.7). The stone-free rate (SFR) was 94.5%. 3.6% of patients experienced Clavien-Dindo grade 1–2 complications, and no severe complications (grade 3–4) were reported. Subjective efficacy was rated as “outstanding” and “very good” in 58.2% and 36.4% of cases, respectively, while retropulsion was subjectively evaluated as “absent” and “very low” in 91.0% and 9.0% of cases, respectively. Conclusions: Endoscopic treatment of renal and ureteral stones using the Cyber Ho generator with the new Magneto pulse modulation technology is safe and effective in this preliminary report. High ablation efficiency and a satisfying anti-retropulsion effect have been reported, potentially leading to faster treatment, higher stone-free rates (SFR), and a lower need for second-stage procedures. Further studies are required to fully evaluate this technology.