Ureteric lithotripsy using Holmium : YAG laser

Abstract

Purpose : Evaluation of the Holmium YAG laser wave length in the treatment of ureteric calculi. Material and Methods : 84 ureteric stones in 62 patients were subjected to lithotripsy by the Ho-YAG laser (wave length 2100 nm). Of the stones treated 54 were lower ureteric, 21 were middle ureteric and 9 were upper uireteric stones. Thirty five stones were subjected to previous unsuccessful endoscopic lithotripsy procedures or ESWL. The mean diameter of the stones was 1.6 cm. The energy parameters followed in the study were 1.5 joules with frequency of 15 to 20 pulse/sec (22-30 watts). KUB was carried out one week and one month after the procedure and intravenous urography was performed 2 months later to evaluate upper tract improvement and to detect any stricture formation alon the ureter. Results : Of the 84 stones, 75 (89.2%) were successfully fragmented : 52 (96%) of the lower, 17 (80.9%) of the middle and 6 (66.6%) of the upper ureteric stones. The cause of failure in fragmentation of the remaining 9 stones (10.7%) was due to failure of instrumentation nor machine malfunction that aborted the procedure. The average operative time per case was approximately 30 minutes and the losing time was approximately 7 minutes. No major complications related to the laser treatment were encountered except in one patient who needed prolonged internal ureteral stenting. Conclusion : Ho-YAG laser lithotripsy is useful and very effective in the endoscopic treatment of ureteric stones. It is safe, if carefully applied and most of the cases can be carried out as an outpatient procedure. Lithotripsy, ureteric calculi, lasers, holmium.