Clinical Experience with a New Pulsed Dye Laser for Ureteral Stone Lithotripsy

Abstract

Forty-five patients with 46 ureteral stones were treated using a new pulsed dye laser (Pulsolith, TMI). A fiber of 250 micrometers was used through rigid (40 cases) or flexible (6 cases) ureteroscopes. Stones were located in the upper third (5 cases), middle third (5 cases), or lower third (36 cases) of the ureter. Stone composition was calcium oxalate dihydrate or monohydrate, struvite, or uric acid in 34, 7, 2, and 2 patients, respectively. Thirty-six stones (78%) were fragmented, including 14 cases that required basket removal of fragments at the same time. Ten stones were not fragmented, 6 because of the pure monohydrate composition and 4 due to a laser breakdown. No damage to the ureteral wall was noted. Retrograde rigid ureteroscopy with laser lithotripsy was effective for lower and middle third ureteral stones. Flexible ureteroscopy with laser lithotripsy was effective (impacted stones) but difficult for upper third ureteral stones. Laser lithotripsy was not effective for pure calcium oxalate monohydrate stones.

Long-Term Experience with Transurethral Rigid Ureteroscopy as a Complementary Method to Extracorporeal Shockwave Lithotripsy

“…Accord ing to the reports of quite a few centers, laser lithotripsy can be regarded as an attractive alternative method of lithotripsy with a low rate of complications [ 18,19], In contrast to rigid ureteroscopes, curvatures of the ureter can be more easily overcome by flexible uretero scopes especially if there are fixations of the ureter. Fur thermore, the complete pyelocaliceal space can be in spected.…”

Endoscopic lithotripsy with the holmium:YAG laser

“…However, from the aspect of efficacy of lithotripsy by Ho:YAG laser, lithotripsy was achieved in all 102 (100%) lithotripsy procedures, which included PNL and vesicolithotripsy. Conversely, the pulsed dye laser had an efficacy rate of 78-98% for lithotripsy [14,15,21,22]. The final effect in our patients treated by TUL using the Ho:YAG laser was 92% efficacy.…”

“…The pulsed dye laser has a wavelength of 504 nm that is selectively absorbed by black or brown, which is the color of many urinary tract stones. Therefore, it is ineffective for so-called pale stones such as a cystine stone [14,15]. Conversely, the Ho:YAG laser has a wavelength of 2,100 nm, which can be absorbed to a large extent by water; hence, the laser beam can be absorbed by water present in the micropores on the stone surface, producing an effect irrespective of the color of the stone.…”

Intracorporeal lithotripsy with the Alexandrite laser

“…In clinical use, the pulsed dye laser has been found to be safe and effective in treating ureteral calculi. Various authors have reported clinically successful ureteral stone fragmentation in 78-88% of patients treated [8][9][10]. In an early series using the pulsed dye laser with an 11.5 Fr.…”