Clinical experience with holmium:YAG laser lithotripsy of ureteral calculi

Abstract

Background and Objective We recently acquired a holmium:YAG laser with wavelength of 2.1 μm. We would like to report our success in using this machine for laser lithotripsy. Study Design/Patients and Methods: Forty‐seven ureteroscopic laser lithotripsies were performed in 44 patients (three bilateral stones) over a 6 month period. Four stones were in the upper ureter, six in the middle ureter, and 37 in the lower ureter. The holmium laser beam was delivered via a 400 micron flexible quartz fiber through a 7 Fr rigid ureteroscope during the procedure. The stone size varied from 4 to 21 mm. Results The success rate was 91%. Most of the stones were fragmented to less than 2 mm in size. Larger fragments were removed with a Dormia basket (six cases) for stone clearance. Endoscopic laser ureterotomy was performed in two patients with stricture below the stone. One patient required conversion to open ureterolithotomy, and three required subsequent Extracorporeal Shock Wave Lithotripsy. A low complication rate was observed. Conclusion The pulsed holmium:YAG laser is safe and effective for use in ureteroscopic laser lithotripsy. © 1996 Wiley‐Liss, Inc.

Holmium : YAG Laser for Intra Corporeal Lithotripsy

“…Once stress fractures develop within the stone, the relatively weak shockwave emission may also contribute to the fragmentation process by breaking up the stone along these weakened cleavage planes. A number of investigators have commented that holmium laser lithotripsy occurs through a "drilling effect", whereby small bits of stone are vaporized, emitting a fine stone dust [10,11,12].…”

A comparison of efficacies of holmium YAG laser, and pneumatic lithotripsy in the endoscopic treatment of ureteral stones

“…[6] Although laser lithotriptor (LL) is quite effective in the management of both proximal ureter stones, and impacted stones, it is more expensive relative to pneumatic lithotriptor. [7] Many studies comparing PL, and LL, as for safety, efficacy, and complications in the management of endoscopic ureteral stones are available. In addition to the studies showing 139 Akdeniz et al A comparison of efficacies of holmium YAG laser, and pneumatic lithotripsy in the endoscopic treatment of ureteral stones similarities between both groups [8][9][10] , some of them reported that LL is more effective with lesser complication rates.…”

Dependence of calculus retropulsion on pulse duration during HO: YAG laser lithotripsy

“…The Ho:YAG laser fragments all stone compositions and produces less stone migration (retropulsion) during treatment than the short pulsed lasers [10][11][12][13][14]. The dominant mechanism in Ho:YAG laser lithotripsy is photothermal along with minor effects of acoustic emission [15].…”