Holmium:YAG lasertripsy for ureteric calculi: an experience of 300 procedures

Abstract

Objective To assess the success of holmium:YAG laserpatients, with the best results in the lower and midureter (97% and 96%, respectively) followed by the tripsy in the management of ureteric calculi and to audit the complications of the procedure, with special upper ureter (89%). Alternative procedures were required in only 17 (7%) patients; extracorporeal reference to strictures in the ureter. Patients and methods A total of 300 ureteroscopic laser shock-wave lithotripsy in 13, percutaneous nephrolithotomy in two and open pyelolithotomy in two procedures were carried out on 265 patients (204 male and 61 female, median age 51 years, range 2-95) with patients. Complications with ureteric perforation in 11 patients, including laparotomy for peritonitis in ureteric calculi. At ureteroscopy, the calculi were present in the upper ureter in 44%, mid-ureter in 37% one, serious sepsis in two and strictures in 10 patients.Strictures were more common in association with and lower ureter in 19% of patients; most calculi were >5 mm. A 7.5 F Wolf semi-rigid ureteroscope was used impacted calculi in the upper ureter early in the series. Conclusions Holmium5YAG lasertripsy is a highly eCecand the holmium:YAG laser energy delivered using the Sharplan ML210 device at 0.8-1.0 J/pulse. The patients tive treatment for ureteric calculi, with strictures related to the treatment of diBcult upper ureteric were followed up at #6 weeks with limited intravenous urography or ultrasonography to assess clearance and calculi.

Ureteric calculi in children: preliminary experience with holmium:YAG laser lithotripsy

“…The mean (range) duration of the procedure was 72 (45-125) min, of fluoroscopy was 17 (13-58) s and of hospital stay was 3.8 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14) days. Of the 28 ureteroscopies, 17 (61%) required mechanical dilatation of the ureteric orifice before negotiating the 8 F ureteroscope into the intramural ureter.…”

“…The Ho:YAG laser represents a further advance in endoscopic stone surgery; it is a tuneable, pulsed, solidstate laser system that operates at a wavelength of 2150 nm, which is readily absorbed by water, resulting in a microscopic vaporization bubble at the tip of the fibre. The laser energy is transmitted through this vapour cavity, the so-called 'Moses effect' [8,9] and the energy absorbed by the water content of the stone leads to thermal disintegration rather than fragmentation of the stone. The effectiveness of the Ho:YAG laser in fragmenting urinary calculi was established experimentally by Sayer et al [10] in 1993.…”

“…Between June 1999 and January 2003, 26 children with ureteric calculi underwent ureteroscopy and Ho:YAG laser lithotripsy at our institution (14 boys and 12 girls, mean age 6.5 years, range [2][3][4][5][6][7][8][9][10][11][12]. The presenting symptoms were colicky abdominal pain in 16 (62%), LUTS in five (19%), acute obstruction with sepsis in four (15%) and haematuria in one (4%) child.…”

Simultaneous saline irrigation during retrograde rigid ureteroscopic lasertripsy for the prevention of proximal calculus migration

“…Devarajan and colleagues report only a 77% success rate for upper ureteric calculi during ureteroscopic holmium:YAG laser lithotripsy. 11 Knispel and colleagues report an incidence rate of 40% to 50% for ureteral calculus migration from the proximal ureter and 5% to 10% from the distal ureter. 12 Gupta reports a 3.3% failure rate due to retropulsion using Holmium laser.…”

Evaluation of emergency extracorporeal shock wave lithotripsy for obstructing ureteral stones

“…This risk can be minimized by stent placement at the time of stone manipulation. Advances in ureteroscopic technology with the introduction of small caliber semi-rigid and flexible ureteroscopes combined with the introduction of the holmium YAG laser have improved stone free rates following ureteroscopy while decreasing the risk of complications (24,25).…”