Flexible ureteroscopy and lithotripsy with the Holmium: YAG laser

Extracorporeal shock wave lithotripsy (ESWL), Dornier Medical Systems, remains the main form of therapy for most urinary stones. The minimally invasive nature of ESWL makes it an attractive form of therapy to both patients and physicians. Many patients however may be most effectively managed by an endoscopic procedure either percutaneously or by transurethral ureteroscopy. Recent years have seen considerable advancement in endoscope technology such that flexible, actively deflectable ureteroscopes of 7.5 F or smaller in diameter have become available for performing upper tract endoscopy. When combined with new intracorporeal lithotripsy devices such as the Holmium:YAG laser, urologists have an effective alternative to ESWL for many stone problems. In this article we review our technique of flexible ureteroscopy combined with Holmium:YAG laser lithotripsy.