Ultrasonic flowmetry and neodymium-yttrium aluminum garnet laser for nephrolithotomy

Intraoperative Doppler flowmetry was used for localization of the intrarenal arteries. To reduce blood loss during nephrolithotomy, a neodymium-yttrium aluminum garnet (YAG) laser beam was used clinically as a cutting instrument. The combination of intraoperative localization of intrarenal arteries by Doppler flowmetry and cutting through renal parenchyma using the neodymium-YAG laser beam was used in 7 patients with stag-horn calculi or recurrent stones. The average blood loss was only 185 ml. Postoperative renal function was normal. Intravenous pyelograms revealed prompt function and no evidence of contrast extravasation. The data indicate that this technique is effective, diminishes blood loss, and does not impair renal function.