Laser lithotripsy for ureteric stones

The use of laser is a relatively new modality of treatment in urology. With the advent of the pulse-dye laser lithotripter and a finer 7.2 ureteroscope (miniscope), we found that it was more effective for treating ureteric stones than the conventional ultrasound lithotripsy. Between May 1989 and December 1991, 239 patients (162 males, 77 females) with 259 ureteric stones were treated endoscopically by this modality. Their ages ranged from 19 to 81 years (mean 46.3). The stones were mostly of 5 to 10 mm in their transverse diameters. They were situated in the upper ureter in 59, middle ureter in 39, and lower ureter in 161 cases. The miniscope was inserted into the ureter without prior dilatation and under direct vision. Stone fragmentation was performed using the 504-nm pulse-dye laser of 30 to 60 mJ energy. Complete fragmentation of the stone using the Candela laser lithotripter was achieved in 202 patients (85%). The average hospital stay was two days. Of the 37 unsuccessful cases, 11 were due to failed ureteroscopy, ten due to poor visibility from bleeding, 14 due to stone migrating up to the kidneys and two were monohydrate calculi which did not fragment with laser lithotripsy. Open ureterolithotomies were necessary in 14 patients (5.9%). Significant morbidity was perforation of the ureters which occurred in three patients (1.3%). This was due to ureteroscopy rather than the laser lithotripsy itself. With the availability of the new shockwave lithotripter (ESWL) which can treat ureteric stones in even less invasive ways, without anaesthesia and as outpatient, we are now reserving laser lithotripsy for those who failed ESWL. Generally they are the stones which cause severe obstruction to the ureter.