Endoscopic pulsed-dye laser lithotripsy: 159 consecutive cases

The application of the coumarin-based pulsed-dye laser has allowed the endoscopist to employ more delicate instruments with smaller working channels in treating urinary and biliary calculi. We have previously reported our first 100 patients treated with this laser. In 159 consecutive patients, 176 renal, ureteral, bladder, urethral, and biliary calculi with an average size of 1.6 cm were treated with the pulsed-dye laser in antegrade or retrograde fashion using rigid (6.9F-11.5F) or flexible (8.5-10.5F) endoscopes. The laser fibers ranged from 200 to 550 microns and the energy from 60 to 200 mJ. In some cases, the laser was used as an adjunct to percutaneous nephrolithotomy for staghorn calculi, to fragment bladder calculi without anesthesia, to free encrusted ureteral catheters, or as a lithotrite in the biliary tree. Only 4 stones (2.5%) could not be fragmented. There were no complications directly attributable to the use of laser energy. The pulsed-dye laser is safe and efficacious as an endoscopic lithotrite.