Clinical experience with holmium:YAG laser lithotripsy of ureteral calculi

We recently acquired a holmium:YAG laser with wavelength of 2.1 microns. We would like to report our success in using this machine for laser lithotripsy.

Forty-seven ureteroscopic laser lithotripsies were performed in 44 patients (three bilateral stones) over a 6 month period. Four stones were in the upper ureter, six in the middle ureter, and 37 in the lower ureter. The holmium laser beam was delivered via a 400 micron flexible quartz fiber through a 7 Fr rigid ureteroscope during the procedure. The stone size varied from 4 to 21 mm.

The success rate was 91%. Most of the stones were fragmented to less than 2 mm in size. Larger fragments were removed with a Dormia basket (six cases) for stone clearance. Endoscopic laser ureterotomy was performed in two patients with stricture below the stone. One patient required conversion to open ureterolithotomy, and three required subsequent Extracorporeal Shock Wave Lithotripsy. A low complication rate was observed.

The pulsed holmium:YAG laser is safe and effective for use in ureteroscopic laser lithotripsy.