Holmium laser lithotripsy for ureteral calculi: an outpatient procedure

A retrospective review was conducted to evaluate the efficacy of ureteroscopic lithotripsy using the holmium laser with a semirigid endoscope in a newly established day surgery center. In 1996, 69 consecutive patients (40 male and 29 female) with a mean age of 46.7 (range 21-73) years and ASA status I or II underwent ureteroscopic lithotripsy for their ureteral calculi using the holmium laser (365-micron fiber; power setting 0.5-1.4 J/5 Hz) and 8.5F semirigid ureteroscope in a day surgery setting. Stone features, postoperative pain scores, readmissions, and complications were evaluated. Eighteen upper, 17 middle, and 34 lower ureteral stones were treated, with a mean size measuring 12.1 (5-45) mm. The mean operative time was 61 minutes including the anesthetic time (range 15-150 minutes), and the success rate was 91% (63/69). The complication rate was 10% (7/69) including four unscheduled readmissions (6%). Telephone follow-up on postoperative Day 1 and Day 3 revealed mean pain scores of 2 and 1, respectively (on a 0-10 scale) and an analgesic requirement of 1 tablet of Dologesic (containing 32.5 mg of dextropropoxyphene + 320 mg of paracetamol) four times a day on both days. Ureteroscopic lithotripsy using the holmium laser and a semirigid endoscope is highly successful and well tolerated and carries a low complication rate. It is indicated as an ambulatory and minimally invasive treatment modality in low-risk patients with ureteral stones.