CLINICAL-EXPERIENCE WITH HOLMIUM-YAG LASER LITHOTRIPSY OF URETERAL CALCULI

Background and Objective: We recently acquired a holmium:YAG laser wit h wavelength of 2.1 mu m. We would like to report our success in using this machine for laser lithotripsy. Study Design/Patients and Methods : Forty-seven ureteroscopic laser lithotripsies were performed in 44 p atients (three bilateral stones) over a 6 month period. Four stones we re in the upper meter, six in the middle ureter, and 37 in the lower u reter. The holmium laser beam was delivered via a 400 micron flexible quartz fiber through a 7 Fr rigid ureteroscope during the procedure. T he stone size varied from 4 to 21 mm. Results: The success rate was 91 %. Most of the stones were fragmented to less than 2 mm in size. Large r fragments were removed with a Dormia basket (six cases) for stone cl earance. Endoscopic laser ureterotomy was performed in two patients wi th stricture below the stone. One patient required conversion to open ureterolithotomy, and three required subsequent Extracorporeal Shock W ave Lithotripsy. A low complication rate was observed. Conclusion: The pulsed holmium:YAG laser is safe and effective for use in ureteroscop ic laser lithotripsy. (C) 1996 Wiley-Liss, Inc.