INTRACORPOREAL LITHOTRIPSY WITH THE HOLMIUM-YAG LASER

Purpose: Preliminary evaluations of the holmium:YAG laser have demonst rated a variety of potential urological applications, including ablati on of soft tissue lesions as well as stone fragmentation. We present o ur experience with the holmium:YAG laser for intracorporeal lithotrips y of urinary calculi. Materials and Methods: During a 24-month period 75 patients underwent 79 laser procedures, including retrograde ureter oscopy for ureteral calculi (71) and fragmentation of caliceal stones remote from the nephrostomy tract during percutaneous nephrolithotrips y (8). Results: Complete stone fragmentation without need for addition al procedures or lithotripsy was achieved in 85% of the cases. Treatme nt failures included 1 case of stone migration, 7 incomplete fragmenta tion requiring other lithotripsy devices and 3 laser malfunction. One ureteral perforation occurred when the laser was activated without dir ect visual guidance. Conclusions: The holmium:YAG laser has demonstrat ed its efficacy as a method of intracorporeal lithotripsy. Advantages include ability to fragment stones of all composition, and the multipu rpose, multispecialty applications of the holmium wavelength. This las er has potential soft tissue effects, and careful attention to techniq ue during lithotripsy is required to avoid ureteral wall injury.