OUTPATIENT FRAGMENTATION OF URETERAL CALCULI WITH MINI-URETEROSCOPES AND LASER LITHOTRIPSY

Laser lithotripsy with mini-ureteroscopes is a minimally invasive meth od to fragment ureteral calculi. This study reviewed the efficacy and morbidity of outpatient laser lithotripsy for the treatment of uretera l calculi. The 248 patients were initially treated by outpatient urete roscopy and laser lithotripsy with the Candela pulsed-dye laser over a period of 3 1/2 years. Thirty-six patients had prior unsuccessful fra gmentation of ureteral calculi by SWL. Twenty-eight patients had under gone unsuccessful ureteroscopy with attempted basket extraction or att empted fragmentation with methods other than laser. Calculi were locat ed in the upper ureter in 31% and in lower ureter in 69% of these pati ents. The 1-month stone-free rate was 92% for upper ureteral calculi a nd 96% for lower ureteral calculi, with an overall success rate of 94. 7%. Ninety per cent of the patients were discharged the same day and 9 6% within 23 hours. Hospital admission was needed in only 4% of patien ts. Parenteral analgesia was required in 18% of patients, and major co mplications occurred in 0.8%. The combination of mini-uteroscopes and laser lithotripsy is an effective method for fragmentation of ureteral calculi in outpatients with low morbidity and few complications.