HOLMIUM-YAG LASERTRIPSY FOR URETERAL CALCULI - AN EXPERIENCE OF 300 PROCEDURES

Objective To assess the success of holmium:YAG lasertripsy in the mana gement of ureteric calculi and to audit the complications of the proce dure, with special reference to strictures in the ureter. Patients and methods A total of 300 ureteroscopic laser procedures were carried ou t on 265 patients (204 male and 61 female, median age 51 years, range 2-95) with ureteric calculi. At ureteroscopy, the calculi were present in the upper ureter in 44%, mid-ureter in 37% and lower ureter in 19% of patients; most calculi were > 5 mm. A 7.5 F Wolf semi-rigid ureter oscope was used and the holmium:YAG laser energy delivered using the S harplan ML210 device at 0.8-1.0 J/pulse. The patients were followed up at approximate to 6 weeks with limited intravenous urography or ultra sonography to assess clearance and the incidence of strictures. Result s Stones were completely cleared in 90% of the patients, with the best results in the lower and midureter (97% and 96%, respectively) follow ed by the upper ureter (89%), Alternative procedures were required in only 17 (7%) patients; extracorporeal shock-wave lithotripsy in 13, pe rcutaneous nephrolithotomy in two and open pyelolithotomy in two patie nts, Complications with ureteric perforation in 11 patients, including laparotomy for peritonitis in one, serious sepsis in two and strictur es in 10 patients. Strictures were more common in association with imp acted calculi in the upper ureter early in the series. Conclusions Hol mium:YAG lasertripsy is a highly effective treatment for ureteric calc uli, with strictures related to the treatment of difficult upper urete ric calculi,