R. Devarajan et al., HOLMIUM-YAG LASERTRIPSY FOR URETERAL CALCULI - AN EXPERIENCE OF 300 PROCEDURES, British Journal of Urology, 82(3), 1998, pp. 342-347
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,