USE OF URETEROSCOPY AND HOLMIUM-YAG LASER IN PATIENTS WITH BLEEDING DIATHESES

Objectives. To assess the safety and efficacy of ureteroscopy and holm ium laser in patients with known bleeding diatheses and upper tract ca lculi or transitional cell carcinoma (TCC). Methods. Eight patients wi th stone disease and 1 patient with upper tract TCC were treated urete roscopically with the holmium laser. The mean age was 58.3 years (rang e 42 to 74). Six patients were receiving Coumadin, with a mean interna tional normalized ratio (INR) of 2. 1 (normal INR less than 1.1). Two patients were thrombocytopenic, and 1 had von Willebrand's disease. No ne of the bleeding diatheses were corrected before surgery. Semirigid or flexible ureteroscopes were used to access the ureter or intrarenal collecting system. The holmium laser was used to fragment calculi or ablate tumor. Results. Only 1 patient had a postoperative bleeding com plication related to the procedure, involving an episode of oliguria s econdary to a small ureteral clot. This cleared without surgical inter vention. Another patient developed an episode of epistaxis after admin istration of ketorolac for pain. Six of 7 patients who underwent laser fragmentation for calculi were stone free on follow-up intravenous ur ogram at 1 month, and no tumor recurrence was noted in the patient wit h TCC (follow-up of 4 months). Conclusions. Ureteroscopy allowed excel lent access to all regions of the upper tracts, and holmium laser frag mentation of calculi or ablation of tumor was effective in managing ea ch particular problem. Use of the holmium laser with ureteroscopic acc ess provides a safe and acceptable combination for treating upper trac t pathology in patients with uncorrected bleeding diatheses. As a resu lt, these patients can avoid added costs of extended hospital stay and risks associated with transfusions. UROLOGY 52: 609-613, 1998. (C) 19 98, Elsevier Science Inc. All rights reserved.