Experience with the holmium laser as an endoscopic lithotrite

Introduction: Holmium laser lithotripsy represents an additional option in the management of urinary tract calculi. We report the results of a cohort of patients with ureteric and bladder calculi treated with this modality. Methods: Twenty-three patients underwent holmium laser lithotripsy to treat ureteric or bladder calculi. Power settings of 0.5 J to deliver 2.5-4.0 wa tts were used for the ureteric calculi, and up to 30 watts for the bladder calculi. Results: The mean ureteric stone size was 7.3 mm (range 4-10 mm). One stone was upper ureteric, seven were mid-ureter and nine were lower-ureter. Eigh teen of the 19 patients with ureteric calculi were free of stones 28 days p ostoperatively. The remaining patient was clear by 12 weeks. All patients w ith bladder calculi were completely cleared of stones. There were no intrao perative complications. Discussion: Ureteric stone position can limit the use of extracorporeal sho ck wave lithotripsy due to imaging difficulties. Ureteric lithotripsy overc omes this problem. The holmium laser has proven to be safe and effective in clearing urinary stone burdens of a variety of sizes, sites and compositio ns in this cohort of patients.