Korean J Urol.  2008 Jan;49(1):60-65.

Holmium:YAG Laser Lithotripsy as a Treatment Modality for Ureteral Calculi

• Hwang HH
• Park RJ
• Moon KH
• Cheon SH

Abstract

PURPOSE: We evaluated the results of Holmium:YAG laser lithotripsy according to the size and location of the ureteral stones.
MATERIALS AND METHODS
Between March 1998 and April 2007, the medical records of 203 patients who were treated with ureteroscopic Holmium: YAG laser lithotripsy due to ureteral calculi were reviewed. They were subgrouped by the size and the location of the ureteral stones. The results of treatment were evaluated by the stone free rate and the mean operation time of each group.
RESULTS
The stone free rates of the upper, mid and lower ureter stone groups were 73.3%, 96.1% and 100%, respectively. There was a significant difference in the upper ureter stone group compared to the other two groups, and especially for the group with stone less than 10mm. Stone migration into the renal pelvis or calyx was a major cause of failure in the patients with upper ureter stones. 8 cases showed stone migration and 2 cases showed fragment migration.
CONCLUSIONS
As Holmium:YAG laser lithotripsy has a low complication rate and a high stone free rate, it is an effective treatment modality for ureteral calculi. However, such procedures should be performed carefully because the thermal effect of the Holmium:YAG laser causes ureteral perforation, and especially in the cases of impacted or large stones. Other effective alternatives such as trapping devices need to be studied for patients with upper ureteral stones to prevent stone migration.

Keyword

Ureteral calculi; Holmium; Lithotripsy

MeSH Terms

Holmium
Humans
Kidney Pelvis
Lasers, Solid-State
Lithotripsy
Lithotripsy, Laser
Medical Records
Ureter
Ureteral Calculi
Holmium

Reference

References

1. Chung JS, Park RJ. Ureteroscopic management of ureteral calculi: comparisons of stone basket, electrohydraulic lithotripsy, Swiss lithoclast and Holmium: YAG Laser. Korean J Urol. 2000; 41:239–45.

2. Vassar GJ, Chan KF, Teichman JM, Glickman RD, Weintraub ST, Pfefer TJ, et al. Holmium: YAG lithotripsy: photothermal mechanism. J Endourol. 1999; 13:181–90.

3. Razvi HA, Denstedt JD, Chun SS, Sales JL. Intracorporeal lithotripsy with the holmium: YAG laser. J Urol. 1996; 156:912–4.

4. Jeon SS, Lee KS, Won HS, Park KH, Lee SW, Choi HY, et al. A comparison of Holmium: YAG laser with lithoclast lithotripsy in ureteral calculi fragmentation. Korean J Urol. 2000; 41:375–80.

5. Sofer M, Watterson JD, Wollin TA, Nott L, Razvi H, Denstedt JD. Holmium: YAG laser lithotripsy for upper urinary tract calculi in 598 patients. J Urol. 2002; 167:31–4.

6. Grasso M. Experience with the holmium laser as an endoscopic lithotrite. Urology. 1996; 48:199–206.

7. McIver BD, Griffin KP, Harris JM, Teichman JM. Cystoscopic holmium lithotripsy of large bladder calculi. Tech Urol. 1996; 2:65–7.

8. Ouwenga MK, Sharma SK, Holley P, Turk TM, Perry KT. Load-release points of two novel ureteral stone-trapping devices. J Endourol. 2005; 19:894–7.

9. Abdelsayed M, Onal E, Wax SH. Avulsion of the ureter caused by stone basket manipulation. J Urol. 1977; 118:868–70.

10. Hodge J. Avulsion of long segment of ureter with Dormia basket. Br J Urol. 1973; 45:328.

11. Chung HS, Park JY, Kim HK, Park CM. Efficacy of the stone cone for treatment of proximal ureteral stones: an initial clinical experience. Korean J Urol. 2006; 47:412–7.

12. Lingeman JE, Matlaga BR, Evan AP. Surgical management of upper urinary tract calculi. Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, editors. editors.Campbell-Walsh urology. 9th ed.Philadelphia: Saunders;2007. p. 1431–507.

13. Mugiya S, Nagata M, Un-No T, Takayama T, Suzuki K, Fujita K. Endoscopic management of impacted ureteral stones using a small caliber ureteroscope and a laser lithotriptor. J Urol. 2000; 164:329–31.

14. Larizgoitia I, Pons JM. A systematic review of the clinical efficacy and effectiveness of the holmium: YAG laser in urology. BJU Int. 1999; 84:1–9.

15. Bagley D, Erhard M. Use of the Holmium laser in the upper urinary tract. Tech Urol. 1995; 1:25–30.

16. Denstedt JD, Razvi HA, Rowe E, Grignon DJ, Eberwein PM. Investigation of the tissue effects of a new device for intracorporeal lithotripsy-the Swiss Lithoclast. J Urol. 1995; 153:535–7.

17. Shroff S, Watson GM, Parikh A, Thomas R, Soonawala PF, Pope A. The holmium: YAG laser for ureteric stones. Br J Urol. 1996; 78:836–9.