Laser-Induced Shock Wave Ureteral Lithotripsy Using Q-Switched Nd:YAG Laser

Holmium:YAG laser treatment of ureteral calculi: a 5-year experience

The purpose of this study was to provide an account of the 5-year experience we have gained using holmium:yttrium-aluminium-garnet (Ho:YAG) lasertripsy in the treatment of ureteral stones. One-hundred thirty-seven transurethral ureterolithotripsies were performed in 131 patients. A Ho:YAG laser device, fibres with diameters of 360 and 550 mum, a video camera as well as semi-rigid and flexible ureterorenoscopes were used. Results showed that the direct success rates-which meant stone-free ureters on the first post-operative day-in the upper, middle and lower ureters were 84.6, 88.7 and 94.8%, respectively. The final success rates--which meant stone-free ureters 4 weeks after the operation without a second intervention--were 84.6, 96.7 and 96.7%, respectively. The pulsatile Ho:YAG laser beam fragmented all kinds of stones easily. No ureteral stricture or reflux was identified during the follow-up period. The advantages of Ho lasertripsy outweighed its disadvantages. Based on our experience, the Ho:YAG laser is one of the most effective and safest energy sources in the treatment of ureteral calculi.

Pulsating Nd-Yag Laser for Treatment of Ureteral Calculi

The authors report their experience with the laser smashing of 105 ureteral calculi between Sept. 1 1989 and Sept. 30 1992. Applying the pulsating Nd-Yag laser through a ureteroscope as a monotherapy, they have obtained good results in 83% of the cases. Using complementary methods in addition, the successful elimination of calculi was 95%. The possible complications are discussed and the advantages and disadvantages of the different energy sources used for smashing the calculi are compared. On the basis of their results, the Authors consider that endoscopic treatment of ureteral calculi may be indicated even in the era of extracorporeal stone-smashing. They stress that endoscopic operations are only preferable compared to ESWL-treatment if all indispensable devices are available: energy sources and thin, flexible devices for energy conduction. Among them — literature confirms it — laser-energy is the most expedient and least invasive. Laser was first applied for smashing ureteral calculi in Hungary.