Low power laser in the management of ureteral stones.

OBJECTIVE: To evaluate the outcome of the low power Holmium-Yag laser in management of ureteral stones, and to report the incidence rate of different types of stones. METHODS: One hundred and seventy patients underwent ureteroscopy and fragmentation of ureteral stones at the International Medical Center, Jeddah, Kingdom of Saudi Arabia between March 2007 and August 2009. Stones were measured by their largest diameter on CT and classified according to their location from the ureter to the proximal middle and distal ureteral stones. We utilized 8-11 F Semi rigid or 7.5 F flexible ureteroscopes to identify the stones, and all stones were fragmented and evaporated using a 10 watt lower power Holmium-yag laser lithotripter. RESULTS: All stones were completely evaporated and fragmented using the Holmium-yag laser through ureteroscopy. The age of the patients varied between 21-76 years with a mean age of 38.6 years (males 113, and females 57). The largest diameter of the largest stone was 6-12mm (mean 8 mm) and classified according to its location in the ureter into proximal (93 [54.7%]), middle (26 [15.3%]), or distal ureteral stones (51 [30%]). We performed stone analysis in 122 patients (oxalate [n=87], uric acid [n=16], cystine [n=11], and calcium phosphate [n=8]). CONCLUSION: Laser lithotripsy using low power 10 watt laser lithotripter is safe and effective method for stone evaporation and disintegration, and can be carried out as a day care procedure. The types of stones in Saudi Arabia are same as it has been reported before in the literature.

Lasertripsy of ureteral calculi using pulsed-dye laser with automatic shut-off after tissue contact.

Since June 1991, 54 patients with ureteral calculi (13 upper, 18 middle, and 23 distal) have been treated in our department using a flashlamp-pumped tunable-dye (rhodamine 6G) laser with a wavelength of 594 nm with an energy at the distal fiber tip between 30 and 120 mJ. The fiber core diameters were 200 and 300 microns. By spectral analysis of the reflected light, immediate shut-off of the laser was obtained after tissue contact. In average, 1599 impulses at a mean energy of 76.4 mJ were applied. In 32 cases (59%), complete disintegration was achieved. In 22 cases (41%), partial disintegration was noted, leading to retrograde mobilization of the fragments followed by SWL in 16 patients. Ureteroscopic extraction of fragments was performed in six patients. All patients were rendered stone free after 6 weeks. Because of the ureteroscopic manipulation, mucosal lesions were found in five patients, but no trauma attributable to the action of the laser was seen. In 42 patients, a double-J stent was placed after the procedure. Lasertripsy using a pulsed-dye laser with automatic shut-off after tissue contact is a safe and effective approach that offers a new aspect in the noninvasive treatment of recalcitrant ureteral calculi in our department.

[Treatment of ureteral lithiasis using the laser]. / Tratamiento de la litiasis ureteral con láser.

A review of the history of lasertripsy from continuous to intermittent Nd:YAG, Alexandrite, or liquid-dye laser is undertaken. Certain calculi require intraureteral fragmentation owing to stone hardness or location. Within a period spanning 20 months, we have treated 350 patients (199 males, 151 females) utilizing dye laser through a very fine caliber 7.5 F ureteroscope. Twenty-six had bilateral calculi. The calculi were located in the upper third in 10% (37), middle third in 25% (93), and lower third in 65% (241). Complete fragmentation was achieved in 341 (93%), push up + ESWL was performed in 24 (6.4%), and two calculi (0.6%) required ultrasonic fragmentation. No patient required surgery and there were no severe complications.

Pulsed dye laser fragmentation of ureteral calculi: a review of the first 50 cases performed at Virginia Mason Medical Center.

During the preceding 2 1/2 years 50 patients have undergone laser fragmentation of ureteral calculi at our medical center. Of these 50 patients 48 (96%) became free of stones without the need for an open operation: 44 (88%) were managed in 1 setting and 4 required adjunctive extracorporeal shock wave or ultrasonic lithotripsy, or a repeat session with the laser. Two patients (4%) eventually required an open operation: 1 required ureterolithotomy for a large impacted stone overlying the bony pelvis after a ureteroscope could not be advanced to this level and 1 had a good initial result with the laser but a persistent ureteral stricture developed and he required ureteroureterostomy 4 months later. Both open procedures were necessitated by mid ureteral stones, and the ureteral stricture was believed to be related to ureteroscopy and the impacted nature of the stone, rather than any damage by the laser probe.

Laser lithotripsy of ureteral calculi: initial experience with a new pulsed dye laser.

Thirty-two patients with ureteral calculi ranging in size from 5 x 5 to 12 x 18 mm underwent lithotripsy with a new pulsed dye laser (Pulsolith, TMI). In 24 cases, the patients were entirely free of stones following laser lithotripsy alone, or with adjunctive stone basket removal. There were three instances of equipment failure and five calcium oxalate monohydrate stones that did not respond to laser energy.