Efficacy of Holmium: Yag Laser in Ureteric Stone Fragmentation

Abstract

ABSTRACT:BACKGROUND: Urolithiasis is a common presenting condition in urologic daily practice, 20% are ureteral stones. The most commonly performed procedures were shock wave lithotripsy (SWL) and ureteroscopy using holmium: YAG laser that can fragment all types of calculi.OBJECTIVE:Here we provide our experience with the use of holmium: YAG laser in the treatment of ureteric stones as fragmentation rather than complete vaporization aiming to decrease the operative time and subsequent complications.MATERIALS AND METHODS:In this prospective study, 54 patients with ureteric stones were treated using Holmium:YAG laser as an intracorporeal lithotripter in Fallujah general hospital between November 2009 and July 2011, using a 9.5 Fr. storz-semirigid ureteroscope. Stones were diagnosed by excretory urography, or spiral computerized tomography. We estimated the time of operation starting from the onset of application of laser on stone till complete clearance or termination of the procedure. Stone forceps retrieval of stone fragments was done. Double J ureteric stent was placed in complicated cases only. Postoperatively all patients were followed up with plain radiography and renal ultrasonography.RESULT: Fifty four patients with ureteric stone were included, their ages range from 19 to 60 years. Complete clearance of the stones was achieved in 38 cases (70.4%). The intraoperative complication was reported in 17 (31.5%) as upward stone migration in 6 cases (11.1%), ureteric perforation only once (1.9%) and bleeding in 10 cases (18.5%). Postoperative complications were infection in 59.3%, urinoma in 1.9% and hematuria in 13%. Complete clearance was 75%, 64.7% and 66.6% in distal, mid and proximal ureter respectively. Stones with sizes less than 1cm, 1-2cm and those with multiple stone the clearance were 81.4%, 65.2% and 25% respectively. The operative time was less in distal stones and in stone size <1cm. Intraoperative complications were higher with longer operative time, while perforation only occurred once when the operative time prolonged >30 min. Postoperative complications were higher with longer operative times, while urinoma complicating perforation occurred in one case when the operative time were more than 30 minutes CONCLUSION: Our clinical results, especially with respect to complication rates and outcome, advocate the trial of fragmentation with stone retrieval rather complete vaporization to shorten the operative time and subsequent complications