Abstract
BackgroundLaser lithotripsy is an established endourological modality. Ho:YAG laser have broadened the indications for ureteroscopic stone managements to include larger stone sizes throughout the whole upper urinary tract. Aim of current work is to assess efficacy and safety of Ho:YAG laser lithotripsy during retrograde ureteroscopic management of ureteral calculi in different locations.Methods88 patients were treated with ureteroscopic Ho:YAG laser lithotripsy in our institute. Study endpoint was the number of treatments until the patient was stone-free. Patients were classified according to the location of their stones as Group I (distal ureteric stones, 51 patients) and group II (proximal ureteral stones, 37). Group I patients have larger stones as Group II (10.70 mm vs. 8.24 mm, respectively, P = 0.020).ResultsOverall stone free rate for both groups was 95.8%. The mean number of procedures for proximal calculi was 1.1 ± 0.1 (1–3) and for distal calculi was 1.0 ± 0.0. The initial treatment was more successful in patients with distal ureteral calculi (100% vs. 82.40%, respectively, P = 0.008). No significant difference in the stone free rate was noticed after the second laser procedure for stones smaller versus larger than 10 mm (100% versus 94.1%, P = 0.13). Overall complication rate was 7.9% (Clavien II und IIIb). Overall and grade-adjusted complication rates were not dependant on the stone location. No laser induced complications were noticed.ConclusionsThe use of the Ho:YAG laser appears to be an adequate tool to disintegrate ureteral calculi independent of primary location. Combination of the semirigid and flexible ureteroscopes as well as the appropriate endourologic tools could likely improve the stone clearance rates for proximal calculi regardless of stone-size.
Highlights
Laser lithotripsy is an established endourological modality
These were classified into 2 groups according to position of ureteric stones; distal ureteral stones below the pelvic brim (37 patients, group I) and proximal ureteral stones located above the pelvic brim (51, group II)
Complete fragmentation during single procedure was achieved in all patients of the 1st group (100%)
Summary
Laser lithotripsy is an established endourological modality. Ho:YAG laser have broadened the indications for ureteroscopic stone managements to include larger stone sizes throughout the whole upper urinary tract. The introduction of the Ho:YAG laser have broadened the indications for ureteroscopic stone managements (URS) to include larger stone sizes throughout the whole upper urinary tract [2]. The Nephrolithiasis Guidelines of both the European Association of Urology (EAU) and American Urological Association (AUA) have focused on the changes in ureteral stone managements According to these guidelines, the extracorporeal shock wave lithotripsy (SWL) and URS remain the two primary treatment modalities for the management of symptomatic ureteral calculi [3]. There was no difference in stone-free rates between SWL and URS after all primary procedures in the proximal ureter (82% versus 81%, respectively) This was dependent on the stone size. URS yields better stone-free rates for distal stones independent of the size (94.5%5 versus 74%, respectively) [3]
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