Endoscopic management of upper urinary tract disease using a 200-μm holmium laser fiber: initial experience in japan

Abstract

Objectives. To study the clinical effectiveness of the 200-μm holmium laser fiber for endoscopic management of upper urinary tract lesions. Methods. From January 1997 to March 1998, we performed retrograde endoscopic treatment in 25 patients with urinary tract lesions using a 200-μm holmium laser fiber. Nineteen patients had 20 stones (16 ureteral, 3 lower calyx, and 1 middle calyx), 4 had bleeding lesions in the lower calyx, 1 had transitional cell carcinoma involving the renal pelvis and upper calyx, and 1 had a ureteral stricture associated with an impacted ureteral stone. We used a 7.5F flexible ureterorenoscope for renal and upper ureteral lesions, and a 6.9F rigid ureteroscope for mid and lower ureteral lesions. For treatment, we used a holmium:yttrium-aluminum-garnet laser generator and a 200-μm flexible quartz fiber. Results. All stones were successfully fragmented, including three lower caliceal stones. Lower caliceal bleeding spots were successfully cauterized for hemostasis in all 4 patients, and the pelvic tumor was successfully vaporized and ablated. In 1 patient, we had previously failed to treat a ureteral stricture with a 365-μm fiber because of inadequate visualization, but it was successfully incised using the 200-μm fiber. There were no significant complications such as ureteral obstruction or stenosis. Conclusions. The improved flexibility of the new 200-μm holmium laser fiber facilitates treatment of stones, tumors, strictures, and lesions in the lower calyx, where access is difficult when using the previously available 365-μm fiber.