Holmium Laser Lithotripter Research Articles

Comparison of Outcomes of Pneumatic Ballistic Lithotripsy, Holmium Laser Lithotripsy, and Combined Electromagnetic with Ultrasonic Lithotripsy during Percutaneous Nephrolithotomy

Objective: To compare outcomes of combined electromagnetic with ultrasonic lithotripter, pneumatic ballistic lithotripter, and holmium laser lithotripter among patients at a Tertiary Care Hospital. Study Design: Prospective comparartieve study. Place and Duration of Study: Department of Urology at Tabba Kidney Institute, Karachi Pakistan, from May 2020 to Jun 2021. Methodology: Ninety patients were divided into three groups of lithotripsy energies. Group-A (n=30) patients got pneumatic lithotripsy, Group-B (n=30) patients got laser lithotripsy, while Group-C (n=30) patients got trilogy lithotripsy technique. Outcomes such as post-operative pain, post-operative complications, and stone clearance were evaluated in all groups. Results: The overall mean age of the patients was 50.23±9.24 years, ranging from 33-74 years. The majority of the participants were males (n=52,57.8%), and 38(35.6%) of the participants were females. The intra-operative time, severity of post-operative pain, fever and UTI were the same between the three groups. However, the proportion of hematuria (p=0.001) and stone clearance (p=0.025) significantly differed between the three groups. Conclusion: Laser and pneumatic lithotripter were more effective in complete stone clearance than trilogy lithotripter. While laser lithotripter significantly decreases the occurrence of hematuria.

Multistaged retrograde intrarenal surgery for large renal stones – our institutional experience

Background: Recent advances such as retrograde intrarenal surgery (RIRS) have become an acceptable and widespread technique for upper urinary tract stone management. However, the outcome and complication of staged RIRS for large stone burden (>2.0) still needs to be reported. A total of 150 cases of renal calculi were treated by RIRS in a single center. Among these, 30 had renal stone size larger than 2.0 cm. Aims and Objectives: This study was conducted to present our views, experience, and outcomes of Retrograde Intra Renal Surgery for the Management of Large Renal Stones in Staged Manner using Flexible Ureteroscope with Holmium Laser as energy Source. Materials and Methods: Between March 2020 and January 2022, we admitted 150 patients with upper urinary tract stones who underwent RIRS using 30 Watt Holmium laser lithotripsy in our institute. Post-surgery, all the cases are evaluated in terms of stone free rates (SFR) complications and effectiveness of RIRS. Results: A total of 150 patients having upper urinary tract stones were included in this study (84 male and 66 female patients). All patients underwent RIRS using 30 watt holmium laser lithotripter. The overall SFR was 90.6%. The average stone size was 1.1 cm with average operation time of 100.6 min. Average hospital stay was 2.2 days. The average pain score was 2.1/10 by the Numerical Rating Scale. No major complications (Clavien Dindo III- V) were noted in the study groups. Conclusion: Through our study, we concluded that RIRS for large renal stone management is an effective and safe treatment modality currently.

A retrospective observational study compared the efficacy of pneumatic and holmium laser ureteroscopic lithotripsy for treatment of ureteral stones

Purpose: To compare the efficacy and complications of holmium laser lithotripters and pneumatic lithotripters, the two most commonly used lithotripters in the endoscopic treatment of ureteral stones, at all ureteral levels. Material and method: Retrospective data on 510 patients who had ureterorenoscopic lithotripsy performed by a single surgeon between January 2018 and 2021 were studied. Patients were divided into two groups: those who received a holmium laser lithotripter and those who received a pneumatic lithotripter. Demographic information, stone-free rates, double-j (JJ) stent usage, JJ stent removal time, type of anesthesia, operation time, hospital stay, and complication rates were all examined. Results: The patient numbers in the holmium laser and pneumatic groups were 265 and 245, respectively. The overall success rate in group 1 was found to be significantly higher than in group 2 (98.5 percent vs 93.9 percent; p=0.006). Group 1 had a significantly higher success rate in proximal ureteral stones (94.4 percent vs 68.9 percent; p=0.001). Patients in group 1 had a significantly higher rate of not using any ureteral stent (29.8 percent vs 17.6 percent; p<0.001). There was no difference between the two groups in terms of mid-ureter and distal ureter stones, anesthesia type, operation time, hospital stay, JJ stent removal time, and complications. Conclusion: For ureteral stones, ureterorenoscopic lithotripsy is the chosen therapeutic approach. The location of the stone in the ureter as well as the type of lithotripters used can have an impact on the outcome. Because of its great efficiency and lack of need for ureteral stents, holmium laser lithotripsy may be preferred for the treatment of proximal ureteral stones.

Flexible ureteroscopic holmium laser lithotripsy with PolyScope for senile patients with renal calculi.

The present study reported the clinical experience of using a PolyScope with holmium laser lithotripter in managing renal calculi in senile patients. Between December 2013 and December 2016, 157 senile patients (69.1±6.1 years old) were treated with PolyScope holmium laser lithotripsy for renal calculi at Xin Hua Hospital (Shanghai, China). The mean stone digitized surface area was 154.2±57.7 mm2 (range, 55.8–478.3 mm2). A thorough medical history investigation, and laboratory and radiological examination were followed by proper preoperative management. The PolyScope was then passed into the renal cavities following the position of the ureteral access sheath, with laser energy maintained at 1.0–2.0 J, frequency 10–15 Hz. The demographical and operative information of senile patients were compared with that of the 332 non-senile patients operated at the same period time. The average operative time was 54.6±13.2 min (range, 37–124 min). No major complications, including ureteral perforation or sepsis were encountered. The single session stone-free rate (SFR) was 81.5% and the overall SFR was 89.2%, similar to that of the non-senile group. PolyScope combined with holmium laser lithotripter is safe and effective in managing renal calculi in senile patients compared with non-senile patients, with considerately high SFRs and low complication rates.

The Efficacy and Safety of Laser Lithotripsy in Pregnancy.

Introduction: The aim of our study was to assess the efficacy and safety of laser lithotripsy in pregnant patients. Methods: In this retrospective study, we reviewed the 15 pregnant women who have been treated for ureteral stones with semi-rigid ureteroscope and holmium laser at our center between Januarys 2007and April 2015. Results: The mean age of patients and mean gestational age was 29.3 years old 27.3 weeks respectively. Mean size of stones was 7.84 mm. Twelve patients had renal colic, and hematuria was found in 3 cases. Irritative urinary symptoms such as frequency and urgency detected in 6 ones and 2 patients had fever. The stone of all patients were fragmented by using holmium laser lithotripter. In 5 patients stone residual fragments were removed by grasper while other 10 patients were left to pass fragments spontaneously. No intraoperative and postoperative urological or obstetric complication was seen. Conclusion: Laser lithotripsy is safe and efficacious in pregnant patients who have ureteral stone that does not respond to conservative management.

Management of bladder stones associated with foreign bodies following incontinence and contraception surgery.

To investigate success of endoscopic lithotripsy for bladder stone following stress urinary incontinance surgery and contraception surgery. Charts of patients admitted in two centers between January 2006 and March 2013 were retrospectively reviewed and seven women were enrolled in our study. Patients demographic parameters including age, main complaint(s), previous surgery type, time to diagnosis were analyzed. Also operative time, hospitalisation lenght, perioperative and postoperative complication( s) were evaluated. Five patients had undergone tension free vaginal tape procedure and one patient had undergone transobturator tape procedure. Median age was 62 (50-71) years. In one patient bladder stone formed around an intrauterine device. Dysuria (85%), hematuria (57%) and recurrent urinary tract infection (57%) were the main complaints. The median diagnosis time was 44.1 months. Abdominal ultrasonography and non contrast enhanced computer tomography were performed for five and two patients respectively and diagnosis was confirmed cystoscopically. Endoscopic lithotripsy using Holmium laser lithotripter or pneumatic lithotripter was used for all cases. The mean operation time was 41.2 minutes (20-70) and success was 100%. There was no intraoperative complication. Only one patient had fever higher than 38ºC postoperatively and was treated by appropriate antibiotic. The median hospitalisation time was 1.57 day. In conclusion endoscopic lithotripsy is a safe and effective approach to manage bladder stone associated with mid-urethral synthetic slings and intrauterine devices.

Inactivation of bacteria inoculated inside urinary stone-phantoms using intracorporeal lithotripters

Intracorporeal lithotripsy is used to treat a high percentage of urinary calculi. Urinary calculi may contain bacteria, which might cause septicemia after lithotripsy; however, little is known about the effects of lithotripters on the viability of microorganisms inside renal calculi. The objectives of this study were to evaluate the bactericidal effect, and the potential effect on intra-bacterial protein release of four different intracorporeal lithotripters on Escherichia coli (E. coli) inoculated inside artificial kidney stones. An electrohydraulic, a pneumatic, an ultrasonic, and a holmium-laser lithotripter were used to pulverize a set of infected kidney stones inside a test tube containing a saline solution. Two different energy levels were tested per lithotripter. The stones were manufactured by mixing gypsum cement and Vel-mix-stone with a suspension containing E. coli. Results were analyzed by analysis of variance. The release of intracellular protein was measured with a spectrophotometer. Bacteria inactivation was observed with all lithotripters. The highest percentage of inactivated bacteria was obtained with the electrohydraulic lithotripter. The smallest effect was observed using the holmium-laser lithotripter. A relatively high amount of intracellular protein was released into the saline solution after stone pulverization. Intracorporeal lithotripters inactivate a high percentage of bacteria during stone comminution; however, intracellular protein is released, increasing the probability of septicemia.

Experience with the holmium laser as an endoscopic lithotrite

Objectives To study, in a clinical series, the safety and efficacy of holmium laser energy applied as an endoscopic lithotrite. Methods Over a 2-year period, patients with urinary tract calculi were treated endoscopically with the holmium laser lithotripter and data were gathered prospectively. Holmium lasers with maximum outputs of 15, 25 and 60 W were used. Various low water density, quartz fiber delivery systems were developed for specific applications. In addition, various combinations of endoscopes and laser fibers were employed. Results A total of 63 patients with 75 calculi were treated. All calculi were cleared endoscopically. Minimal variation in laser efficiency was noted with different stone compositions, including cystine. Thirty-three of 34 ureteral calculi were treated to completion in one sitting (97%). Twenty-nine renal stone burdens were treated with the holmium laser, 26 of which were treated solely in a retrograde fashion. Of the latter, 23 (88.5%) required only a single sitting. Complications from holmium laser energy, including ureteral stricture disease, were not encountered in this series. Patients with complex, large stone burdens were treated to completion without sequelae. The combination of the actively deflectable, flexible ureteroscope and 200-^m fiber facilitated clearance of 18 lower-pole caliceal calculi. Three patients with partial staghorn stone burdens averaging 30 mm in diameter were treated ureteroscopically. Chronic urinary infections that were problematic preoperatively completely resolved after therapy. All 12 patients who had large bladder calculi with a mean diameter of 55.8 mm were treated to completion in one sitting. Conclusions Holmium laser energy is uniquely suited to treat all urinary calculi safely and effectively.