Holmium YAG Laser Lithotripsy Research Articles

Comparison of lithotripsy methods during mini-PNL: is there a role for ballistic lithotripsy in the era of high-power lasers

BackgroundFor renal stones > 20 mm, percutaneous nephrolithotomy (PNL) offers the best stone clearance rates with acceptable complication rates. This study aimed to compare the efficiency of high-power holmium YAG laser and ballistic lithotripsy during mini-PNL.MethodsData from 880 patients who underwent mini-PNL for renal stones was investigated retrospectively. The study utilized propensity score matching to create two groups: laser lithotripsy (n = 440) and ballistic lithotripsy (n = 440). The groups were matched based on stone size, Guy’s stone score, and stone density. The main objectives of the study were to assess the stone-free rate (SFR), duration of surgery, and complication rates.ResultsThe average age of the population was 51.4 ± 7.1 years, with a mean stone size of 28.6 ± 8.3 mm and a mean stone density of 1205 ± 159 HU. There were no significant differences between the groups. The SFRs of the laser lithotripsy and ballistic lithotripsy were 92.5% and 90.2%, respectively (p = 0.23). The laser lithotripsy group had a notably shorter surgery time (40.1 ± 6.3 min) compared to the ballistic lithotripsy group (55.6 ± 9.9 min) (p = 0.03). Complication rates were similar (p = 0.67).ConclusionsOur study shows that a high-power holmium YAG laser provides quicker operation time compared to ballistic lithotripsy. However, ballistic lithotripsy is still an effective and safe option for stone fragmentation during mini-PNL. In places where a high-power holmium YAG laser is not available, ballistic lithotripters are still a safe, effective, and affordable option for mini-PNL.

MP05-08 POSSIBLE ROLE OF THE MICROBIOTA IN URINARY STONES: A PROSPECTIVE STUDY TO CORRELATE RADIOLOGICAL DENSITY (HOUNSFIELD UNITS) AND CULTURAL EXAMINATION OF URINARY CALCULI

You have accessJournal of UrologyCME1 Apr 2023MP05-08 POSSIBLE ROLE OF THE MICROBIOTA IN URINARY STONES: A PROSPECTIVE STUDY TO CORRELATE RADIOLOGICAL DENSITY (HOUNSFIELD UNITS) AND CULTURAL EXAMINATION OF URINARY CALCULI Antonio Luigi Pastore, Yazan Al salhi, Andrea Fuschi, Alessia Martoccia, Fabio Maria Valenzi, Alessandro Sciarra, Stefano Salciccia, De Nunzio Cosimo, Andrea Tubaro, Costantino Leonardo, Giorgio Franco, Silvio Scalzo, Paolo Pietro Suraci, Onofrio Antonio Rera, Alice Antonioni, and Antonio Carbone Antonio Luigi PastoreAntonio Luigi Pastore More articles by this author , Yazan Al salhiYazan Al salhi More articles by this author , Andrea FuschiAndrea Fuschi More articles by this author , Alessia MartocciaAlessia Martoccia More articles by this author , Fabio Maria ValenziFabio Maria Valenzi More articles by this author , Alessandro SciarraAlessandro Sciarra More articles by this author , Stefano SalcicciaStefano Salciccia More articles by this author , De Nunzio CosimoDe Nunzio Cosimo More articles by this author , Andrea TubaroAndrea Tubaro More articles by this author , Costantino LeonardoCostantino Leonardo More articles by this author , Giorgio FrancoGiorgio Franco More articles by this author , Silvio ScalzoSilvio Scalzo More articles by this author , Paolo Pietro SuraciPaolo Pietro Suraci More articles by this author , Onofrio Antonio ReraOnofrio Antonio Rera More articles by this author , Alice AntonioniAlice Antonioni More articles by this author , and Antonio CarboneAntonio Carbone More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003216.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The aim of the study is to evaluate a possible correlation between the hardness of the urinary stone expressed in Hounsfield Units and the bacterial contamination by cultural examination of the lithiasic fragments obtained after endoscopic treatment (ureteral lithotripsy and retrograde intrarenal surgery). METHODS: This prospective study investigated patients with unilateral urinary lithiasis (ureteral and / or renal) who underwent endoscopic lithotripsy between January and December 2021. All patients were studied preoperatively with Uro-CT scan, measuring the Hounsfield Units, the number and size of the calculi for each patient. Two lithiasic fragments were extracted at the end of each procedure (one from the core and one from the periphery of the stone) and sent for chemical-physical and cultural examination. RESULTS: Seventy-three patients were enrolled and studied prospectively. 56 submitted to ureteral Holmium Yag Laser lithotripsy and 17 to RIRS. The chemical-physical evaluation showed 92% of the stones made up of calcium oxalate, 4% of calcium phosphate, 2% of uric acid and 2% of various composition. The bacterial analysis of the fragments showed a positive culture in 68% of cases, with positive Staphylococcus Epidermidis in 46% of cases, Proteus Mirabilis in 24%, Escherichia Coli in 23% and 7% with other microorganisms. The correlation between stone core culture and formation HU was statistically significant, with Staphylococcus Epidermidis associated with a mean Hounsfield value of 1234 HU; Proteus Mirabilis with average Hounsfield 872 HU; Escherichia Coli with mean Hounsfield 642 HU (p values <0.0001). The mean radiological density in the negative culture urinary stones was 843 HU. CONCLUSIONS: Our study demonstrates a statistically significant correlation between urinary stone infection and its radiological density (HU). We postulate that the correlation between the stone core isolated microorganism and the calculi hardness (HU) might impact on the treatment choice and results (stone free rate). Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e46 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Antonio Luigi Pastore More articles by this author Yazan Al salhi More articles by this author Andrea Fuschi More articles by this author Alessia Martoccia More articles by this author Fabio Maria Valenzi More articles by this author Alessandro Sciarra More articles by this author Stefano Salciccia More articles by this author De Nunzio Cosimo More articles by this author Andrea Tubaro More articles by this author Costantino Leonardo More articles by this author Giorgio Franco More articles by this author Silvio Scalzo More articles by this author Paolo Pietro Suraci More articles by this author Onofrio Antonio Rera More articles by this author Alice Antonioni More articles by this author Antonio Carbone More articles by this author Expand All Advertisement PDF downloadLoading ...

Requirement of ESWL after ureterorenoscopy and lithotripsy in the management of upper ureteric stone: comparison between Holmium Yag laser and pneumatic lithotripsy in a referral hospital, Bangladesh

Various methods have been employed for the removal of ureteric calculi all over the world. Both Ureteroscopic Pneumatic and Laser lithotripsy are popular procedures for this purpose. However proximal migration of stone fragments are not uncommon in these procedures while treating upper ureteric stones. Extra corporeal shock wave lithotripsy (ESWL) may require to fragment those proximally migrated stones after the ureteroscopic Pneumatic or Laser lithotripsy. To compare the requirement of ESWL in the management of ureteric stone between Holmium Yag Laser and Pneumatic Lithotripsy. This study included 100 patients with upper ureteric stones who underwent ureteroscopic lithotripsy at the Department of Urology, CMH, Dhaka, between October 2010 and September 2012. Laser lithotripsy was used in 50 patients (Group A), and pneumatic lithotripsy was used in the remaining 50 patients (Group B). In each case, the same ureteroscope, video monitor, baskets, or irrigation devices were used. A kidney ureter and bladder radiograph and ultrasonograph were performed on patients one month and three months after lithotripsy. Patients with migrated fragments or insufficient clearance underwent a supplementary procedure such as ESWL. Mean age was 41.9}10.9 years and 41.3}12.3 years in Group A and Group B respectively. Males were predominant in both groups. Mean stone size was 1.36 } 0.36 cm in Group A and 1.37} 0.36 cm in Group B. Complete stone clearance was 94.0% in Group A and 76.0% in Group B. EWSL requirement rate was significantly higher in Group B (24.0%) than Group A (6.0%). Peri procedural complications like hemorrhage was significantly higher in Group B and mucosal disruption/perforation was almost same in both the groups. EWSL requirement rate was comparatively higher in pneumatic lithotripsy than laser lithotripsy. BSMMU J 2022; 15(2): 111-114

A dual neglected double J stent: a rare case report

BackgroundA neglected ureteric stent with encrustations is an uneasy problem for the patient and treating urologist. We report a rare case of single urinary system retained dual ureteric stents that was complicated by extensive encrustation.Case presentationA 36-year male patient referred from prison hospital with intermittent left loin pain and burning micturition. Pelvi-abdominal ultrasonography, plain X-ray and non-contrast computed tomography revealed neglected dual double J stents on the left side with large renal and urinary bladder stone burden and heavy ureteral encrustation. Staged endoscopic management was planned. At first session, both bladder and renal calculus was fragmented and removed by mechanical cystolithotripsy and percutaneous nephrolithotomy, respectively. After one week; the lower, middle and upper ureteral encrustations were cleared carefully using Holmium YAG Laser lithotripsy through 7 Fr. distal tip semi-rigid ureteroscopy. Both neglected double J were removed successfully and the patient was asymptomatic.ConclusionsNeglected ureteral stents are complicated by massive encrustation and need combined staged endoscopic procedures. Patient and health service provider should be learned for importance of stent removal.

Comparison of vacuum suction ureteroscopic laser lithotripsy and traditional ureteroscopic laser lithotripsy for impacted upper ureteral stones.

To compare a novel vacuum suction ureteroscopic laser lithotripsy (VS-URS) with traditional ureteroscopic laser lithotripsy (T-URS) for impacted upper ureteral stones and to better define the potential benefits of VS-URS. Between May 2019 and March 2021, 158 patients with impacted upper ureteral stones underwent ureteroscopic holmium-YAG laser lithotripsy. Of these, 76 underwent VS-URS and 82 underwent T-URS. In VS-URS procedures, the vacuum suction device is composed of a 5F ureteral catheter and a tee joint. The ureteral catheter is linked to the vacuum aspirator by the sidearm of the tee joint, and a 200μm fiber is inserted through the tee joint and the ureteral catheter into the stone site for lithotripsy. When compared to the T-URS group, the VS-URS group had a shorter mean operation time (38.18 ± 6.37min vs. 46.65 ± 5.66min;P = 0.000), lower fever rate (3.9% vs. 14.6%; P < 0.022), less stone retropulsion (5.3% vs. 18.3%; P = 0.012), lower extra management rate (6.58% vs. 21.95%; P = 0.006), and a higher stone-free rate of the first postoperative day (88.2% vs. 72.0%;P = 0.011). There were no significant differences in stone-free rates 1month after surgery between groups (94.7% vs. 92.7%; P = 0.748). VS-URS is an effective modality for impacted upper ureteral stones, and has a shorter operating time, lower fever rate, less stone retropulsion, and a higher primary stone-free rate compared with T-URS.

Thermal Injury and Laser Efficiency with Holmium YAG and Thulium Fiber Laser-An In Vitro Study.

Objective: To evaluate using an inanimate model the thermal injury and laser efficiency on high frequency, high energy, and its combination in hands of junior and experienced urologists during holmium YAG (Ho:YAG) and Thulium fiber laser (TFL) lithotripsy. Methods: A Cyber: Ho 150 WTM and Fiber Dust TFL (Quanta System) with 200 μm core-diameter laser fibers (LF) were used in a saline in vitro ureteral model. Each participant (five junior and five experienced urologists) performed 32 sessions of 5-minute lasering (125 mm3 phantom BegoStones™), comparing four modes (3 J/5 Hz [1.5 W], 0.3 J/20 Hz [6 W], 1.2 J/5 Hz [6 W], and 1.2 J/20 Hz [24 W]). Transparent tip and cleaved LF, and digital and fiberoptic ureteroscopes were also compared. Ureteral damage was classified in a scale (0-5) according to the burns and holes seen in the ureteral model's surface. Results: High-power (HP) setting (24 W) was associated with higher delivered energy and higher ablation rates (ARs) in both lasers (p < 0.001). For the same power setting (6 W), there was no difference in delivered energy or stone ARs. Regardless the settings, a higher AR was observed with TFL than with Ho:YAG (0.5Δ mg/s ± 0.33 vs 0.39 Δmg/s ± 0.31, p = 0.002) laser. Higher mean AR was found with cleaved tip vs transparent tip (p = 0.03) in TFL. For both lasers, higher ureteral damage was observed in the 24 W group (p = 0.006) and in the junior urologists (p = 0.03). Between 6 W groups, different types of lesions were found and junior urologist have more lesions when high frequency was used, for both Ho:YAG (p = 0.05) and TFL (p = 0.04). Conclusion: More stone ARs and reduced operative time are observed in HP settings; however, more ureteral thermic-related damage is produced. When comparing the same power, higher energy or frequency does not modify the AR. Nonetheless, more ureteral thermic-related thermal damage is observed in high-frequency settings in unexperienced hands.

MP027 - Holmium-YAG laser lithotripsy versus ballistic lithotripsy for treatment of proximal ureteral calculi: A prospective, randomized, bicentric and comparative study

MP027 - Holmium-YAG laser lithotripsy versus ballistic lithotripsy for treatment of proximal ureteral calculi: A prospective, randomized, bicentric and comparative study

OUR RESULTS FOR RIGID URETEROSCOPY AND LASER LITHOTRIPSY IN PEDIATRIC AGE GROUP

Objective: Urolithiasis is an important disease that can lead to permanent kidney dysfunction and severe clinical symptoms in pediatric patients. We aimed to present our findings of rigid ureteroscopy combined with Holmium YAG laser lithotripsy.Material and Methods: We retrospectively reviewed the ultrasonography, and medical records of pediatric patients with urolithiasis who were operated in Sutcu Imam University Department of Pediatric Surgery, Kahramanmaraş between April 2018 and December 2019.Results: Sixty-one pediatric patients (M/F=38/23) with urolithiasis were enrolled in this study. The mean age was 6.7±4.9 years (range 3 month-17 years). Thirteen (34.2%) male patients need an urgent operation (rigid ureteroscopy combined with Holmium YAG laser lithotripsy) while the corresponding number was 4 (17.4%) in female patients. The difference between two sexes was statistically non-significant (p=0.156). Thirty-two male patients (84.2%) and 12 (52.2%) females patients had a successful operation (rigid ureteroscopy combined with Holmium YAG laser lithotripsy). The difference between the two sexes was statistically significant (p=0.019). The ratio of female patients with right-sided stone was significantly greater than the corresponding rates of male patients (p=&amp;lt;0.001). There was no difference between infants (&amp;lt;3 years of age) and toddlers (&amp;gt;3 years of age) with respect to gender, side of stone, procedural success, and need for urgent surgery (p&amp;gt;0.05). Regression analysis showed that female gender was a risk factor for a failed attempt (OR=-0.313, 95% CI: 0.052 – 0.528; p=0.0018).Conclusion: Safe and effective stone treatment can be performed considering that more than one operation can be performed in infants and children with mini ureteroscopy and holmium laser. However, while evaluating this treatment option in female patients, alternative treatment methods such as flexible or percutaneous nephrolithotomy may be preferred.

Efficacy and safety of ureteroscopy using holmium-YAG laser lithotripsy in treatment of pediatric ureteral stones.

Background: Endoscopic lithotripsy in pediatrics has increasingly used for the treatment of ureteral stones especially with the accessibility of smaller instruments. The safety and efficacy of Holmium: YAG laser lithotripsy makes it the intracorporeal lithotripter of choice. Aim of Study: To assess the effectives of ureteroscopy using Holmium: YAG lithotripsy in the treatment of ureteric stone in pediatrics. Patients and Methods: 30 children (20 boys and 10 girls) with ureteric stones were treated by semirigid ureteroscope using Holmium: YAG laser lithotripsy between October 2018 to May 2020. Mean patient age 3.6 years (range 8 months to 14 years). Mean stone size 12.8 mm (range 7-20 mm). Preoperative evaluation done including urinalysis, abdominal ultrasonography, plain radiography and blood investigations such as complete blood count and renal function test. Non contract abdominal CT scan used in some cases. Results: The stone free rate was 100% in one session. The mean operative time was 37.3 (25-60 minutes). No significant intraoperative or postoperative complications were encountered. Conclusion: Ureteroscopy using Holmium: YAG lithotripsy is safe and effective in treatment of ureteric stone in pediatrics.

Factors Impacting Stone-Free Rate After Retrograde Intrarenal Surgery for Calyceal Diverticular Calculi.

ObjectiveTo evaluate the outcomes of retrograde intrarenal surgery (RIRS) treatment of calyceal diverticular calculi and identify the associated factors affecting post-operative stone-free rate.Materials and MethodsFrom August 2015 to May 2019, data of 32 patients with calyceal diverticular calculi who were treated by RIRS in a Siriraj Hospital were retrospectively studied. All operations were performed by the same surgeon using flexible ureterorenoscopy (f-URS) and holmium YAG laser lithotripsy. Calyceal diverticula were identified by our refluxing technique and from the collected demographic, diverticular and stone data. Operative outcomes were retrospectively evaluated. Data were analysed to identify the factors associated with stone-free outcomes. Stone-free was defined as no residual stones remaining after surgery.ResultsMean age of the patients was 55.7 years. Stone locations were non-lower pole in 81.2% of cases and lower pole for the remaining 18.8% of cases. Median stone size was 1.2 cm with three as the median number of stones per patient. Calcium oxalate was the most common stone composition (56.3%). Positions of the diverticulum were anterior calyx (34.4%) and posterior calyx (50%), while the remainder were undetermined (incomplete data). Average length of the diverticular neck was 0.4 cm. Mean operative time was 46 minutes and mean hospital stay was 2.9 days. Complications included fever in three patients (9.3%) and sepsis in two patients (6.3%), with overall post-operative stone-free rate at 75%. Factors significantly affecting stone-free status were stone size (P=0.003) and length of diverticular neck (P=0.038). Multivariate analysis determined that only stone size had a statistically significant effect on post-operative stone-free status (P=0.015). Cut off point for stone size that increased the chances of a post-operative stone-free outcome was less than 1.5 cm, as determined by the ROC curve.ConclusionRIRS was found to be an effective and safe treatment option for the removal of calyceal diverticular calculi. Stone size of less than 1.5 cm offered a better chance of post-operative stone-free condition.

Comparison of Holmium: YAG Laser and Pneumatic Lithotripsy in the Treatment of Ureteral Stones: An Update Meta-Analysis

Purpose: Holmium YAG laser lithotripsy (LL) and pneumatic lithotripsy (PL) are the most commonly used procedures in the treatment of ureteral calculi. In a previous meta-analysis examining the treatment effect of the 2 modalities, the authors highlighted the need for large sample size and high quality trials to provide more uncovered outcome. Recently, several randomized controlled trials (RCTs) evaluating the same issue with larger patient number and more complicated data have been published. Therefore, we conducted this meta-analysis to update and synthesize evidence on the efficacy and safety of the 2 procedures in the treatment of ureteral calculi. Methods: The relevant studies were identified by searching Medline, EMBASE and Cochrane Library Database from January 1990 to November 2015. RCTs assessing the efficacy and safety of Holmium YAG laser and PL for ureteral stones were included. Two reviewers independently screened studies and extracted data. Results: A total of 8 studies were identified including 1,555 patients. Compared with PL, Holmium YAG LL significantly reduced the mean operative time (weighted mean difference = -11.52, 95% CI -17.06 to -5.99, p < 0.0001) and increased the early stone-free rate (OR 2.69, 95% CI 1.91-3.78, p < 0.00001) and the delayed stone-free rate (OR 2.12, 95% CI 1.40-3.21, p = 0.0004). However, a higher postoperative ureteral stricture rate (OR 3.38, 95% CI 1.56-7.31, p = 0.002) was observed in LL group over PL group. There was no statistical significance in the ureteral perforation rate (OR 1.19, 95% CI 0.65-2.16, p = 0.58), the stone migration rate (OR 0.64, 95% CI 0.41-1.00, p = 0.05), the postoperative gross hematuria rate (OR 0.71, 95% CI 0.40-1.25, p = 0.23) and the postoperative fever rate (OR 0.73, 95% CI 0.50-1.09, p = 0.12). Conclusions: Our data reconfirmed that Holmium LL for ureteral stones can achieve shorter mean operative time, better early and delayed stone-free rate with larger sample size and more high quality studies. And further trials are unlikely to considerably alter this conclusion. In terms of higher risk of postoperative ureteral stricture in LL group over PL group observed in our review, more high quality, multicenter RCTs with long-term follow-up outcome are warranted to better assess this issue.

Ureteroscopy and Laser Lithotripsy for Treatment of Ureteral Stones in Pregnants: Single Center Experience

Objective: To report our ureteroscopic laser lithotripsy experiences in the treatment of symptomatic ureter stones in pregnants which do not respond to conservative treatment Methods: A total of 6 pregnants aged between 22-33 years in second or third trimester were studied. Holmium-YAG laser lithotripsy was performed with 6.5 F semirigid uretroscope. Results: The diagnosis of ureter stone was made with abdominal ultrasonography in 5 patients and with magnetic resonance in one patient. Adequate stone fragmentation was performed in 2 mid-ureter and 4 distal-ureter stones. J stent was applied in one patient after the fragmentation process. The mean operation time was 24.8 ± 10.0 minutes after the entry of bladder with ureteroscope under spinal anesthesia. No urologic, anesthetic or obstetric complication was seen and all patients gave healthy birth at term. Conclusion: Fine calibrated ureteroscopes for the treatment of ureter stones in pregnants are fast and effective treatment modalities which decrease the operation time and remove difficulties in entering the ureter. Key words: Pregnancy, urolithiasis, ureteroscopy, lithotripsy, Holmium-YAG laser

Retrograde intrarenal surgery with holmium-YAG laser lithotripsy in the primary treatment of renal lithiasis

Introductionretrograde intrarenal surgery (RIRS) appears as a safe and effective technique as well as a good therapeutic alternative to extracorporeal shock wave lithotripsy (ESWL) and percutaneous nephrolithotomy (PNL). Material and methodsdescriptive study in 50 patients surgically treated between November 2012 and April 2013. Demographic, operative and postoperative data as well as early and late complications data were collected. The minimum follow-up of patients was one year. Surgery was performed under general anesthesia. Flexible ureteroscopy with ureteral access sheath and laser fragmentation were employed. Surgery success was defined as stone free rate in postoperative control test and at three months after surgery (simple radiography, abdominal ultrasound or CT without contrast). Resultsmean age was 51.1±15.5 years old. The highest-frequency location was the lower calyceal group (26%), single stones were described in 58% of patients whilst multiple lithiasis were found in the 42%. Regarding the stone burden in 44% of the patients was low (<2cm), and high (>3cm) in 22% of the patients. The stone clearance rate was 89.7±17.5. Average surgery time was 96.6±35.2min. Complications were reported in 4 patients (8%), all of them early ones and minor in nature. ConclusionsRIRS is an effective and safe option whose results are comparable to ESWL and PCNL. RIRS can be considered as first-line treatment. These results are corroborated by numerous studies. To strengthen these findings, prospective studies focusing on quality of life, length of stay, complications and cost-effectiveness of different treatments are needed.

Impact of pulse duration on Ho:YAG laser lithotripsy: treatment aspects on the single-pulse level.

Holmium-YAG (Ho:YAG) laser lithotripsy is a multi-pulse treatment modality with stochastic effects on the fragmentation. In vitro investigation on the single-pulse-induced effects on fiber, repulsion as well as fragmentation was performed to identify potential impacts of different Ho:YAG laser pulse durations. A Ho:YAG laser system (Swiss LaserClast, EMS S.A., Nyon, Switzerland) with selectable long- or short-pulse mode was tested with regard to fiber burn back, the repulsion capacity using an underwater pendulum setup and single-pulse-induced fragmentation capacity using artificial (BEGO) stones. The laser parameters were chosen in accordance with clinical application modes (laser fiber: 365 and 200 µm; output power: 4, 6 and 10 W in different combinations of energy per pulse and repetition rate). Evaluation parameters were reduction in fiber length, pendulum deviation and topology of the crater. Using the long-pulse mode, the fiber burn back was nearly negligible, while in short-pulse mode, an increased burn back could be observed. The results of the pendulum test showed that the deviation induced by the momentum of short pulses was by factor 1.5-2 higher compared to longer pulses at identical energy per pulse settings. The ablation volumes induced by single pulses either in short-pulse or long-pulse mode did not differ significantly although different crater shapes appeared. Reduced stone repulsion and reduced laser fiber burn back with longer laser pulses may result in a more convenient handling during clinical application and thus in an improved clinical outcome of laser lithotripsy.

A comparison of efficacies of holmium YAG laser, and pneumatic lithotripsy in the endoscopic treatment of ureteral stones.

We aimed to compare the effectiveness of holmium YAG laser and pneumatic lithotripsy in the treatment of ureteral stones. A total of 216 patients who had established indications of ureteroscopy between November 2011 and June 2012 were included in this study. Patients' files were retrospectively reviewed by dividing cases as groups that underwent pneumatic (PL) or laser lithotripsy (LL) procedures. Age, sex, stone burden and localization, duration of follow-up, operative times were evaluated. Stone-free rates were evaluated by ureteroscopical examination, postoperative scout films and ultrasonography. Group PL consisted of 109 and group LL of 107 patients. Median age was 43.93±15.94 years in Group PL and 46.15±14.54 years in Group LL. Male to female ratio, stone burden and localization were similar for both groups. Overall success rate was 89.9% in Group PL and 87.9% in Group LL, respectively (p<0.791). With the aid of additional procedures, success rate was 100% for both groups at the end of the first month. Groups were not different as for operative time, rate of insertion of an ureteral catheter and its removal time. Hospitalization period was apparently somewhat shorter in Group LL (p=0.00). Pneumatic lithotripsy can be as efficacious as laser lithotripsy and be used safely in the endoscopic management of ureteral stone. In comparison of both methods, we detected no differences as to operative time, success of operation and the time to removal of the catheter, however, hospitalization period was shorter in Group LL.

Transurethral holmium-YAG laser lithotripsy for large symptomatic prostatic calculi: initial experience

Symptomatic prostatic calculi are a rare clinical entity with wide range of management options, however, there is no agreement about the preferred method for treating these symptomatic calculi. In this study we describe our experience of transurethral management of symptomatic prostatic calculi using holmium-YAG laser lithotripsy. Patients with large, symptomatic prostatic stones managed by transurethral lithotripsy using holmium-YAG laser over 3-year duration were included in this retrospective study. Patients were evaluated for any underlying pathological condition and calculus load was determined by preoperative X-ray KUB film/CT scan. Urethrocystoscopy was performed using 30° cystoscope in lithotomy position under spinal anesthesia, followed by transurethral lithotripsy of prostatic calculi using a 550μm laser fiber. Stone fragments were disintegrated using 100W laser generators (VersaPulse PowerSuite 100W, LUMENIS Surgical, CA). Larger stone fragments were retreived using Ellik's evacuator while smaller fragments got flushed under continuous irrigation. Five patients (median age 42years) with large symptomatic prostatic calculi were operated using the described technique. Three patients had idiopathic stones while rest two had bulbar urethral stricture and neurogenic bladder, respectively. Median operative time was 62min. All the patients were stone free at the end of procedure. Median duration of catheterization was 2days. Significant improvement was observed in symptoms score and peak urinary flow and none of the patient had any complication. Transurethral management using holmium-YAG laser lithotripsy is a safe and highly effective, minimally invasive technique for managing symptomatic prostatic calculi of all sizes with no associated morbidity.

Urétéro-renoscopie souple chez un nourrisson de 22 mois

With the endourological development, the management of urinary tract calculi in children has significantly improved. The miniaturization of endoscopic equipment has allowed the use of flexible ureteroscopic with holmium YAG laser lithotripsy in children. We highlighted the case of a 22-month-old child, with an antecedent of megaureter, who had calculi in the right kidney lower pole. In collaboration with the urologist specialising in adult care, using an adapted technical tray, we underwent a laser intracorporeal lithotripsy using a 8 Charriere (Ch) ureteroscope and an holmium laser. No ureteral dilatation was required. A complete fragmentation of this infectious calculus was performed. This experience with a flexible ureteroscopy confirms that this technique is practicable, efficient and safe for stone treatment in children.

M1468: Holmium-YAG Laser Lithotripsy in the Treatment of Pancreaticobiliary Calculi Utilizing Peroral Single Operator Cholangioscopy (SPYGLASS): An Update on a Multi-Center Experience

5-10% of biliary stones are not amenable to standard endoscopic extraction techniques (extraction balloon, dormia basket or mechanical lithotripsy). Electrohydraulic and laser lithotripsy have been shown to be very effective in this setting but have been used sparingly. Single operator steerable cholangioscopy (Spyglass, Natick, MA) now permits for routine use of these technologies. Our pilot data using Holmium-YAG laser lithotripsy in the management of difficult intraductal biliary stones showed this technique to be safe and effective.

Holmium-YAG Laser Lithotripsy in the Treatment of Difficult Biliary Stones Utilizing Peroral Single Operator Cholangioscopy (SPYGLASS): A Multi-Center Experience

5-10% of biliary stones are not amenable to standard endoscopic extraction techniques. Electrohydraulic and laser lithotripsy have been shown to be very effective in this setting but have been utilized sparingly. The recent development of single operator steerable cholangioscopy (SpyGlass, Boston Scientific, Natick, MA) now permits for routine use of these technologies. We report our multi-center cumulative experience of using Holmium:YAG laser lithotripsy with SpyGlass cholangioscopy in the management of difficult intraductal biliary stones. METHODS Patients presenting with refractory bile ducts stones underwent ERCP with SpyGlass and Holmium:YAG lithotripsy using a SlimLine GI disposable laser probe (Lumenis, Santa Clara, CA). ERCP with SpyGlass was performed in the standard fashion. Once the stones were visually identified, the laser probe was placed in very close proximity to the stone and short bursts (< 5 sec) of energy (8-12 Watts) were applied until adequate fragmentation was achieved. Repeat ERCP sessions were performed as needed to achieve complete stone clearance. Safety and efficacy parameters were retrospectively collected utilizing a standardized data collection form.

The holmium-YAG laser: a suitable instrument for stone fragmentation in choledocholithiasis. The assessment of the results of its use under babyscopic control

Stone fragmentation is required in ca. 5% of patients with choledocholithiasis to free the patients of stones. Several extra- and intracorporal methods of stone fragmentation (lithotripsy) have been available. We here report our experience with the recently available holmium-YAG laser, used under babyscopic monitoring. Between September 1997 and May 1998 lithotripsy was performed by holmium-YAG laser under monitoring in 20 patients with choledocholithiasis in whom conventional methods had failed to achieve stone fragmentation. All stones were cleared in 19 of the 20 patients. A second session was necessary in four patients, three sessions in one. There was no serious complication and no death during a 30-day follow-up. Holmium-YAG laser lithotripsy under babyscopic monitoring has been shown to be a suitable method in patients with choledocholithiasis in whom previous treatment has failed it is complementary to current methods of stone fragmentation.