Pulsed Dye Laser Lithotripsy—Which Laser Fiber Is Preferable? Critical Evaluation in 204 Consecutive Lasertripsies

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Abstract
In 200 patients, 204 ureteral calculi were treated with the pulsed-dye laser using 7.2F semirigid, 7.5F rigid, or 10.4F flexible steerable ureteroscopes. Two types of lasertripter were compared: the 200-μm fiber with an energy output restricted to 60 mJ and the 320-μm fiber with a maximum energy output of 140 mJ. The laser succeeded in destroying or fragmenting the calculi into passable pieces in 183 of 204 cases (89.7%). The laser alone was applied in 174 cases and lasertripsy plus Dormia basket extraction in 9 cases. In 28 ureters, 31 calculi were treated with the 200-μm laser. Complete destruction or breakage into spontaneously passable fragments was achieved in 18 cases (58%). There were 24 calcium oxalate monohydrate calculi in this group, of which only 11 (46%) were fragmented. A change was then made to the more powerful 320-μm fiber, with which success was achieved in 165 of 173 cases (95%), including 103 of 109 calcium oxalate monohydrate calculi (95%). One cystine stone was treated with the 320-μm fiber; it did not respond.

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