Techniques of Laser Lithotripsy

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Abstract
A tunable pulsed dye laser has been used for the treatment of 157 patients with renal and ureteral calculi too large to be extracted by ureteroscopy or not appropriate for ESWL. In 106 cases, the stone was completely fragmented with the laser. The laser was used in combination with ESWL in 34 cases. In ten cases, the laser had no action on the calculus. There were three instances of machine failure. The first two patients in the series developed ureteral strictures well below the level of laser action. One required operative repair. A newly developed 7.2F semirigid ureteroscope has enhanced the utility of the laser. The current uses of the laser include lower ureteral stones, calculi in the upper ureter unable to be treated by ESWL, stones in narrow ureters unable to be traversed by larger ureteroscopes, Steinstrasse, disimpaction of ureteropelvic junction stones, and percutaneous treatment of renal calculi via the flexible nephroscope.