Flexible Ureteroscopic Lithotripsy Using Pulsed-Dye Laser

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Abstract
The combination of flexible ureteroscopy and pulsed-dye laser lithotripsy was employed in treating 31 proximal ureteral and caliceal calculi. Initially, seven of nine calculi were fragmented using the Candela MDL-1 laser with the 200-μm fiber delivery system. Those calculi that did not fragment were composed of calcium oxalate monohydrate. An additional 22 patients were successfully treated using the Technomed Pu Isolith, a more powerful system employing larger, interchangeable laser fibers. Greater than 60% of these calculi were composed of calcium oxalate monohydrate, and some were impacted. Proximal and caliceal calculi are best-treated via actively deflectable flexible ureteroscopes. Calculi in the distal third of the ureter are best treated with short rigid ureteroscopes. Larger calcium oxalate monohydrate fragments should be removed, with the 3-prong grasper the instrument of choice. Baskets should be avoided.