Holmium:YAG lasertripsy for ureteric calculi: an experience of 300 procedures

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Abstract
To assess the success of holmium:YAG lasertripsy in the management of ureteric calculi and to audit the complications of the procedure, with special reference to strictures in the ureter. A total of 300 ureteroscopic laser procedures were carried out on 265 patients (204 male and 61 female, median age 51 years, range 2–95) with ureteric calculi. At ureteroscopy, the calculi were present in the upper ureter in 44%, mid-ureter in 37% and lower ureter in 19% of patients; most calculi were >5 mm. A 7.5 F Wolf semi-rigid ureteroscope was used and the holmium:YAG laser energy delivered using the Sharplan ML210 device at 0.8–1.0 J/pulse. The patients were followed up at ≈6 weeks with limited intravenous urography or ultrasonography to assess clearance and the incidence of strictures. Stones were completely cleared in 90% of the patients, with the best results in the lower and mid-ureter (97% and 96%, respectively) followed by the upper ureter (89%). Alternative procedures were required in only 17 (7%) patients; extracorporeal shock-wave lithotripsy in 13, percutaneous nephrolithotomy in two and open pyelolithotomy in two patients. Complications with ureteric perforation in 11 patients, including laparotomy for peritonitis in one, serious sepsis in two and strictures in 10 patients. Strictures were more common in association with impacted calculi in the upper ureter early in the series. Holmium:YAG lasertripsy is a highly effective treatment for ureteric calculi, with strictures related to the treatment of difficult upper ureteric calculi.