Holmium:YAG Lasertripsy with semirigid ureterorenoscope for upper-ureteral stones >2 cm.
OBJECTIVE
Shockwave lithotripsy (SWL) has a variable but low success rate for impacted stones of the upper ureter. Ureterorenoscopic stone manipulation is another option, the appropriateness of which decreases with increasing size of the stone. This report examines the feasibility and effectiveness of ureterorenoscopic holmium:YAG lasertripsy (URSL) for impacted upper-ureteral stone >2 cm.


METHODS
Twenty-six patients with impacted upper-ureteral stones >2 cm were treated with URSL using a 6/7.5F semirigid tapered ureterorenoscope and holmium:YAG laser under spinal anesthesia. Double-J ureteral stents were placed in all patients owing to the large stone burden and edema of the intraluminal mucosa. Success was defined as stone-free status on radiography at 1 month. Demographics, stone parameters, and outcomes were analyzed.


RESULTS
The retrograde accessibility rate of these stones was 96.2% (25 of 26). The stone-free rate achieved after one sitting was 84% (21 of 25). After an auxiliary treatment, the total stone free-rate reached 100%. In only one patient, who had a sharply angulated ureter, did access with the ureterorenoscope fail; this patient received open surgery. There were no intraoperative or postoperative complications.


CONCLUSIONS
Although 16% of patients need an auxiliary treatment, the holmium:YAG laser combined with a semirigid ureterorenoscope can be considered the first choice for large impacted upper-ureteral stones.
Chen
Chih Shou
CS
Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chia-Yi, Taiwan, R.O.C. cv7589@adm.cgmh.org.tw
Wu
Ching F
CF
Shee
Jia J
JJ
Lin
Wei Y
WY
D000328:Adult; D000368:Aged; D000535:Aluminum; D005240:Feasibility Studies; D005260:Female; D006695:Holmium; D006801:Humans; D017602:Lithotripsy, Laser; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014514:Ureteral Calculi / Q000628:therapy*; D020709:Ureteroscopes; D015019:Yttrium
C503779:yttrium-aluminum-garnet; D015019:Yttrium; D000535:Aluminum; D006695:Holmium