title: Holmium:YAG Lasertripsy with semirigid ureterorenoscope for upper-ureteral stones >2 cm.
abstract: 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.
authors.affiliation: Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chia-Yi, Taiwan, R.O.C. cv7589@adm.cgmh.org.tw
authors.forename: Chih Shou
authors.initials: CS
authors.lastname: Chen
authors.forename: Ching F
authors.initials: CF
authors.lastname: Wu
authors.forename: Jia J
authors.initials: JJ
authors.lastname: Shee
authors.forename: Wei Y
authors.initials: WY
authors.lastname: Lin
mesh_terms: 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
chemical_list: C503779:yttrium-aluminum-garnet; D015019:Yttrium; D000535:Aluminum; D006695:Holmium