title: Minimally invasive management with holmium laser in total urinary tract calculi.
abstract: OBJECTIVE
  The purpose of this article was to study the management of total urinary tract calculi using holmium laser minimally invasive techniques.
  
  
  BACKGROUND
  It is rare for patients to present kidney stones, ureteral stones, and bladder stones simultaneously, and their treatment is considered to be complicated and difficult, specifically by minimally invasive techniques.
  
  
  METHODS
  We collected seven cases of total urinary tract calculi from May 2007 to September 2012. Three cases were unilateral, and the others were bilateral. All of the cases presented calculus in the bladder, ureter, and kidney, which were secondary to the long-term indwelling double J stent or lower urinary obstruction.
  
  
  RESULTS
  Extracorporeal shock-wave lithotripsy (SWL) was administered first, followed by the operation. For patients with bilateral calculi, at one stage, ureteroscopic lithotripsy (URL) with holmium laser was performed in all four cases to remove the bladder and bilateral ureter stones. Then, all patients underwent percutaneous nephrolithotomy (PCNL) with holmium procedures to address the bilateral kidney and upper ureter stones at the second stage. The indwelling double J stents were removed at the same time. For the patients with unilateral calculi, we performed a single operation, but it was conducted using the same treatment sequence as the bilateral procedure. The related symptoms in all cases disappeared after the operation. Re-examination showed that the stones were nearly dissolved and that renal function was recovered.
  
  
  CONCLUSIONS
  URL with holmium laser for the bladder and ureters combined with PCNL to dissolve kidney and upper ureteral stones could be the ideal choice for the treatment of total urinary tract calculi.
authors.affiliation: Department of Urology, the Affiliated Hospital of Shanghai JiaoTong University, Shanghai Sixth People's Hospital, Shanghai, China.
authors.forename: Xiao
authors.initials: X
authors.lastname: Zhang
authors.forename: Jianjun
authors.initials: J
authors.lastname: Yu
authors.forename: Ranxing
authors.initials: R
authors.lastname: Yang
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D006869:Hydronephrosis / Q000628:therapy; D053844:Lasers, Solid-State; D008096:Lithotripsy; D008297:Male; D008875:Middle Aged; D014545:Urinary Calculi / Q000628:therapy*