title: Efficacy and safety of Ho:YAG laser lithotripsy for ureteroscopic removal of proximal and distal ureteral calculi.
abstract: BACKGROUND
  Laser lithotripsy is an established endourological modality. Ho:YAG laser have broadened the indications for ureteroscopic stone managements to include larger stone sizes throughout the whole upper urinary tract. Aim of current work is to assess efficacy and safety of Ho:YAG laser lithotripsy during retrograde ureteroscopic management of ureteral calculi in different locations.
  
  
  METHODS
  88 patients were treated with ureteroscopic Ho:YAG laser lithotripsy in our institute. Study endpoint was the number of treatments until the patient was stone-free. Patients were classified according to the location of their stones as Group I (distal ureteric stones, 51 patients) and group II (proximal ureteral stones, 37). Group I patients have larger stones as Group II (10.70 mm vs. 8.24 mm, respectively, P = 0.020).
  
  
  RESULTS
  Overall stone free rate for both groups was 95.8%. The mean number of procedures for proximal calculi was 1.1 ± 0.1 (1-3) and for distal calculi was 1.0 ± 0.0. The initial treatment was more successful in patients with distal ureteral calculi (100% vs. 82.40%, respectively, P = 0.008). No significant difference in the stone free rate was noticed after the second laser procedure for stones smaller versus larger than 10 mm (100% versus 94.1%, P = 0.13). Overall complication rate was 7.9% (Clavien II und IIIb). Overall and grade-adjusted complication rates were not dependent on the stone location. No laser induced complications were noticed.
  
  
  CONCLUSIONS
  The use of the Ho:YAG laser appears to be an adequate tool to disintegrate ureteral calculi independent of primary location. Combination of the semirigid and flexible ureteroscopes as well as the appropriate endourologic tools could likely improve the stone clearance rates for proximal calculi regardless of stone-size.
authors.affiliation: Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians University, Marchioninistrasse 15, D - 81377 Munich, Germany. wael.khoder@med.uni-muenchen.de.
authors.forename: Wael Y
authors.initials: WY
authors.lastname: Khoder
authors.forename: Markus
authors.initials: M
authors.lastname: Bader
authors.forename: Ronald
authors.initials: R
authors.lastname: Sroka
authors.forename: Christian
authors.initials: C
authors.lastname: Stief
authors.forename: Raphaela
authors.initials: R
authors.lastname: Waidelich
mesh_terms: D005260:Female; D006801:Humans; D053844:Lasers, Solid-State / Q000009:adverse effects* / Q000627:therapeutic use*; D017602:Lithotripsy, Laser / Q000009:adverse effects* / Q000379:methods*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies; D014514:Ureteral Calculi / Q000473:pathology / Q000601:surgery*; D018666:Ureteroscopy / Q000295:instrumentation
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