Application of the holmium yttrium-aluminum-garnet laser for complicated impacted ureteral stones: a preliminary report.

BACKGROUND: Minimally invasive surgery is a current trend in all kinds of surgical fields. Endoscopic stone manipulation with electrohydraulic lithotripsy (EHL) is the preferred method for treating lower ureteral stones or calculi which cannot be resolved with extracorporeal shock wave lithotripsy (SWL). We evaluated the efficiency and safety of holmium yttrium-aluminum-garnet (YAG) laser for treatment of large impacted ureteral stones. METHODS: In a clinical trial period including April and May 1998, 13 patients with ureteral stones underwent holmium YAG lasertripsy. Six patients had large impacted ureteral stones (1.3 to 3.8 cm). We conducted lasertripsy with a 6.5-Fr. rigid tapered ureteroscope and a 550-nm SlimLine laser fiber under the guidance of a 3-Fr. ureteral catheter. The irrigation pump was set at 300 mmHg to increase the surgeon's visual clearance and to help keep the operative field ston-free. RESULTS: The postoperative stone-free rate was 100%. There were no intraoperative complications, even in the treatment for a 3.8-cm steinstrasse in the upper ureter. All preoperative hydronephrosis improved. In general, the operative time, not including anesthesia, was less than 30 minutes. There was no intraoperative or postoperative flank pain or fever when the procedure was combined with pressure irrigation for visual clearance and keeping the area stone-free. CONCLUSION: Holmium YAG lasertripsy is an excellent treatment modality, especially for a large impacted ureteral stone or steinstrasse. The treatment is efficient and safe. Furthermore, there is no learning curve necessary for an experienced endo-urologist. It helps the urologist to carry out a minimally invasive lithotripsy instead of an open surgery for large impacted ureteral stones.