Low power laser in the management of ureteral stones

To evaluate the outcome of the low power Holmium-Yag laser in management of ureteral stones, and to report the incidence rate of different types of stones. One hundred and seventy patients underwent ureteroscopy and fragmentation of ureteral stones at the International Medical Center, Jeddah, Kingdom of Saudi Arabia between March 2007 and August 2009. Stones were measured by their largest diameter on CT and classified according to their location from the ureter to the proximal middle and distal ureteral stones. We utilized 8-11 F Semi rigid or 7.5 F flexible ureteroscopes to identify the stones, and all stones were fragmented and evaporated using a 10 watt lower power Holmium-yag laser lithotripter. All stones were completely evaporated and fragmented using the Holmium-yag laser through ureteroscopy. The age of the patients varied between 21-76 years with a mean age of 38.6 years [males 113, and females 57]. The largest diameter of the largest stone was 6-12mm [mean 8 mm] and classified according to its location in the ureter into proximal [93 [54.7%]], middle [26 [15.3%]], or distal ureteral stones [51 [30%]]. We performed stone analysis in 122 patients [oxalate [n=87], uric acid [n=16], cystine [n=l 1], and calcium phosphate [n=8]]. Laser lithotripsy using low power 10 watt laser lithotripter is safe and effective method for stone evaporation and disintegration, and can be carried out as a day care procedure. The types of stones in Saudi Arabia are same as it has been reported before in the literature

Laser prostatectomy in high-risk patients

To evaluate the short-term tolerability and outcome of high power green light potassium titanyl phosphate laser prostatectomy in high-risk patients with symptomatic benign prostatic hyperplasia. Eleven high risk operative patients were included in this study at the International Medical Center, Jeddah, Kingdom of Saudi Arabia, between January and September 2007. Patients enrolled in this study underwent preoperative and postoperative, cardiac and anesthesia evaluation. Clinical presentations, ultrasound of urinary tract, and preoperative laboratory investigation were recorded. All patients underwent high power green light laser prostatectomy using the green light photo vaporization system with setting of 120 watts. The intraoperative and postoperative complications, and follow up were recorded. The patients' age varied between 65-82 years with a mean age of 75.3 +/- 8.6 years old. Seven patients presented with refractory acute urinary retention, and 4 patients presented with severe lower urinary tract symptoms. The average prostate volume was 61.2 cc. All patients had uneventful intra- and postoperative course, without any significant complications, except one patient who required postoperative admission to the intensive care. The average blood loss was insignificant, and only one of the patients required blood transfusion. Foley catheters were removed one day after the procedure. All patients voided satisfactorily after removal of the catheter, and 8 patients complained of urgency. High power green light laser prostatectomy is a safe and effective method of treating symptomatic benign prostatic hyperplasia in patients with high operative risk

Shock wave lithotripsy in patients with renal calculi

To demonstrate the efficacy of shock wave lithotripsy [SWL] in the primary treatment of 1647 patients with renal calculi using a Dornier Doli U/50 lithotripter. One thousand and six hundred forty-seven patients underwent SWL as day-cases at King Abdulaziz University Hospital in Jeddah, Saudi Arabia between October 2001 and July 2007, using intravenous sedation [Pethidine 1mg/kg and Midazolam 5-10mg] for analgesia in 85.5% of the patients. The treatment outcome of 2241 renal calculi was analyzed and stratified according to the size and the site of the stones. Recorded data included shock waves intensity, number of shocks, treatment time, analgesia, stone related factors such as size, site, number, nature, composition, and any related complications. The stones were grouped into 5 groups according to the largest stone size in the kidney. Patients were followed up for 6-18 months, mean of 13 months. Complete clearance of the stones occurred in 2154 kidneys [89.5%]. At 3-months follow up. The overall re-treatment rate was 57.2% and for each group it was 132 [23.5%] for Group I, 254 [36.1%] for Gourp II, 473 [85.5%] for Group III, 278 [100%] for Group IV and 147 100% for Group V. Treatment failed in 87 patients with stone size of 20-29mm in 57 patients, and in 30 patients with stone size of 30-39mm. Fifty-six were solitary pelvic stones treated with ureteroscopy, while 31 were calyceal stones treated by other modalities such as percutaneousnephro-lithotomy. The most common complication was pyelonephritis with or without obstruction. Shock wave lithotripsy treatment was a successful primary management of renal stones of variable sizes in 89.5% of the treated kidneys