Ureteroscopic Holmium lasertripsy for treatment of impacted ureteral calculi

ABSTRACT

To evaluate the efficacy and safety of Holmium YAG laser lithotripsy for the treatment of impacted ureteral stones. From January 2000 to January 2007, 150 patients [105 males and 45 females] with impacted ureteral stones were treated at the Urology Department of the Assiut University Hospital, Assiut, Egypt. Their mean age was 36 years [range 20 to 66 years]. The mean duration of stone impaction was 4.6 months. The patients were managed via the retrograde endoscopic approach using small caliber [6.9 F rigid and 7.5 F flexible] ureteroscopes and the HolmiumYAG laser lithotriptor. Out of 150 ureteral stones, 144 [96%] were completely fragmented with a single endoscopic procedure. Proximal stone migration occurred in two cases, and the stones were treated by extracorporeal shock wave lithotripsy [ESWL]. Intra-operative ureteral perforation occurred in 4 cases and was managed by open surgical treatment. Endoscopic observation revealed inflammatory polyps at the site of impaction in 75 patients and a stricture adjacent to the stone in 20 cases. Holmium YAG laser lithotripsy may be considered an effective first-line therapy for chronically impacted ureteral stones, which are frequently associated with chronic inflammation, polyps and strictures. It is quite safe and it avoids the futile repetition of ESWL and problems caused by a prolonged passage of stone fragments