Ureteroscopic Treatment of Ureteral Calculi with Holmium: YAG Laser Lithotripsy

Abstract

Purpose: We evaluated the effectiveness and safety of holmium: YAG laser lithotripsy with a semirigid ureteroscope for ureteral calculi in a prospective cohort of 697 patients. Patients and Methods: Holmium: YAG laser lithotripsy was performed with a semirigid ureteroscope in 697 inpatients between September 2002 and January 2006. Calculi were located in the distal ureter in 382 patients (54.8%), the midureter in 143 (20.5%), and the proximal ureter in 172 (24.7%). Patients were assessed 2 to 24 weeks postoperatively with repeat plain radiography, ultrasonography, intravenous urography, or some combination. Results: The overall stone-free rate was 92.2%, the rate being 100% for calculi in the distal ureter (N = 382), 97.9% for calculi in the midureter (N = 140), and 70.3% for calculi in the proximal ureter (N = 121). Complications occurred in 13 patients (1.9%). Postoperative ureteral stricture developed in five patients (0.72%) and was managed surgically. Conclusions: Holmium: YAG laser lithotripsy with a semirigid ureteroscope is a highly effective and safe treatment for ureteral calculi, especially those in the distal ureter and midureter.