Holmium: yttrium-aluminum-garnet laser for endoscopic lithotripsy.

OBJECTIVES: To evaluate the holmium:yttrium-aluminum-garnet (Ho:YAG) laser for endoscopic lithotripsy on patients diagnosed with urinary tract calculi.

METHODS: Thirty-eight procedures utilizing transurethral ureterolithotripsy or percutaneous nephroureteral lithotripsy were evaluated: 5 renal calculi, 31 ureteral calculi (most in the upper ureter), 1 ureteropelvic junction calculus, and 1 bladder calculus. These were mainly in cases that, after being treated with extracorporeal shock-wave lithotripsy (ESWL), were contraindicated for further ESWL. Laser parameters included energy of 0.5 to 1.0 J/pulse and pulse rate of 5 to 10 Hz.

RESULTS: Composition of calculi was determined in 26 procedures. The Ho:YAG laser was effective for fragmenting all types of calculi. Patient outcome evaluated at 6 weeks after treatment showed that 33 of 38 procedures (87%) were effective. Residual calculi in 4 of the 5 unsuccessful procedures were less than 5 mm in size and judged to be able to pass spontaneously. In the remaining procedure, the calculus was passed spontaneously 3 months after treatment. No severe damage to tissues or adverse effects to the body were observed due to the Ho:YAG laser.

CONCLUSIONS: On the basis of these results, we determine that this wavelength is effective for lithotripsy in addition to its previously reported usefulness for soft tissue applications, and, thus, is a cost-effective and highly useful clinical device.