Holmium:YAG Laser Lithotripsy as a Treatment Modality for Ureteral Calculi

Hyun Ho Hwang; Ro Jung Park; Kyung Hyun Moon; Sang Hyeon Cheon

doi:10.4111/kju.2008.49.1.60

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Hwang, Park, Moon, and Cheon: Holmium:YAG Laser Lithotripsy as a Treatment Modality for Ureteral Calculi

Original Article

Korean J Urol 2008;49(1):60-65.

Published online: 20 January 2008

DOI: https://doi.org/10.4111/kju.2008.49.1.60

Holmium:YAG Laser Lithotripsy as a Treatment Modality for Ureteral Calculi

Hyun Ho Hwang, Ro Jung Park, Kyung Hyun Moon, Sang Hyeon Cheon

From the Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea

Received 13 June 2007 Revised 29 October 2007

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We evaluated the results of Holmium:YAG laser lithotripsy according to the size and location of the ureteral stones.

Materials and Methods

Between March 1998 and April 2007, the medical records of 203 patients who were treated with ureteroscopic Holmium: YAG laser lithotripsy due to ureteral calculi were reviewed. They were subgrouped by the size and the location of the ureteral stones. The results of treatment were evaluated by the stone free rate and the mean operation time of each group.

Results

The stone free rates of the upper, mid and lower ureter stone groups were 73.3%, 96.1% and 100%, respectively. There was a significant difference in the upper ureter stone group compared to the other two groups, and especially for the group with stone less than 10mm. Stone migration into the renal pelvis or calyx was a major cause of failure in the patients with upper ureter stones. 8 cases showed stone migration and 2 cases showed fragment migration.

Conclusions

As Holmium:YAG laser lithotripsy has a low complication rate and a high stone free rate, it is an effective treatment modality for ureteral calculi. However, such procedures should be performed carefully because the thermal effect of the Holmium:YAG laser causes ureteral perforation, and especially in the cases of impacted or large stones. Other effective alternatives such as trapping devices need to be studied for patients with upper ureteral stones to prevent stone migration.

Keywords: Ureteral calculi, Holmium, Lithotripsy

References

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Table 1.

Patients' characteristics

Stone location (number)	Upper (45)	Mid (51)	Lower (107)	Total (203)	p-value
Male/female	26/19	28/23	67/40	121/82	0.627∗
Mean age±SD (years)	46.8±11.5	41.8±11.5	45.0±12.9	44.6±12.3	0.118^†
Mean stone size±SD (mm)	10.2±4.99	8.61±2.81	8.85±3.45	9.09±3.74	0.072^†

^∗ : statistical analysis by chi-square equation,

^† : statistical analysis by One-Way ANOVA

Table 2.

Results according to stone location

Stone location (number)	Upper (45)	Mid (51)	Lower (107)	Total (203)	p-value
Mean operation time±SD (m	in) 74.4±33.9∗	68.4±35.1	60.5±31.1	65.6±33.1	0.045^†
Mean hospitalization±SD (da	ays) 1.98±1.32∗	2.69±2.40	2.15±1.59	2.25±1.79	0.110^†
Stone free rate (%)	73.3%∗ (33/45)	96.1% (49/51)	100.0% (107/107)	93.1% (189/203)	＜0.001^‡

^∗ : statistical significant comparing to other two groups,

^† : statistical analysis by One-Way ANOVA,

^‡ : statistical analysis by chi-square equation

Table 3.

Comparison of outcomes according to the stone location and stone size

Stone free rate (%)				Mean operation time (min)
	＜10mm (n=108)	≥10mm (n=95)	p-value	＜10mm (n=108)	≥10mm (n=95)	p-value
Upper	52.4 (11/21)	91.7 (22/24)	0.003^†	60.7	83.7	0.016^‡
Mid	100.0 (26/26)	92.0 (23/25)	0.141^†	52.1	85.4	0.001^‡
Lower	100.0 (61/61)	100.0 (46/46)		50.7	73.5	＜0.001^‡
Total	90.7 (98/108)	95.8 (91/95)	0.157^†	53.0	79.9	0.005^‡
p-value	＜0.001∗	0.141∗		0.224∗	0.260∗

^∗ : statistical analysis by One-Way ANOVA,

^† : statistical analysis by chi-square equation,

^‡ : statistical analysis by Student's t-test

Table 4.

Causes of failure (n=14)

	Upper	Mid	Lower	Total
	(n=12)	(n=2)	(n=0)	(n=14)
Stone migration (%)	8	0	0	10 (71.4)
Ureteral perforation (%)	2	1	0	3 (21.4)
Fragment migration (%)	2	1	0	1 (7.1)

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