Single-stage Ureteroscopic Ho:YAG Laser Lithotripsy for Multiple and Bilateral Ureteral Stones

Abstract

Multiple and bilateral ureteral stones pose therapeutic challenges to the urologist. The authors we reviewed their experience with single-stage ureteroscopic Ho:YAG intracorporeal laser lithotripsy (ICL) as monotherapy for patients with bilateral obstructive and multiple unilateral ureteral calculi.

Methodology: A retrospective chart review was done on all patients diagnosed with multiple unilateral or bilateral ureteral calculi from July 2009 to May 2012. All stones were diagnosed using a helical unenhanced CT scan. A 9.5Fr semi-rigid ureteroscope (Storz®) was used and intracorporeal lithotripsy was performed using a Ho-YAG laser machine (Sphinx®) by urologists of varying experiences in a single institution. Stone-free status was defined as total stone residual of < 3mm. based on a repeat ultrasound or CT scan.

Results: A total of 63 patients diagnosed with multiple unilateral (45) or bilateral (18) ureteral stones.

The mean stone number per patient was 2.46±1.71 and the mean stone burden was 1.36±0.91cm. The mean operative time was 88.62±75.40mins. The over-all stone-free rate after a single session was 98%. The stone-free rate after a repeat ureteroscopy was 100%. Thirteen patients (21%) developed fever (Clavien 1) and one patient (1%) developed died of uremic complications (Clavien 5).

Conclusion: Ureteroscopic Ho:YAG laser lithotripsy is effective as monotherapy for multiple or bilateral stones with an acceptable low complication rate.