Holmium laser lithotripsy (HoLL) of ureteral calculi

The effectiveness and side-effects of ureteroscopic HoLL of ureteral stones should be evaluated. In 63 patients (17 female, 46 males) a total of 75 stones of 3-20 mm diameter were treated with ureteroscopic Hell. 18.7 per cent of stones were located in the proximal third, 24.0 per cent in the middle third and 57.3 per cent in the distal third of the ureter. HoLL was performed with small diameter semirigid and flexible ureteroscopes, 220 or 365 nm flexible laser fibers and a holmium:YAG laser at a power of 5-15 W. 10.5-1.0 J., 10-15 Hz.), 47 of 63 patients (74.6 per cent) were immediately free of stones, and 8 others (12,6 per cent) lost their residual fragments spontaneously within two weeks. Another 2 patients recieved additional chmolitholysis for uric accid stone fragments, i.e. 90.5 per cent of patients were stone free by one sitting of ureteroscopic HoLL. Of the remaining 6 patients (9.5 per cent) who still had residual calculi 4 weeks after HoLL, 2 asymptomatic patients refused any additional treatment, 2 patients preferred treatment with ESWL, and 2 patients had a successful second HoLL, thereby raising the success rate of ureteroscopic HoLL to 93.7 per cent. 2 patients showed contrast medium extravasation on retrograde ureterograms, due to guide wire perforation. No ureteral stricture occurred. In conclusion, transurethral ureteroscopic HoLL proved to be a safe and successful minimal invasive treatment of ureteral calculi.