A multi-institutional study demonstrating the safety and efficacy of holmium laser ureterolithotripsy

Purpose: To present the results of a large multi-institutional series of patients treated with ureteroscopic holmium laser lithotripsy (UHLL) for ureteric stones; demonstrating its safety and efficacy in different age groups, stone locations, and other special situations. Materials and Methods: The medical records of 239 patients with ureteral stones managed by UHLL were reviewed. Patients' medical records were reviewed for age, sex, stone laterality, location, the number and size of stones, the need for ureteral dilation, stenting, and residual fragment extraction. Results: The 239 patients included 199 males and 40 females. The mean age was 40.6 years (range: 5 to 93 years). Six patients had bilateral ureteric stones that were managed in 1 session. The average stone burden was 9.8 mm (range: 4 to 20 mm). The 239 patients harbored 272 ureteral stones and underwent 255 UHLL sessions. Acute ureteral dilation was performed just prior to ureteroscopy in 73 procedures (28.6%). Stone retrieval was done in 124 (48.6%) of the procedures. Twenty-six patients presented with renal insufficiency and were rendered stonefree with UHLL. Following ureteroscopy, minimal stone clearance was noted on the first postoperative day (20%) but improved to 96% after 3 months. The success rate after a single session was 96.3% and increased to 99% after 2 sessions. Conclusion: This study demonstrates that the use of holmium laser lithotripsy is a safe and effective modality in the treatment of ureteral stones regardless of sex, age, stone location, or stone size. Good stone clearance was also obtained in patients with renal impairment.