Techniques of Laser Lithotripsy

Abstract

A tunable pulsed dye laser has been used for the treatment of 157 patients with renal and ureteral calculi. All calculi treated were too large to be extracted by ureteroscopy or were not appropriate candidates for ESWL. In 106 cases, the stone was completely fragmented with the laser. The laser was used in combination with ESWL in 34 cases. In ten cases the laser had no action on the calculus. There were three instances of machine failure. The first two patients in the series developed ureteral strictures well below the level of laser action. One required operative repair. A newly developed 7.2 Fr. semi-rigid ureteroscope has enhanced the use of the laser. The current uses of laser include lower ureteral stones, calculi in the upper ureter unable to be treated by ESWL, stones in narrow ureter unable to be traversed by larger ureteroscopes, steinstrasse, for disimpaction of UPJ stones, and for percutaneous treatment of renal calculi via the flexible nephroscope.