Treatment Options

Holmium Laser Lithotripsy

The Holmium:YAG (Ho:YAG) and pulse-dye laser are used for fragmentation of urinary calculi through miniaturized rigid and flexible endoscopes. The Ho:YAG laser is effective at fragmenting all stones types. However, it can also cut a stone basket or the wall of a ureter if contact occurs. In contrast, the pulse-dye laser is essentially free of thermal risk.

Holmium:YAG laser utilizes a wavelength in the infrared zone (2100 microns). This laser creates a vapor "tunnel" in the irrigating fluid. The laser works on the surface of the stone by vaporizing water and organic matter in the stone resulting in destruction in the urinary calculus.

Advantages of Holmium:YAG Laser

  1. This laser will small stone fragments from large stones either by fragmentation or by vaporization
  2. This laser devise is easy to use
  3. It is ready to use within one minute after it is turned on
  4. No special non-conduction solution is required
  5. The fiber can be placed with great precision and controlled action
  6. Protective eye ware does not compromise the ureteroscopic view of the stone or fiber
  7. The machine is readily moved from one operating room to another
  8. The laser fibers are versatile and can be used in rigid or flexible ureteroscopes
  9. This laser can be used with high efficacy regardless of stone composition
  10. This laser reduces the need for stone manipulation or basketing
Disadvantages
  1. Destruction of large stones can be tedious and time consuming
  2. The laser will melt the wires of a basket or guide wire if fired directly onto the wire making extraction of the basket or wire difficult

Suggested readings
Grocela JA, Dretler SP. Intracorporeal lithotripsy: Instrumentation and development. Urol Clin North Am 1997, 24:1:13-23.

Shroff S, Watson GM, Parikh A, Thomas R, Soonawalla PF and Pope A. The holmium:YAG laser for ureteric stones. Brit J Urol 1996, 78:836-839.

Teichman JM, Rao RD, Rogenes VJ, et al: Ureteroscopic management of ureteral calculi: Electrohydraulic versus holmium: YAG lithotripsy. J Urol 1997; 158(4): 1357-1361.

Freiha GS, King DH, Teichman JM: Holmium: YAG laser damage to ureteral guidewire. J Endo 1997; 11 (3): 173-175.

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