Intracorporeal laser lithotripsy

Abstract

ObjectivesTo review the current literature on intracorporeal laser lithotripsy.MethodsWe searched PubMed for relevant reports up to January 2012, using the keywords ‘laser’, ‘lithotripsy’ and ‘intracorporeal’.ResultsWe studied 125 relevant reports of studies with various levels of evidence. Efficient lithotripsy depends on the laser variables (wavelength, pulse duration and pulse energy) and the physical properties of the stones (optical, mechanical and chemical). The most efficient laser for stones in all locations and of all mineral compositions is the holmium yttrium–aluminium–garnet laser (Ho:YAG). The frequency-doubled double-pulse Nd:YAG laser functions through the generation of a plasma bubble. New laser systems, such as the erbium:YAG and the thulium laser, are under evaluation. Laser protection systems have also been developed for the novel digital flexible ureteroscopes. Although complications are rare, a high relevant clinical suspicion is necessary.ConclusionsLaser lithotripsy technology is continuously developing, while the Ho:YAG laser remains the reference standard for intracorporeal lithotripsy.

Peri-Ureteral Abscess Formation Following Ureteroscopic Laser Lithotripsy: A Case Report

“…Ureteroscopic lithotripsy is often followed by ureteral stent placement in order to aid with the relief of postoperative pain, prevent ureteral obstruction, improve hydronephrosis, improve healing, and prevent ureteral stricture [ 5 , 6 ]. It is one of the safest forms of treatment for urolithiasis but may cause urothelial tissue injury adjacent to the targeted stone, sometimes progressing to stricture development [ 7 , 8 ]. The only contraindication for laser lithotripsy is the presence of an untreated urinary tract infection (UTI) due to the risk of urosepsis [ 8 ].…”

“…It is one of the safest forms of treatment for urolithiasis but may cause urothelial tissue injury adjacent to the targeted stone, sometimes progressing to stricture development [ 7 , 8 ]. The only contraindication for laser lithotripsy is the presence of an untreated urinary tract infection (UTI) due to the risk of urosepsis [ 8 ]. Life-threatening complications of ureteroscopy include renal rupture, perirenal hematoma, subcapsular hematoma, acute sepsis, arteriovenous (AV) fistula formation, ureter avulsion, and retroperitoneal hematoma [ 9 ].…”

Therapeutic use of lasers in urology

“…Bezpośrednio za fragmentację kamieni odpowiada efekt fototermiczny i fotomechaniczny. Należy zaznaczyć, że litotrypsja z użyciem lasera holmowego charakteryzuje się wysoką skutecznością, sięgającą 92-96%, i niskim odsetkiem powikłań, które są związane w dużej mierze z doświadczeniem operatora [20][21][22]. Średni czas zabiegu wynosi ok. 30 min.…”

Urolithiasis: An Update on Diagnostic Modalities and Treatment Protocols

“…Ureteroscopy is a minimally invasive technique that utilizes a flexible fiberoptic ureteroscope that passes through urethra via bladder up to the ureter for accessing [61,62,64,67] (hydrochlorothiazide, trichlormethiazide, chlorthalidone, indapamide) Calcium oxalate, calcium phosphate stones Potassium phosphate [66,87] Calcium oxalate stones Sodium cellulose phosphate [71,72] Calcium oxalate stones Allopurinol [65,82] Uric acid stones D-penicillamine [66,73,88] Cystine stones Febuxostat [89][90][91] Uric acid stones Potassium citrate [68,71] Calcium oxalate, uric acid stones Alpha blockers (tamsulosin, terazosin, doxazosin) [66,92] Ureteral stones Alpha mercaptopropionylglycine [66,88] Cystine stones Acetohydroxamic acid [66,71] Struvite stones Calcium channel blockers (nifedipine) [55] Ureteral stones Acetazolamide [21] Uric acid, cystine stones Sodium bicarbonate [66,93] Uric acid stones NSAIDs (diclofenac, indomethacin, ketorolac, ibuprofen) [19,94] All stone types the entire renal collecting system [96,[100][101][102] . It is equipped for extracting smaller stones as well as fragmenting larger ones using ballistic and laser (holmium: yttrium-aluminium-garnet laser/holmium: YAG laser) lithotripsy [17,96,101] due to which it has become a popular modality for treatment of urolithiasis in children and getting wider acceptance in pregnant women as well as in patients after urinary diversion …”

“…It is equipped for extracting smaller stones as well as fragmenting larger ones using ballistic and laser (holmium: yttrium-aluminium-garnet laser/holmium: YAG laser) lithotripsy [17,96,101] due to which it has become a popular modality for treatment of urolithiasis in children and getting wider acceptance in pregnant women as well as in patients after urinary diversion [96,103,104] . Although, now in constant decline with the advent of more flexible and narrow ureteroscopes; ureteral injury and perforation, steinstrasse, haematuria and infection are the complications that are associated with ureteroscopy [96] .…”