Endoscopic Management of Upper Urinary Tract Disease Using a 200-Micron Holmium Laser Fiber: Initial Experience in Japan
Mugiya S, Ohhira T, Un-No T, Takayama T; Suzuki K, Fujita K

OBJECTIVES: To study the clinical effectiveness of the 200-microm holmium laser fiber for endoscopic man-agement of upper urinary tract lesions.

METHODS: From January 1997 to March 1998, we performed retrograde endoscopic treatment in 25 patients with urinary tract lesions using a 200-microm holmium laser fiber. Nineteen patients had 20 stones (16 ureteral, 3 lower calyx, and 1 middle calyx), 4 had bleeding lesions in the lower calyx, 1 had transitional cell carcinoma involving the renal pelvis and upper calyx, and 1 had a ureteral stricture associated with an impacted ureteral stone. We used a 7.5F flexible ureterorenoscope for renal and upper ureteral lesions, and a 6.9F rigid ureteroscope for mid and lower ureteral lesions. For treatment, we used a holmium yttrium aluminum garnet laser generator and a 200-microm flexible quartz fiber.

RESULTS: All stones were successfully fragmented, including three lower caliceal stones. Lower caliceal bleeding spots were successfully cauterized for hemostasis in all 4 patients, and the pelvic tumor was successfully vaporized and ablated. In 1 patient, we had previously failed to treat a ureteral stricture with a 365-microm fiber because of inadequate visualization, but it was successfully incised using the 200-micron fiber. There were no significant complications such as ureteral obstruction or stenosis.

CONCLUSIONS: The improved flexibility of the new 200-micron holmium laser fiber facilitates treatment of stones, tumors, strictures, and lesions in the lower calyx, where access is difficult when using the previously avail-able 365-microm fiber.

Urology, Vol. 53, Number 1, 60-64, Jan 1999

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