Retrograde Flexible Ureterorenoscopic Holmium-YAG Lithotripsy: The New Gold Standard
Gould D

To demonstrate the efficacy of flexible retrograde ureterorenoscopic holmium-YAG intracorporeal laser lithotripsy for the treatment of renal calculi, a total of 86 patients presenting to our hospital with renal calculi underwent flexible retrograde ureterorenoscopic holmium-YAG intracorporeal laser lithotripsy of their stones, and the data were collected prospectively. As extracorporeal shock wave lithotripsy is not available at our institution, all patients with renal calculi in this study were treated in a retrograde fashion using the Richard Wolfe 6.0F semirigid ureteroscope, the 7.5F flexible ureterorenoscope, and the holmium-YAG laser by Coherent Inc. Except for in hospital consults or patients requiring admission secondary to infection, all cases were performed on an ambulatory basis. All renal calculi 3 cm or smaller were approached in a retrograde fashion. Where possible, the stones were initially debulked using the semirigid ureteroscope and the 550-micrometer fiber followed by the flexible ureterorenoscope in combination with the 360- or 200-micrometer laser fiber depending on stone position. Stones were fragmented until they were small enough to be removed by hydrocleansing. Using this technique, stone-free success rates for calculi 2.5 cm or smaller after a single treatment, regardless of stone composition or location, are superior to those of extracorporeal shock wave lithotripsy. For calculi between 2.5 and 3 cm, the results also are noted to be superior. We conclude that for calculi larger than 3 cm or for partial staghorn calculi, the treatment of choice appears to be percutaneous approach.

Techniques in Urology, Vol. 4, Number 1, 22-24, Mar 1998

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