Clinical outcomes of endoscopic therapy with holmium: Yag laser for upper urinary tract calculi

We investigated the clinical outcomes of endoscopic therapy with the holmium: YAG (Ho: YAG) laser for upper urinary tract calculi. This study included 65 patients (35 men and 30 women) who underwent transurethral lithotripsy (TUL) or percutaneous nephrolithotripsy (PNL) between September 2010 and September 2012. The median age of the patients was 66 years (range, 21-92 years). One patient had bilateral stones and 11 patients had multiple stones. Twenty-one stones were located in the renal pelvis, 9 in the ureteropelvic junction, 13 in the proximal ureter, 10 in the middle ureter, and 24 in the distal ureter. The median stone size was 9 mm (range, 4~63 mm) for renal stones and 6 mm (range, 3-13 mm) for ureteral stones. As one patient had bilateral stones, 66 treatments were performed. Thirty-four patients were treated by TUL with rigid ureteroscopy, 27 by TUL with flexible ureteroscopy, and 5 by PNL. The stone-free rate was 95.5%, and no difference was found with regard to the efficacy of fragmentation among the various types of stone. No intraoperative complications were identified. Seven patients (10.6%) developed macrohaematuria and seven patients (10. 6%) had acute pyelonephritis as postoperative complications, however, all cases were cured conservatively. The Ho: YAG laser is an excellent modality, which can treat upper urinary tract calculi both safely and effectively.