Abstract
Objectives
In this study, we try to evaluate the efficacy and safety of holmium lasers for treatment of ureteric stones in patients with renal impairment or obstructive anuria.
Patients and methods
Twenty-six patients were included in this study, of which 20 patients presented with elevated blood urea and serum creatinine (2.1–7.6 mg%), and six patients presented with calcular anuria (mean serum creatinine 22 mg%). None of the patients had a ureteric stent or nephrostomy tube before the ureteroscopy. All patients were treated with holmium laser. A stone basket or grasper was used to remove significant stone fragments at the end of the procedure in seven patients. In these seven patients, ureteric stents were placed at the end of the procedure.
Results
All patients were free of any stone fragments at 1 week and at 3 months postoperatively. In all patients, including the six with obstructive anuria, the renal impairment resolved or improved as evidenced by normalization or fall in blood urea and creatinine. Thus, in this small group of uremic patients, the success rate for treatment of ureteral stone was 100%.
Conclusions
A holmium laser is a safe and effective modality of ureteroscopic lithotripsy in patients with significant renal impairment or even obstructive anuria. The use of holmium laser with ureteroscopy may be considered in this group of patients as long as the general condition of the patient permits the safe administration of anesthesia.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Wu CF, Chen CS, Lin WY et al (2005) Therapeutic options for proximal ureter stone: extracorporeal shock wave lithotripsy versus semirigid ureterorenoscope with holmium: yttrium–aluminum–garnet laser lithotripsy. Urology 65:1075–1079
Lingeman JE, Shirrell WL, Newman DM et al (1987) Management of upper ureteral calculi with extracorporeal shock wave lithotripsy. J Urol 138:720–723
Hofbauer J, Hobarth K, Marberger M (1995) Electrohydraulic versus pneumatic disintegration in the treatment of ureteral stones: a randomized, prospective trial. J Urol 153:623–625
Teichman JM, Rao RD, Rogenes VJ et al (1997) Ureteroscopic management of ureteral calculi: electroydraulic versus holmium: YAG lithotripsy. J Urol 158:1357–1361
Vassar GJ, Chan KF, Teichman JM et al (1999) Holmium: YAG lithotripsy: photothermal mechanism. J Endourol 13:181–190
Teichman JM, Vassar GJ, Bishoff JT et al (1998) Holmium: YAG lithotripsy yields smaller fragments than lithoclast, pulsed dye laser or electrohydraulic lithotripsy. J Urol 159:17–23
Lam JS, Greene TD, Gupta M (2002) Treatment of proximal ureteral calculi: holmium: YAG laser ureterolithotripsy versus extracorporeal shock wave lithotripsy. J Urol 167:1972–1976
Biyani CS, Cornford PA, Powell CS (1998) Ureteroscopic holmium lasertripsy for ureteric stones. Initial experience. Scand J Urol Nephrol 32:92–93
Grasso M, Chalik Y (1998) Principles and applications of laser lithotripsy: experience with the holmium laser lithotrite. J Clin Laser Med Surg 16(1):3–7
Jeon SS, Hyun JH, Lee KS (2005) A comparison of holmium: YAG laser with lithoclast lithotripsy in ureteral stone fragmentation. Int J Urol 12:544–547
Tang ZY, Ding J, Peng KL et al (2006) Holmium: YAG laser lithotripsy under ureteroscopy for treating urinary caluli combined with acute renal failure. Zhong Nan Da Xue Xue Bao Yi Xue Ban (J Central South Univ Med Sci) 31(1):125–127
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Safwat, A.S., Bissada, N.K., Kumar, U. et al. Ureteroscopic holmium laser lithotripsy in patients with renal impairment. Int Urol Nephrol 40, 15–17 (2008). https://doi.org/10.1007/s11255-007-9250-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11255-007-9250-6