Laser lithotripsy.

OBJECTIVE

All literature related to laser lithotripsy published within the past year was reviewed. Salient articles have been reviewed and grouped according to safety issues, efficacy, comparison studies, biliary applications or future directions.

RESULTS

There is no evidence of renal deterioration after holmium:yttrium-aluminium-garnet lithotripsy. Laser-related complications occur in less than 1%. Stone-free rates from holmium:yttrium-aluminium-garnet lithotripsy are greater than 90% for ureteral calculi, and 67-84% for renal calculi. This method of lithotripsy is effective for ureteral and renal calculi in morbidly obese patients who are not suitable candidates for shock-wave lithotripsy or percutaneous nephrolithotomy. Holmium:yttrium-aluminium-garnet lithotripsy is more effective than pneumatic lithotripsy for ureteral calculi, but no more effective than shock-wave lithotripsy (Dornier HM-3) for distal ureteral calculi. Holmium:yttrium-aluminium-garnet lithotripsy of biliary calculi is uniformly effective. Preliminary data showed the erbium:yttrium-aluminium-garnet laser to be more efficient than holmium:yttrium-aluminium-garnet energy, but current erbium:yttrium-aluminium-garnet fibers are impractical.

CONCLUSIONS

The holmium:yttrium-aluminium-garnet laser is safe and effective. It is the lithotrite of choice for endoscopic ureteral and ureterorenoscopic lithotripsy.