We studied 122 patients with
ureteral calculi who could not be treated by extracorporeal
shock wave
lithotripsy (ESWL) because the stones could not be localized or focused for treatment, the patient had failed prior ESWL, the stones were impacted and in situ ESWL was likely to fail or the stones were proximal to a ureteral
stricture. These patients underwent
laser lithotripsy using the Candela
pulsed dye laser. In 107 patients (88%) the
calculi were completely fragmented with the
laser alone, while 10 (8%) needed another procedure (ESWL in 8 and stone fragment extraction by basket in 2), and 5 (4%) had failed
laser therapy and needed some other form of treatment (ESWL in 4 and percutaneous antegrade extraction in 1). At 3 months 116 of 122 patients (95%) were stone-free. There were 2 immediate complications (ureteral perforations) and 1 late complication (ureteral
stricture).
Laser lithotripsy is a safe and effective method of intracorporeal fragmentation, even of the difficult
ureteral calculus, and it is a useful adjunct to ESWL.