Lithotripsy with the
pulsed-dye laser has been shown to be a safe and effective method of intracorporeal
urinary stone fragmentation. Recently, a new device, the
holmium: YAG laser, has been developed with both soft tissue and
lithotripsy applications. We present our preliminary experience with the
Ho:YAG laser for
lithotripsy of
urinary calculi. Ureteroscopy and lasertripsy resulted in successful fragmentation of ureteral stones in 92% of 21 patients when the
laser was used alone or in combination with electrohydraulic
lithotripsy. One complication directly related to the use of the
laser occurred, a ureteral perforation, when the device was utilized under fluoroscopic control. In four patients undergoing percutaneous flexible nephrolithotripsy, the
laser demonstrated utility in fragmenting caliceal stones remote from the
nephrostomy tract. In summary, the
Ho:YAG laser has demonstrated its efficacy as a method of intracorporeal
lithotripsy. The tissue effects of this device, as well as the optimal energy/pulse and frequency settings, need further evaluation in order to minimize the risks of tissue injury.