Ureterorenoscopic lithotripsy with Laser U-100 for the treatment of urinary calculi (report of 162 cases)

Objective To evaluate the efficacy and safety of lithotripsy with W.O.M.Laser U-100 in the treatment of urinary tract calculi,and to introduce a new method of improving lithotripsy efficiency of upper ureteral calculi.Methods The data of 162 patients(97 males and 65 females;age range,19-82 years;mean age,41 years) who underwent lithotripsy with W.O.M.Laser U-100(optical fiber 730 μm,laser energy 120 mJ,frequency 5-10 Hz,pulse 36-21500 Σ,average 1300 Σ) were reviewed.Of the 162 patients,7 cases had urethral stones;26,bladder stones;115,ureter calculi(38 upper,32 middle,45 lower);and 14,kidney stones.Among them,bilateral urinary stones occurred in 11 cases;unilateral multiple stones in 7;complicated moderate/severe hydronephrosis in 89;no image on IVU in 17;previous ESWL in 32;encapsulated stones and stricture of distal ureter in 25;complicated urinary infection in 9;previous open surgery in 13;emergent lithotripsy in 12;TURP simultaneously in 18.The size of the stones varied from 4 mm to 50 mm in diameter,with a mean of 12 mm.The success criterion of lithotripsy was defined as the fragmented stones of 1-2 mm in diameter.Results The success rate of lithotripsy for urinary tract stones with W.O.M.Laser U-100 was 94.4%(153/162).In the remaining cases,3 were transferred to ESWL therapy due to up-drift of calculi,2 experienced conversion to open surgery due to multiple stones of the bladder,and 3 also had conversion to open surgery due to ureteral perforation or ureteral mucosa avulsion during the procedure,and 1 had to terminate the operation due to massive hemorrhage during percutaneous nephrolithotomy.The success rate of lithotripsy for upper urinary tract stones through the blocked ureteral balloon catheter was 93.9%(31/33).Of the 153 cases,151(98.7%) removed the fragmented stones completely within 1-3 months.One case of ureteral stricture with steinstrasse underwent transureteroscopic laser lithotripsy successfully.One case of pyelolithiasis had some stone fragments in the lower calices after operation.No intraoperative complications were attributable to the laser therapy.Conclusions Ureterorenoscopic lithotripsy with W.O.M.Laser U-100 is effective and safe for the treatment of urinary tract stones.Blocking the ureteral lumen with ureteral balloon catheter may improve the success rate of lithotripsy.