Urinary Stone Removal With The Holmium/Nd:YAG Laser

How Is Holmium Laser Lithotripsy Performed?
Holmium laser lithotripsy is a safe and effective, minimally-invasive procedure that ensures removal of urinary stones with the least discomfort.

Under a general anaesthetic, a narrow tube , called a ureteroscope, is painlessly introduced through the urethra into the ureter and to the stone itself. Fine (200, 365 and 500 micron thickness) fibres, passed via the ureteroscope, deliver laser energy directly to the stone causing it to shatter into small fragments. These fragments are then easily washed out through the ureteroscope. A thin plastic tube, called a stent, may be left in the ureter for about 24 hours to facilitate passage of any remaining fragments. Slight haematuria (blood in urine) may also be noticed during this period.

Stone sizes of up to 2.5 cm can be treated at a single session. Larger stones may require additional treatments. Patients are usually discharged home the day following the procedure.

Advantages of Holmium Laser Lithotripsy
Holmium laser lithotripsy has several advantages over other conventional forms of treatment. Some of these are as follows:

• The procedure is minimally-invasive and does not require any incisions or cutting.
• It is extremely effective. Stones of up to 2.5 cm anywhere in the urinary tract can be treated at a single session.
• Short hospital stay - usually an overnight stay is required.
• Minimal post-operative discomfort.
• Very low complication rate.

Preventing Kidney Stones
Fluid Intake. Of all preventive measure recommendations, drinking enough fluid to produce at least two and a half litres of urine each day is the most important. In general, a glass of water every four hours and one with each meal. More water is needed after exertion and during the summer period.
Sodium Restriction. Because salt intake increases the amount of calcium in urine, patients with calcium stones should restrict their sodium intake. Some studies have shown that restricting sodium is the most important dietary measure for preventing stones. Dietary calcium is not believed to affect stone formation.
Fibre. Fibre may be beneficial for people with kidney stones. It is, in any case, important for general health.
Protein restriction. Diets high in protein, particularly animal protein, have been consistently associated with kidney stones.
Purine restriction. Those who have gout or are at risk for uric acid stones should reduce their intake of beer and other alcoholic beverages, anchovies, sardines, yeast, organ meats (e.g. liver, kidneys), legumes, mushrooms, spinach, asparagus, cauliflower, and poultry.

Other Laser Treatments In Urology
The Holmium/Nd:YAG laser has several other therapeutic applications in urology. It is also used to treat:

• Urothelial tumours in the kidney, ureter, bladder and urethra.
• Skin lesions, such as penile and peri-anal warts.
• Strictures in the urethra and ureter.
• Benign prostatic enlargement.

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