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PubMed1998

Color vision deficits during laser lithotripsy using safety goggles for coumarin green or alexandrite but not with holmium:YAG laser safety goggles.

PURPOSE: Laser lithotripsy requires urologists to wear laser eye protection. Laser eye protection devices screen out specific light wavelengths and may distort color perception. This study tests whether urologists risk color confusion when wearing laser eye protection devices for laser lithotripsy. MATERIALS AND METHODS: Urologists were tested with the Farnsworth Dichotomous Test for Color Blindness (D-15) and the Farnsworth-Munsell 100-Hue Test (FM-100) without (control) and with laser eye protection devices for coumarin green, alexandrite and holmium:YAG lasers. Error scores were tabulated. The pattern of color deficits was characterized with confusion angles, confusion index (C-index), scatter index (S-index) and color axes. Laser eye protection devices were tested with spectrophotometry for spectral transmittance and optical density. RESULTS: The D-15 transposition errors (mean plus or minus standard deviation) for control, holmium:YAG, alexandrite and coumarin green laser eye protection were 0 +/- 0, 0 +/- 0, 0.3 +/- 0.5 and 6.4 +/- 1.6, respectively (p = 0.0000001). The FM-100 error scores (mean plus or minus standard deviation) were 20 +/- 15, 20 +/- 14, 91 +/- 32 and 319 +/- 69, respectively (p = 0.0001). The confusion index scores indicated a mild color confusion for the alexandrite and pronounced color confusion for the coumarin green laser eye protection. The confusion angles and scatter indexes mimicked a congenital blue-yellow deficit for coumarin green laser eye protection. Color axes showed no significant deficits for control or holmium:YAG laser eye protection in any subject, red-green axis deficits in 3 of 6 tested with alexandrite and blue-yellow axis deficits in 12 of 12 tested with coumarin green (p < 0.001). Spectrophotometry showed that laser eye protection for coumarin green blocks light less than 550 nm., alexandrite blocks light greater than 650 nm. and holmium:YAG blocks light greater than 825 nm. CONCLUSIONS: Laser eye protection for coumarin green causes pronounced blue-yellow color confusion, whereas alexandrite causes mild red-green color confusion among urologists, holmium:YAG causes no significant color confusion compared to controls. The differences are explained by laser eye protection spectrophotometry characteristics and visual physiology.

Adult↗

PubMed1993

Nonvisual laser lithotripsy aided by plasma spectral analysis: viability study and clinical application.

Nonvisual laser lithotripsy implies laser fragmentation without the aid of endoscopic or direct vision. Using the laser delivery fiber for retrograde transmission of plasma spectrum and its analysis on an optical multichannel analyzer, we designed a project with the objective of identification and fragmentation of calculi by continuous analysis of the plasma feedback spectrum. We were successful in achieving the objectives in the in vitro and ex vivo studies. In the in vivo studies we successfully recorded the plasma spectrum of the stones from inside the ureter and monitored the process of fragmentation with the laser. We have been able to identify the problems for its clinical application. We conclude that by monitoring the feedback spectrum of plasma emission, nonvisual laser lithotripsy is reliable and safe, and can be used successfully in patients with some modifications. Its development is not to replace established endoscopic lithotripsy procedures but rather as an additional armament for the urologist in special situations. Also, the technique can be further exploited for a variety of clinical uses.

Humans↗

PubMed1999

Holmium laser lithotripsy of a complicated biliary calculus.

More than 500,000 cholecystectomies are performed annually. Extracorporeal shockwave lithotripsy and endoscopic laser lithotripsy have been used for the management of common bile duct calculi, which complicate 10% of cases. We report the first successful clinical application of the Ho:YAG laser to a complex biliary calculus case.

Aged↗

PubMed2004

Comparison between extracorporeal shock wave lithotripsy and semirigid ureterorenoscope with holmium:YAG laser lithotripsy for treating large proximal ureteral stones.

PURPOSE: Management of large impacted upper ureteral calculi remains challenging for urologists. These calculi are frequently associated with obstructive uropathy and deteriorated renal function. Extracorporeal shock wave lithotripsy (SWL) is the least invasive treatment but its success rate is decreased for large impacted upper ureteral calculi. According to the American Urological Association guidelines on ureteral stones published in 1997, the appropriateness of ureteroscopy decreases when stone size exceeds 1 cm. However, the application of advanced ureteroscopy and techniques has increased the success rate of treating proximal ureter calculi. In this study we compared the safety and efficacy of ureterorenoscopic holmium:YAG laser lithotripsy (URSL) with SWL for large impacted proximal ureteral stones. MATERIALS AND METHODS: This study evaluated 82 patients with large impacted upper ureteral stones. Two patients were excluded from study owing to conversion to open surgery. SWL and URSL were performed in 41 and 39 patients, respectively. Those in the SWL group were treated on an outpatient basis with Medispec Econolith 2000 (Medispec, Germantown, Maryland) under intravenous sedation. The URSL was performed with a 6/7.5Fr semirigid tapered ureterorenoscope and holmium:YAG laser with the patient under spinal anesthesia on an inpatient basis. Successful outcome was defined as the patient being stone-free on radiography 1 month after treatment. Stone size, success rate, postoperative complications and cost were analyzed in each group. RESULTS: A total of 80 patients were enrolled in this study. Hematuria and flank pain were the most common complaints in each group. Mean stone size +/- SD was 1.28 +/- 0.04 cm in the SWL group and 1.51 +/- 0.05 cm in URSL group (p = 0.0009). Accessibility of the semirigid ureterorenoscope for impacted upper ureteral stones was 95.1% (39 of 41) and the stone-free rate achieved after 1 sitting was 92% (36 of 39). The initial stone-free rate of in situ SWL was 61% (25 of 41). Notably, the initial stone-free rate in the URSL group was better than that of the SWL group (p = 0.003). The efficiency quotient was 0.53 for URSL and 0.59 for SWL. The average cost in the URSL group appears to be lower than in the SWL group. Both groups were free of major complications. CONCLUSIONS: This study demonstrated that URSL achieved excellent results for upper ureteral calculi greater than 1 cm. Thus, this procedure should be considered first line therapy for large proximal ureteral stones.

Equipment Design↗

PubMed1998

Principles and applications of laser lithotripsy: experience with the holmium laser lithotrite.

INTRODUCTION AND OBJECTIVES: The initial clinical experience with holmium laser energy applied for endoscopic lithotripsy was positive. The current study is presented as a contrast to the preliminary findings and as a means of defining the clinical usefulness of this specific laser lithotrite. MATERIALS AND METHODS: Calculi were treated endoscopically with the holmium laser lithotriptor and data was gathered prospectively. The youngest patient in the series was a thirteen-month--old who underwent percutaneous therapy, while the youngest patient on whom a retrograde endoscopic procedure was performed was a six-year old male patient with a proximal ureteral calculus. Lower water density, quartz fibers delivery systems were developed and employed. Fiber diameters ranged from 200-1000 micrograms. The smaller fibers were employed most commonly through the actively deflectable, flexible endoscope to facilitate treatment with maximum deflection. Larger fibers, with their much larger vaporization bubbles, were used through rigid endoscopes to debulk large stone burdens. RESULTS: A total of 210 patients with 249 calculi were treated. All major stone compositions were treated with minimal variation in laser efficiency. All but three of 109 ureteral calculi were treated in a retrograde fashion to completion (i.e., "stone free") in one sitting (97%). One-hundred thirteen renal stone burdens were treated with the holmium laser; 99 of these were treated solely in a retrograde fashion. Of the latter, 79 (80%) required only a single session. The combination of the actively deflectable, flexible ureteroscope and the 200-micrograms fiber facilitated treatment to completion of 38 to 45 lower-pole caliceal calculi (85%). The success of ureteropyeloscopic lithotripsy with the holmium laser for all intrarenal calculi, including staged or second sitting for large complex stone burdens, was 90%. Sixteen percutaneous procedures (13 renal and 3 ureteral calculi) employed the holmium laser as an endoscopic lithotrite. All 28 patients with large bladder calculi with a mean diameter of 41.8 mm were treated to completion in one sitting. Complications from holmium laser energy, including postoperative ureteral stricture disease, were not encountered in this series. CONCLUSIONS: Holmium laser energy is uniquely suited to treat urinary calculi safely regardless of stone size, location, or metabolic composition, and has particular efficacy in complex clinical presentations.

Child↗

PubMed1999

Initial experience with endoscopic holmium laser lithotripsy for pediatric urolithiasis.

PURPOSE: Due to the unavailability of suitable pediatric instruments children have not benefited from advances in endoscopic lithotripsy. This limitation may be overcome by the holmium: YAG laser. We evaluated the indications for, and efficacy and complications of holmium:YAG laser lithotripsy. MATERIALS AND METHODS: We retrospectively reviewed all cases of laser lithotripsy. Access to the calculus was antegrade or retrograde. A solid state holmium:YAG laser was used. RESULTS: Eight patients 4 to 14 years old underwent laser lithotripsy during the study period. Average calculous surface area was 357.13 mm.2 (range 14 to 1,645). Five patients required 1 procedure to render them stone-free, while the remaining 3 required multiple procedures. No complications were associated with laser lithotripsy. CONCLUSIONS: The ability of the holmium:YAG laser to pulverize urinary calculi makes it an alternative choice for lithotripsy. In our series all patients are stone-free with stable renal function. The advantages of the holmium:YAG laser are that it may be precisely applied via small fibers, and it pulverizes calculi with minimal scattering of energy and retropulsion of the calculus, decreasing trauma to tissues at the perioperative site. There is also a lower risk of residual fragments, which is associated with a lower incidence of calculous regrowth. Holmium: YAG laser is safe and effective for treating pediatric urolithiasis.

Adolescent↗

PubMed1991

Laser lithotripsy: a nursing perspective.

Laser lithotripsy represents the urologist's newest option in urinary stone management and is fast becoming the procedure of choice when treating calculi. Approximately 400,000 people yearly require treatment for urinary stone disease. 60% pass the calculi spontaneously while 40% require some type of intervention (Dretler, 1988). While the initial cost of the laser is expensive, maintenance cost is relativity low. Therefore, the laser lithotripter becomes a very cost effective tool when compared with other alternatives because of the decreased hospital stay and the absence of significant complications. Adverse effects to the patient are primarily due to the endoscopic procedure and not the laser itself. Additional benefits to the patient include reduced pain and edema, minimal bleeding, no incision and decreased convalescence time.

Humans↗

PubMed2002

Urethroscopy and laser lithotripsy for the diagnosis and treatment of obstructive urolithiasis in goats and pot-bellied pigs.

OBJECTIVE: To explore the use of urethral endoscopy and laser lithotripsy in the diagnosis and management of urolithiasis in goats and pot-bellied pigs. DESIGN: Prospective clinical study. ANIMALS: 16 male goats and 6 male pot-bellied pigs with dysuria. PROCEDURE: Abdominal ultrasonography and urethral endoscopy were performed on all 22 animals. Endoscopic-guided holmium:yttrium-aluminum-garnet laser lithotripsy was performed in 3 goats and 2 pot-bellied pigs. RESULTS: Urolithiasis was identified in 15 goats and 5 pot-bellied pigs. Primary urinary bladder paralysis and cystitis were identified in the remaining pot-bellied pig and goat. Mean bladder diameters of obstructed small- and large-breed goats were 7 and 9.5 cm, respectively. The mean bladder diameter of obstructed pot-bellied pigs was 9.5 cm. Five of 20 animals with obstructive urolithiasis had severe urethral necrosis or stricture formation at the time of urethroscopy. All of these animals were euthanatized within 6 months because of persistent dysuria. When used, laser lithotripsy successfully fractured the distally located obstructing stones in the 3 goats and 2 pot-bellied pigs. CONCLUSIONS AND CLINICAL RELEVANCE: Urethral endoscopy is useful for evaluating urethral patency in goats and pot-bellied pigs. Examination of the urethral mucosa following relief of urethral obstructions aids in the assessment of the long-term prognosis for urethral stricture. Urethral endoscopy also expands the therapeutic options for management of urolithiasis by providing a route for conducting laser lithotripsy. Laser lithotripsy proved to be safe and effective for clearing distally located calculi refractory to removal by traditional urethral flushing. Lithotripsy application is restricted to calculi lodged in the urethra.

Abdomen↗

PubMed2004

[Ureteroscopic holmium: YAG laser lithotripsy for managing urinary tract calculi].

OBJECTIVE: To evaluate the effectiveness and safety of ureteroscopic holmium: YAG laser lithotripsy for managing ureteral calculi. METHODS: Ureteroscopic holmium: YAG laser lithotripsy was used in 168 ureteral calculi (proximal 27 cases, middle 33 cases, distal 108 cases). Transurethral cystoscopic holmium: YAG laser lithotripsy in 12 bladder calculi. RESULTS: Four to six weeks after operation, The stone-free rate was 93% (25/27) in the proximal ureteral calculi, 94% (31/33) in the middle ureteral calculi, 94% (102/108) in the distal ureteral calculi, respectively. The complication rate was 5% (8 cases). the stone-free rate of bladder calculi was 100% (12/12), no complication. CONCLUSION: Ureteroscopic holmium: YAG laser lithotripsy is a highly effective and safe treatment modality for managing ureteral calculi.

Aged↗

PubMed2004

Erbium:YAG laser lithotripsy using hybrid germanium/silica optical fibers.

BACKGROUND AND PURPOSE: Previous studies have demonstrated that the erbium:YAG laser is two to three times more efficient for laser lithotripsy than the holmium:YAG laser. However, the lack of a suitable optical fiber delivery system remains a major obstacle to clinical application of Er:YAG laser lithotripsy. This paper describes the initial testing of a hybrid germanium oxide/silica optical fiber for potential endoscopic use with the Er:YAG laser. MATERIALS AND METHODS: Er:YAG laser radiation with a wavelength of 2.94 microm, a pulse energy of 10 to 600 mJ, a pulse length of 220 microsec, and pulse-repetition rates of 3 to 10 Hz was focused into either 350- or 425- microm-core hybrid germanium/silica fibers in contact with human uric acid or calcium oxalate monohydrate stones. RESULTS: Average Er:YAG pulse energies of 157 +/- 46 mJ (66 J/cm(2)) (N = 8) were delivered at 10 Hz through the 425-microm hybrid fibers in contact with urinary stones before fiber damage was observed. A maximum pulse energy of 233 mJ (98 J/cm(2)) was also measured through the hybrid fiber in contact with the stones. These values are significantly greater than the stone ablation thresholds of 15 to 23 mJ (6-10 J/cm(2)) and the fiber damage thresholds measured for germanium oxide, 18 +/- 1 mJ (13 J/cm(2)), and sapphire, 73 mJ (51 J/cm(2)), optical fibers during Er:YAG laser lithotripsy (P < 0.05). CONCLUSIONS: A prototype hybrid germanium/silica optical fiber demonstrated better performance than both germanium oxide and sapphire fibers for transmission of Er:YAG laser radiation during in vitro lithotripsy.

Aluminum Oxide↗

PubMed1996

Management of ureteric calculi during pregnancy by ureteroscopy and laser lithotripsy.

OBJECTIVE: To evaluate the efficacy and safety of ureteric stone treatment by ureteroscopy and laser lithotripsy during pregnancy. PATIENTS AND METHODS: Four pregnant women (mean age 29.5 years, range 27-35) with five episodes of ureteric stones were treated by ureteroscopy and laser lithotripsy when the fetus was at 26-35 weeks of gestation. The stones (between 5 and 16 mm in diameter) were located in the proximal (one) or distal ureter (four). RESULTS: All five stones were removed successfully by ureteroscopy and laser lithotripsy. The operating time varied between 15 and 70 min. In two of the five cases, topical anaesthesia was adequate and in no case was fluoroscopy necessary. No complications occurred that could be related to the procedure. CONCLUSIONS: Ureteroscopy and laser lithotripsy seem, in experienced hands, to be a safe and reliable method in the treatment of ureteric calculi during pregnancy. Most cases can be treated without using fluoroscopy and in some cases the operation can be performed under local anaesthesia.

Adult↗

PubMed1990

Laser lithotripsy in the treatment of ureteral calculi.

We examined the effectiveness of laser lithotripsy with a flash-lamp-pumped tunable dye laser in the treatment of ureteral calculi that were too large for direct extraction and that could not be treated with or had not responded to extracorporeal shock-wave lithotripsy (ESWL) or forms of ureteroscopic lithotripsy other than laser lithotripsy. In 20 (74%) of the 27 patients the laser alone successfully fragmented the calculi into pieces small enough to pass spontaneously or to be easily extracted with a basket. In five (19%) laser lithotripsy was partially successful: another procedure (ESWL in three and fragment extraction with a basket in two) was needed. In two patients (7%) the stones could not be fragmented with the laser, and either ESWL or percutaneous antegrade extraction was performed. At follow-up 3 months after treatment there was no sign of stone fragments in 26 (96%) of the patients. We believe that laser lithotripsy is a safe and effective method of ureteral stone fragmentation.

Follow-Up Studies↗

PubMed2002

Safety and efficacy of holmium: YAG laser lithotripsy in patients with bleeding diatheses.

PURPOSE: We assessed the safety and efficacy of ureteroscopy and holmium:YAG laser lithotripsy for treating upper urinary tract calculi in patients with known and uncorrected bleeding diathesis. MATERIALS AND METHODS: We retrospectively reviewed the charts at 2 tertiary stone centers to identify patients with known bleeding diathesis who were treated with holmium:YAG laser lithotripsy for upper urinary tract calculi. A total of 25 patients (29 upper urinary tract calculi) underwent ureteroscopic holmium laser lithotripsy. Bleeding diathesis involved warfarin administration for various conditions in 17 patients, liver dysfunction in 3, thrombocytopenia in 4 and von Willebrand's disease in 1. The mean international normalized ratio, platelet count and bleeding time were 2.3, 50 x 109/l. and greater than 16 minutes in patients on warfarin and in those with liver dysfunction, thrombocytopenia and von Willebrand's disease, respectively. RESULTS: Overall the stone-free rate was 96% (27 of 28 cases) and 29 of 30 procedures were completed successfully without significant complication. In a patient treated concomitantly with electrohydraulic lithotripsy significant retroperitoneal hemorrhage required blood transfusion. CONCLUSIONS: Upper tract urinary calculi in patients with uncorrected bleeding diathesis can be safely managed by contemporary small caliber ureteroscopes and the holmium laser as the only modality of lithotripsy. Ureteroscopic holmium laser lithotripsy without preoperatively correcting hemostatic parameters limits the risk of thromboembolic complications and costs associated with an extended hospital stay. Avoiding electrohydraulic lithotripsy is crucial for decreasing bleeding complications in this cohort of patients.

Adult↗

PubMed1996

Clinical experience with holmium:YAG laser lithotripsy of ureteral calculi.

BACKGROUND AND OBJECTIVE: We recently acquired a holmium:YAG laser with wavelength of 2.1 microns. We would like to report our success in using this machine for laser lithotripsy. STUDY DESIGN/PATIENTS AND METHODS: Forty-seven ureteroscopic laser lithotripsies were performed in 44 patients (three bilateral stones) over a 6 month period. Four stones were in the upper ureter, six in the middle ureter, and 37 in the lower ureter. The holmium laser beam was delivered via a 400 micron flexible quartz fiber through a 7 Fr rigid ureteroscope during the procedure. The stone size varied from 4 to 21 mm. RESULTS: The success rate was 91%. Most of the stones were fragmented to less than 2 mm in size. Larger fragments were removed with a Dormia basket (six cases) for stone clearance. Endoscopic laser ureterotomy was performed in two patients with stricture below the stone. One patient required conversion to open ureterolithotomy, and three required subsequent Extracorporeal Shock Wave Lithotripsy. A low complication rate was observed. CONCLUSION: The pulsed holmium:YAG laser is safe and effective for use in ureteroscopic laser lithotripsy.

Adult↗

PubMed2002

Laser lithotripsy.

PURPOSE OF REVIEW: 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. RECENT FINDINGS: 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. SUMMARY: The holmium:yttrium-aluminium-garnet laser is safe and effective. It is the lithotrite of choice for endoscopic ureteral and ureterorenoscopic lithotripsy.

Glomerular Filtration Rate↗

PubMed2006

Ureteroscopic laser lithotripsy for upper urinary tract calculi with active fragment extraction and computerized tomography followup.

PURPOSE: Management of fragments generated by ureteroscopic laser lithotripsy remains controversial. In this study we explored the impact of active fragment extraction after ureteroscopic laser lithotripsy on stone clearance. MATERIALS AND METHODS: A total of 69 patients with 3 or less upper urinary tract calculi (5 to 15 mm) demonstrated on preoperative CT were prospectively evaluated. Stones were translocated to a dependent upper pole calix where laser lithotripsy was performed. An attempt was made to clear all fragments using tipless stone baskets. One month after surgery stone clearance was evaluated exclusively with noncontrast spiral CT. RESULTS: In 58 patients undergoing surgery on protocol, average stone burden was 9.4 +/- 3.4 mm and was significantly smaller in 44 patients with stones in a solitary location (8.5 +/- 2.9 mm) than in 14 patients with stones in multiple locations (12.3 +/- 3.2 mm, p <0.001). Primary stone location was categorized as renal nonlower pole (in 16), renal lower pole (in 19) and proximal ureter (in 23). Average operative time (43.7 +/- 18.4 minutes) was unaffected by stone location or multiplicity after controlling for stone size (p >0.05). Stone clearance rates were not affected by stone location or multiplicity, with overall success rates of 54%, 84% and 95% at fragment thresholds of 0, 2 and 4 mm, respectively (p >0.05). CONCLUSIONS: Ureteroscopic laser lithotripsy with active fragment extraction was time efficient and highly effective. Sensitive postoperative imaging reveals the challenge of achieving a true stone-free state. We were unable to demonstrate an impact of stone location on stone-free rates.

Female↗

PubMed1992

[Percutaneous transhepatic cholangioscopic color laser lithotripsy in bile duct calculi].

Tunable dye laser lithotripsy is an effective and low risk treatment in patients with bile duct stones in which transpapillary maneuvers failed. The percutaneous approach allows to introduce small caliber endoscopes (10.5 F) to fragment the calculi under vision. This technique was evaluated in 8 patients who had undergone a biliodigestive anastomosis or in whom the biliary calculi could not removed by standard retrograde treatment. Laser lithotripsy resulted in sufficient fragmentation in 7 patients. Bile duct clearance proved to be a particular problem with the percutaneous access. When a retrograde sphincterotomy is not possible an antegrade papillotomy must be attempted under fluoroscopic guidance. In bile duct strictures the implantation of expandable stents facilitates the passage of fragments and may prevent recurrent stricture and development of new stones.

Aged↗

PubMed2002

Ureteroscopy and holmium:YAG laser lithotripsy: an emerging definitive management strategy for symptomatic ureteral calculi in pregnancy.

OBJECTIVES: To review the results of holmium laser lithotripsy in a cohort of patients who presented with symptomatic urolithiasis in pregnancy. Symptomatic urolithiasis in pregnancy that does not respond to conservative measures has traditionally been managed with ureteral stent insertion or percutaneous nephrostomy. Holmium:yttrium-aluminum-garnet (YAG) laser lithotripsy using state-of-the-art ureteroscopes represents an emerging strategy for definitive stone management in pregnancy. METHODS: A retrospective analysis was conducted at two tertiary stone centers from January 1996 to August 2001 to identify pregnant patients who were treated with ureteroscopic holmium laser lithotripsy for symptomatic urolithiasis or encrusted stents. Eight patients with a total of 10 symptomatic ureteral calculi and two encrusted ureteral stents were treated. The mean gestational age at presentation was 22 weeks. The mean stone size was 8.1 mm. The stones were located in the proximal ureter/ureteropelvic junction (n = 3), midureter (n = 1), and distal ureter (n = 6). RESULTS: Complete stone fragmentation and/or removal of encrusted ureteral stents were achieved in all patients using the holmium:YAG laser. The overall procedural success rate was 91%. The overall stone-free rate was 89%. No obstetric or urologic complications were encountered. CONCLUSIONS: Ureteroscopy and holmium laser lithotripsy can be performed safely in all stages of pregnancy, providing definitive management of symptomatic ureteral calculi. The procedure can be done with minimal or no fluoroscopy and avoids the undesirable features of stents or nephrostomy tubes.

Adult↗