laser lithotripsy


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laser lithotripsy

fragmentation and vaporization of calculi with laser-generated energy.
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The widespread extent of stone made ureteroscopic laser lithotripsy unsuitable and so the patient was managed with percutaneous nephrolithotomy (PCNL) (Figure 3).
(2) Forty-two percent of the patients presenting with ureteral stones underwent urological intervention, including cystoscopy with retrograde pyelography, placement of ureteric stent, Shockwave lithotripsy, and/or ureteroscopic laser lithotripsy. A radiologist and a urologist independently reviewed all CT scans for predefined criteria of ureteral obstruction (no obstruction, partial, or complete obstruction) based on degree of hydronephrosis, hydroureter, nephromegaly, and perinephric stranding.
Although Ho:YAG laser lithotripsy can effectively fragment bladder stones especially for the large bladder stones (greater than 2cm) it is time consuming to evacuate such stone fragments through the cystoscope sheath.
Histologically, laser lithotripsy produced complete necrosis of ureteral epithelium with partial necrosis of the lamina propria and muscle as early as Day 0.1 Electrohydraulic lithotripsy (EHl) produced total abrasion of the epithelium with edema of the remaining layers by Day 1, and it is believed that EHL has the narrowest margin of safety of all forms of intracorporeal lithotripsy.11 Lithoclast produces the least microscopic and macroscopic damage to the urothelium.10 Some investigators also suggested ESWL be used as the first line of management for ureteric stone but most of the times kidneys are obstructed in most of the cases and stones are impacted.
Stones in common bile duct are now manageable by endoscopic procedures like sphincterotomy with balloon trail, basket extraction or both or stenting and mechanical / laser lithotripsy .Diagnostic ERCP is a prerequisite2,3 before using any endoscopic therapeutic option.
Flexible ureterorenoscopy (FURS) and laser lithotripsy has become increasingly popular in the treatment of large renal stones because of decreased morbidity rates and hospital stay, coupled with high stone-free rates that are similar to percutaneous nephrolithotomy (PCNL) (2,3).
(3) Therapeutic intervention with both extracorporeal shockwave lithotripsy and ureteroscopy (URS) with laser lithotripsy involve ionizing radiation exposure through the use of fluoroscopy.
There have been reports on the effectiveness and safety of ureteroscopy with laser lithotripsy for the management of renal calculi [4].
Now URSL has evolved to the extent that even renal calyceal stones can be well managed with ureteroscopic laser lithotripsy. (8), (9) However, for the proximal ureteral calculi preferred choice still remains SWL and for the distal calculi literature partly favours URSL.