Holmium: YAG Laser in the Management of Impacted Ureteral Stones HYLe Study

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Background: Holmium: yttrium-aluminium-garnet (YAG) laser is considered cost-effective and efficient choice in ureteroscopic lithotripsy on all types of stones. We aim to evaluate the efficacy of Holmium: YAG laser in impacted ureteral stones. Methods: We conducted a prospective case series at the Sindh Institute of Urology and Transplantation (SIUT) Pakistan from 1st October 2016 till 30th September 2017. All adult patients between 18 to 60 years of age with single <20mm ureteral stone impacted for more than one month. The primary outcomes include stone-free and recurrence of ureteric stone during two-year follow-up. Analyses performed using SPSS version 21.0. Results: A total of 117 patients recruited, of which most were males (61,52.14%). The average duration of disease was 7.82±1.79 months, with a stone size of 12.49±3.8 mm. Most of the stones were located in the middle of the ureter (56,47.86%). Holmium: YAG laser for treatment was effective in 99 (84.62%) cases, and efficacy above 80% in all age groups, but the insignificant difference was observed between both gender, location, duration of disease, size of the stone, use of a guidewire and the different catheter. All of the patients were found to be stone-fragment free at six weeks. The ureteral injury was observed (4,3.41%) and recurrence rate in the same ureter was found in a total of 5 (4.27%) patients. Conclusions: Holmium: YAG laser lithotripsy may be considered a safe and effective first-line therapy for impacted ureteral stones, avoiding futile repetition and complication of extracorporeal shock wave lithotripsy (ESWL). Keyword: ureteroscopic lithotripsy, stone-fragment, YAG laser lithotripsy.

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