Holmium Laser Lithotripsy

What is Holmium Laser Lithotripsy?

Holmium laser lithotripsy is a method for using lasers to remove stones that are located in the urinary tract. This could include stones in the bladder, kidneys, ureters (tubes that carry urine from the kidneys to the bladder), or urethra (tube through which urine leaves the body). A flexible laser fiber is inserted through the urethra to break up the stones. The procedure is completed without any incisions.

The kidneys — two fist-sized, bean-shaped organs on either side of the spine — serve as filters, removing waste and excess fluid from the blood. That waste becomes urine. When calcium and other minerals in urine build up, stones—hard, pebble-like pieces of material — can form in the kidneys. Kidney stones are very common and occur in 1 in 11 people over their lifetime.

Kidney stones aren’t just painful. They can impact your urinary tract. Dietary factors play a major role in kidney stone formation and prevention. In some cases, kidney stones are a sign of overactive parathyroid glands in the neck, chronic kidney disease, or genetic disorders. That’s why it is crucial to have a urologic evaluation if you are diagnosed with a kidney stone. The kidney stone specialist Dr. Mario Delgadillo can identify why the stones formed — based on your medical and dietary history as well as the kidney stone composition — and devise an appropriate treatment plan.

Kidney stones can become trapped anywhere in the urinary tract, including the kidney and the ureter. The ureter is a tube that carries urine from the kidneys to the bladder. If a stone gets stuck in the ureter it can cause a blockage and the back-up of urine into the kidney. They can also be quite painful.

Laser lithotripsy is used to break apart the kidney stone so that it can pass through the ureter. The pieces will either be removed by the surgeon using a special basket or left in place where they will move from the ureter to the bladder, then out of the body with the urine.

Ureteroscopy will be used primarily for stones that are being passed unsuccessfully and are therefore lodged in the ureter, the tube that connects the kidney to the bladder.  An ureteroscope is a very narrow scope, either rigid or flexible, that allows Urologists to travel up the ureter to the stone and see it on a video monitor via fiber optics.  Here, instead of using sound waves as the energy source to crumble the stone gradually, ureteroscopy uses the energy pulse of a laser beam, applied directly to the stone, to chip it away into tiny pieces.  Ureteroscopy is thus more direct, and therefore more successful than ESWL, and there will be fewer stone fragments to pass.

Laser lithotripsy may be chosen if other non-surgical treatments have failed or if kidney stones are:

  • Too large to pass
  • Irregular in shape
  • Causing bleeding or damage to surrounding tissue

Risks of Ureteroscopy

Ureteroscopy is a safe procedure, usually performed in an outpatient surgical center setting.  Risks include of course pain, infection and bleeding.  Very rare risks included ureteral perforation or injury, or subsequent scarring called stricturing.  The main thing for patients to be concerned about after any stone procedure would be fevers.  Fevers after a stone procedure could trigger bacteremia (bacteria in the bloodstream) and even sepsis.  If you experience any of these risks, a trip to the emergency room is necessary.

Considerations & Complications

  • Up to 15% of patients will have one or more symptoms including moderate abdominal pain, constipation and/or bladder irritation
  • No more than 5% of patients will feel symptoms to be severe
  • Pain, infection and bleeding
  • Rarely, ureteral perforation or injury leading to stricture
  • Fevers will require an immediate visit to the emergency room

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