Dubosq Francis, Pasqui Federico, Girard Frédéric, Beley Sébastien, Lesaux Nicolas, Gattegno Bernard, Thibault Philippe, Traxer Olivier
Urology Department, Tenon Hospital, Paris, France.
J Endourol. 2006 May;20(5):296-9. doi: 10.1089/end.2006.20.296.
The frequency-doubled double-pulse neodymium:YAG (FREDDY) laser has been developed for endoscopic lithotripsy and combines the characteristics of solid and dye lasers with a thin flexible optical fiber enabling it to be used with flexible ureterorenoscopy. Furthermore, it is less expensive and easier to maintain than other lasers. Our goal was to evaluate its efficacy and role in the ureteroscopic treatment of urinary stones.
We used a FREDDY laser in 26 patients (29 stones). For 4 stone cases, this was the first line of treatment; for the remaining cases, this was the second line of treatment, following SWL in 23 cases and nephrolithotomy in 2 cases. The mean stone size was 9 mm, with a range of 6 to 15 mm. There were 13 renal and 16 ureteral stones. The absence of residual fragments at 3-month postoperative radiography was considered to reflect successful treatment.
Twenty-six stones were treated with satisfactory results. Within 3 months, 18 patients were stone free (69%), and 72.4% of the stones (21/29) had been treated completely. Fragments of 8 stones still remained in 8 patients. Of these stones, 5 were >10 mm and persisted at 3 months. Fragmentation was ineffective for 2 cystine stones and poor for 1 calcium oxalate monohydrate stone. Hospitalization, on average, was 1.5 days with a range of 1 to 3 days. A ureteral perforation was observed in the case of an impacted ureteral stone.
Because of the wavelengths used, endoscopic FREDDY laser lithotripsy is an effective and harmless method. This laser can be used as a therapeutic tool because of its moderate cost and ability to be used with flexible ureterorenoscopy. However, it is important to be aware of the FREDDY laser's limited fragmentation capabilities for cystine stones and its inability to treat tissue lesions such as urinary-tract stenosis and tumors.
倍频双脉冲钕：钇铝石榴石（FREDDY）激光已被开发用于内镜下碎石术，它结合了固体激光和染料激光的特性，并配有细的柔性光纤，使其能够与柔性输尿管肾镜配合使用。此外，它比其他激光成本更低且易于维护。我们的目标是评估其在输尿管镜治疗尿路结石中的疗效和作用。
我们对26例患者（29颗结石）使用了FREDDY激光。对于4例结石病例，这是一线治疗方法；对于其余病例，这是二线治疗方法，其中23例在体外冲击波碎石（SWL）后使用，2例在肾切开取石术后使用。结石平均大小为9毫米，范围为6至15毫米。有13颗肾结石和16颗输尿管结石。术后3个月的X线检查未发现残留碎片被认为反映治疗成功。
26颗结石得到治疗，结果令人满意。在3个月内，18例患者结石清除（69%），72.4%的结石（21/29）得到完全治疗。8例患者的8颗结石仍有碎片残留。在这些结石中，5颗直径大于10毫米且在3个月时仍存在。2颗胱氨酸结石碎石无效，1颗一水草酸钙结石碎石效果差。平均住院时间为1.5天，范围为1至3天。在输尿管结石嵌顿的病例中观察到输尿管穿孔。
由于所使用的波长，内镜下FREDDY激光碎石术是一种有效且无害的方法。这种激光因其成本适中且能够与柔性输尿管肾镜配合使用，可作为一种治疗工具。然而，重要的是要意识到FREDDY激光对胱氨酸结石的碎石能力有限，且无法治疗诸如尿路狭窄和肿瘤等组织病变。
