Endoscopic management of upper urinary tract disease using a 200-microm holmium laser fiber: initial experience in Japan.

OBJECTIVES

To study the clinical effectiveness of the 200-microm holmium laser fiber for endoscopic management of upper urinary tract lesions.

METHODS

From January 1997 to March 1998, we performed retrograde endoscopic treatment in 25 patients with urinary tract lesions using a 200-microm holmium laser fiber. Nineteen patients had 20 stones (16 ureteral, 3 lower calyx, and 1 middle calyx), 4 had bleeding lesions in the lower calyx, 1 had transitional cell carcinoma involving the renal pelvis and upper calyx, and 1 had a ureteral stricture associated with an impacted ureteral stone. We used a 7.5F flexible ureterorenoscope for renal and upper ureteral lesions, and a 6.9F rigid ureteroscope for mid and lower ureteral lesions. For treatment, we used a holmium:yttriumaluminum-garnet laser generator and a 200-microm flexible quartz fiber.

RESULTS

All stones were successfully fragmented, including three lower caliceal stones. Lower caliceal bleeding spots were successfully cauterized for hemostasis in all 4 patients, and the pelvic tumor was successfully vaporized and ablated. In 1 patient, we had previously failed to treat a ureteral stricture with a 365-microm fiber because of inadequate visualization, but it was successfully incised using the 200-microm fiber. There were no significant complications such as ureteral obstruction or stenosis.

CONCLUSIONS

The improved flexibility of the new 200-microm holmium laser fiber facilitates treatment of stones, tumors, strictures, and lesions in the lower calyx, where access is difficult when using the previously available 365-microm fiber.