Holmium Laser Lithotripsy

Overview

What is holmium laser lithotripsy?

Holmium laser lithotripsy uses lasers to break 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 (the tube through which urine leaves the body from the bladder). A flexible laser fiber is inserted through a scope (camera) placed in the urinary tract via the urethra to break up the stones. The stone fragments are then removed with a small basket or other instruments. The procedure is done without any incisions (cuts).

Why is holmium laser lithotripsy done?

It's an alternative to a procedure called extracorporeal shockwave lithotripsy. In that procedure, sound waves from outside the body are used to break up the stones. Holmium laser lithotripsy has been shown to be effective no matter the size, location and/or hardness of stone. These factors limit the shockwave lithotripsy's effectiveness.

Procedure Details

What should I do to prepare for holmium laser lithotripsy?

Check with your doctor to see if there are any medications you should avoid prior to the procedure. You will likely be asked to not eat or drink anything after midnight prior to the procedure.

What should I expect after holmium laser lithotripsy?

You may have some blood in your urine or discomfort with urination depending on where your stones were. If a stent is placed, this can cause some irritation of the bladder. You may also have nausea and fatigue after having anesthesia. Follow all recommendations that your doctor provides in your discharge instructions.

Risks / Benefits

What are the advantages of using holmium laser lithotripsy?

Compared to extracorporeal shock wave lithotripsy, holmium laser lithotripsy has been shown to have higher success rates and decreased chance of steinstrasse (a complication of extracorporeal shockwave lithotripsy in which fragments of the stones block the ureter).

The procedure has been shown to be effective for a patient with multiple stones and can also be used in patients who must be on blood thinner medications

What are some possible complications of holmium laser lithotripsy?

  • Pain.
  • Blood in urine.
  • Trouble urinating or other urination symptoms.
  • Injury to the ureters.

Last reviewed by a Cleveland Clinic medical professional on 08/20/2020.

References

  • National Center for Biotechnology Information. Accessed 8/20/2020.Comparison of ESWL and Ureteroscopic Holmium Laser lithotripsy in Management of Ureteral Stones (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3912003/)
  • National Kidney Foundation. Accessed 8/20/2020.Lithotripsy (https://www.kidney.org/atoz/content/lithotripsy)
  • Feng, C., Wu, Z., Jiang, H., Ding, Q., & Gao, P. (2013). Ureteroscopic Holmium:YAG laser lithotripsy is effective for ureteral steinstrasse post-SWL. Minimally Invasive Therapy & Allied Technologies, 22(5), 279-282.
  • Jeon, S. S., Hyun, J., & Lee, K. (2005). A comparison of holmium:YAG laser with Lithoclast lithotripsy in ureteral calculi fragmentation. International Journal of Urology, 12(6), 544-547.
  • Takazawa, R., Kitayama, S., & Tsujii, T. (2012). Single-session ureteroscopy with holmium laser lithotripsy for multiple stones. International Journal of Urology, 19(12), 1118-1121.

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