Minimally invasive therapy is currently invaluable for the treatment of biliary stones. Clinicians should be familiar with the various endoscopic modalities that have been evolving. I reviewed the treatment of biliary stones from the common practice to pioneering procedures, and here I also briefly summarize the results of many related studies. Lithotripsy involves procedures that fragment large stones, and they can be roughly classified into two groups: intracorporeal modalities and extracorporeal shock-wave lithotripsy (ESWL). Intracorporeal modalities are further divided into mechanical lithotripsy (ML), electrohydraulic lithotripsy, and laser lithotripsy. ESWL can break stones by focusing high-pressure shock-wave energy at a designated target point. Balloon dilation after minimal endoscopic sphincterotomy (EST) is effective for retrieving large biliary stones without the use of ML. Peroral cholangioscopy provides direct visualization of the bile duct and permits diagnostic procedures or therapeutic interventions. Biliary stenting below an impacted stone is sometimes worth considering as an alternative treatment in elderly patients. This article focuses on specialized issues such as lithotripsy rather than simple EST with stone removal in order to provide important information on state-of-the-art procedures.
Aged ; Bile Ducts ; Humans ; Lithotripsy ; Lithotripsy, Laser ; Sphincterotomy, Endoscopic ; Stents

PURPOSE: We report our experience to assess the effectiveness and safety of Holmium:YAG laser lithotripsy for managing ureteral calculi. MATERIALS AND METHODS: Ureteroscopic Holmium:YAG laser lithotripsy was performed in 116 cases from November 1999 to October 2003. Calculi were located at the upper ureter in 9%, mid ureter in 19% and lower ureter in 72%. The mean stone size was 1.2cm. A 8Fr semirigid ureterorenoscope, 7.5Fr flexible ureterorenoscope and holmium:YAG laser (Trimedyne, Irvine, USA) with 365mul laser fiber were used. RESULTS: Stones were completely cleared in 113 cases among 116 cases. Stone-free rates according to stone position were 97.6% in the lower ureter, 100% in the mid ureter and 90.9% in the upper ureter. Stone-free rates according to stone size were 100%, 100% and 85.7% in the cases of which diameter is below 10mm, between 10mm and 15mm and above 15mm respectively. Fragmentation was incomplete in 3 cases, so ESWL was performed in 2 cases and repeated procedure in on case. Ureteral perforation was developed in 1 case. CONCLUSIONS: The Holmium:YAG laser lithotripsy was highly effective and safe in managing ureteral calculi irrespective of their location.
Calculi ; Holmium ; Lithotripsy ; Lithotripsy, Laser ; Ureter* ; Ureteral Calculi*

We treated 550 ureteral calculi patients with stone basket or Candela MDL-l laser lithotripter using the rigid ureteroscope(URS) between April 1988 and November 1993. The laser lithotripsy was applied for the patients who had failed URS stone removal with stone basket. The success rates of URS stone removal with stone basket were 33.7%(120/356) in the lower ureter stones, 1.7%(2/112) in the mid, none(0/82) in the upper. The laser lithotripsy rates and success rates were 63.4%(226/356), 99.5%(225/226) in the lower ureter, 90.1%(101/112), 85.1%(86/101) in the mid, 79.2%(65/82), 80%(52/65) in the upper, respectively. The total URS stone removal success rates were 96.9%(345/356) in the lower ureter, 78.6%(88/112) in the mid, 63.4 %(52/82) in the upper. There were 65 failures due to upward migration(27 cases), approach failure to stone by URS (35 cases), no fragmentation(3 cases). Ureterolithotomy was required in 8 cases and shockwave lithotripsy in 11 cases and retry in 22 cases. The complication of URS were minimal, gross hematuria (11.2%), pain(9.5%) and infection (1.6%). Ureteral perforation occurred in only 10 patients. In conclusion, laser lithotripsy has been significantly contributed improving of success rates and expanding of applying area for URS stone removal in our series.
Hematuria ; Humans ; Lithotripsy ; Lithotripsy, Laser ; Ureter ; Ureteral Calculi

The pulsed dye laser(Technomed pulsolith) with a wave-length of 504nm was irradiated directly in vitro on four human ureters which were obtained by ureteronephrectomy. The irradiation was at 5Hz with a pulse energy of 40 to 100mJ and total pulse count of 200 to 1000. Immediately after irradiation, the ureteral tissues were fixed with formalin solution and H&E stain. The extent of tissue damage was examined with light microscope. In this experimental study, we observed that mucosal damage occurred from pulse energy of 60mJ, total pulse rate of 600 and submucosal damage occurred from pulse energy of 80mJ, total pulse rate of 800. But We believed that the pulsed dye laser was safe because most stones were fragmented at less than a pulse energy of 80mJ, a total pulse rate of 800, and the ureter was irradiated indirectly during laser lithotripsy.
Formaldehyde ; Heart Rate ; Humans* ; Lasers, Dye ; Lithotripsy, Laser ; Ureter*

Ureteroscopic management of ureteral calculi is now an established highly successful technique with low morbidity. Manipulation of calculi can be done under direct vision using flexible forceps or stone baskets. We also have used a laser lithotriptor to disintegrate stones that were too large to be removed by manipulation. Between April 1988 and July 1989, 136 ureteroscopic procedures were performed for removal of stone. The stones were removed successfully in 119( 87.5% ) procedures. Laser lithotripsy was used successfully to remove the stone in 70(51.5%) procedures. There were no immediate complications except one case of urine extravasation because of ureteral injury. We conclude that ureteroscopic management of ureteral calculi can be done safely if certain guide lines such as proper selection of patient, adequate equipment, and proper execution of the basic technique are adhered to strictly.
Calculi ; Humans ; Lithotripsy, Laser ; Surgical Instruments ; Ureter* ; Ureteral Calculi ; Ureteroscopy*

The effectiveness and safety of ureteroscopic holmium: YAG laser lithotripsy for managing ureteral calculi was evaluated. Ureteroscopic holmium. YAG laser lithotripsy was performed in 168 ureteral calculi (upper 27 cases, middle 33 cases and lower 108 cases). The results showed that the stone-free rate was 92.6% in the upper ureteral calculi, 93.9% in the middle ureteral calculi and 94.4% in the lower ureteral calculi, respectively. The complication rate was 4.8% (8 cases). It was suggested that ureteroscopic holmium: YAG laser lithotripsy is a highly effective and safe treatment modality for managing ureteral calculi.
Holmium ; *Lithotripsy, Laser/methods ; Ureteral Calculi/*therapy ; *Ureteroscopy

Holmium ; Humans ; Kidney ; Lithotripsy, Laser ; Shock, Hemorrhagic ; Ureteroscopy

From April to October, 1988, 34 patients with ureteral calculi more than O.5 cm or smaller but impacted ureteral stone underwent pulsed dye laser lithotripsy under ureteroscopy. The results were as follows : 1. The locations of stone were upper ureter in 9(26.5%), mid ureter in 8(23.5%), lower ureter in 11(32.4%), and UVJ in 6(17.6%). 2. The success rates according to location were 66.7% in upper ureter, 87.5% in mid ureter, 91% in lower ureter, and 100% in UVJ and the average success rate was 85.3%. 3. The success rates according to stone size were 83% in 0.3-0.5 cm, 90% in 0.5-1.0 cm, and 75% in 1.0-2.3 cm. 4. The average procedure time was about 85 minutes, with a range of 30 to 120 minutes and the average hospitalization after laser therapy was about 3 days, with a range of 1 to 6 days. 5. There were 5 cases (14.8%) of failure due to upward migration of stone in 3 cases, ureteral injury in 1 case and ureteral stricture in 1 case. 6. Complications occurred in 10 patients (29.5 %), almost by ureteroscopy but laser induced complication was not found. Therefore, we confirm that laser lithotripsy is a safe and effective method for treatment of ureteral stone.
Constriction, Pathologic ; Hospitalization ; Humans ; Laser Therapy ; Lasers, Dye* ; Lithotripsy ; Lithotripsy, Laser ; Ureter* ; Ureteral Calculi* ; Ureteroscopy* ; Urinary Calculi

PURPOSE: We evaluated the results of Holmium:YAG laser lithotripsy according to the size and location of the ureteral stones. MATERIALS AND METHODS: Between March 1998 and April 2007, the medical records of 203 patients who were treated with ureteroscopic Holmium: YAG laser lithotripsy due to ureteral calculi were reviewed. They were subgrouped by the size and the location of the ureteral stones. The results of treatment were evaluated by the stone free rate and the mean operation time of each group. RESULTS: The stone free rates of the upper, mid and lower ureter stone groups were 73.3%, 96.1% and 100%, respectively. There was a significant difference in the upper ureter stone group compared to the other two groups, and especially for the group with stone less than 10mm. Stone migration into the renal pelvis or calyx was a major cause of failure in the patients with upper ureter stones. 8 cases showed stone migration and 2 cases showed fragment migration. CONCLUSIONS: As Holmium:YAG laser lithotripsy has a low complication rate and a high stone free rate, it is an effective treatment modality for ureteral calculi. However, such procedures should be performed carefully because the thermal effect of the Holmium:YAG laser causes ureteral perforation, and especially in the cases of impacted or large stones. Other effective alternatives such as trapping devices need to be studied for patients with upper ureteral stones to prevent stone migration.
Holmium ; Humans ; Kidney Pelvis ; Lasers, Solid-State ; Lithotripsy ; Lithotripsy, Laser ; Medical Records ; Ureter ; Ureteral Calculi

The pulsed laser lithotripsy has been used in the treatment of urinary calculi. We treated 153 patients of stones, via the pulsed dye laser(Technomed Pulsolith) with 7.5 and 6.5 F. rigid ureteroscope between January 1992 and January 1995. Stones were in bladder(4 cases), upper ureter(17), mid ureter(31) and lower ureter(101). The laser lithotripsies were applied for impacted stones and relatively large stones(more than 6 mm) The success rates according to location were 47%(8/17) in upper ureter, 77%(24/31)in middle ureter, 95%(96/101)in lower ureter and 100%(4/4) in bladder and mean success rate was 86% (132/153). There were 21 failures due to upward migration(9 cases), poor visual field(7), laser resistant stone(3) and malfunction of laser(2). Complications were showed in 28 cases that were gross hematuria(16 cases), ureteral perforation(6), fever(4) and ileus(2), but most of them might be related to ureteroscopy rather than laser, and all of them were resolved with conservative management. So laser lithotripsy is safe and effective method of middle and lower ureteral calculi, and upward migration of stones, the major cause of failure may be resolved by use of extracorporeal shock wave lithotripsy and flexible ureteroscope.
Humans ; Lithotripsy ; Lithotripsy, Laser* ; Shock ; Ureter ; Ureteral Calculi ; Ureteroscopes ; Ureteroscopy ; Urinary Bladder ; Urinary Calculi