Intrarenal use of the holmium laser

Background and Objective: We investigated the safety, effectiveness, and techniques of the holmium (Ho:YAG) laser intrarenally. Data are presented on 52 patients who were treated with the Ho:YAG laser intrarenally for urinary calculi or neoplasms. Study Design/Materials and Methods: The Ho:YAG laser has a wavelength of 2,100 nm, which is delivered in pulsed fashion via a small flexible quartz fiber (365 μm), which is placed through a working channel (>2.2 Fr) of a small diameter endoscope. Results: Sixty-three intrarenal procedures were performed with the Ho:YAG laser for calculi and neoplasms. Twenty-four procedures were performed for intrarenal neoplasms. Average total energy used in these patients was 2.61 kilojoules (kJ) with a maximum of 15.28 kJ. Thirty-nine procedures were performed for intrarenal calculi; 7/39 procedures were approached percutaneously. Average total energy in stone patients was 5.41 kJ with a maximum of 37.77 kJ. Conclusion: The Ho:YAG laser can be used safely and effectively to treat intrarenal calculi or neoplasms. All types of calculi were fragmented and all patients with intrarenal tumor were treated successfully. There were no vascular or renal injuries and there was no evidence of renal loss. No intrarenal strictures were seen on follow-up. The Ho:YAG laser energy can be delivered through a small flexible quartz fiber passed through a small diameter endoscope. The techniques and applications of the Ho:YAG laser make it well suited for urologic application.