High versus low frequency holmium laser lithotripsy: A prospective randomized study in patients undergoing ureteric calculus management
Volume : 1
Issue : 3
Online ISSN : XXXX
Print ISSN : XXXX
Article First Page : 43
Article End Page : 46
Stone disease is very common in urological practice in modern society. Holmium laser is the most versatile intracorporeal lithotripter available at present but there is no definite literature regarding the different settings to be used.
Materials and Methods: This study was done in 80 patients, having single ureteric calculus, undergoing ureteroscopy with holmium laser lithotripsy. The patients were randomized and allocated to one of the two groups, high frequency or low frequency group. Informed consent was taken from all patients. For ureteroscopy semi rigid ureteroscope of 6/7.5 Fr. Richard Wolf was used. For intracorporeal lithotripsy Lumenis Versa Pulse Power Suite, Holmium 100 watt laser was used. Patients in High frequency group underwent holmium laser lithotripsy at 40 Hz. and low frequency group at 20 Hz. Total power was 12 watts in both groups. Operating time, total energy used, lasing time, and requirement of additional instrumentation (forceps/basket) to achieve stone clearance were noted. Complications likeretropulsion, ureteric injury and postoperative hematuria were noted.
Results: Overall stone clearance rate was 95% in high frequency group and 92.5 % in low frequency group at 1 week of follow up. After the second procedure the overall stone clearance was 100% in both the groups. The mean stone size in both the groups were similar. The lasing time and total energy used in high frequency group was significantly higher but it did not increase the overall operative time. The complication rates were comparable to other studies but between the groups the low frequency group had significantly higher rates of ureteral mucosal injury that could be attributed to the increased use of intra operative additional procedures to attain complete stone clearance.
Conclusion: High frequency Ho: YAG laser lithotripsy is safe and effective method of achieving stone free status for ureteric calculus.
Keywords: Ureteric stones, Ureteroscopy, Urolithiasis, High frequency, Holmium laser lithotripsy, Ureteric calculus.