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Percutaneous nephrolithotomy with holmium: Yttrium-aluminum-garnet laser and fiber guider--report of 349 cases.Jou YC, Shen JH, Cheng MC, Lin CT, Chen PC Department of Urology, Chiayi Christian Hospital, Chiayi, Taiwan. b729@cych.org.tw OBJECTIVES: To assess the efficacy and safety of holmium:yttrium-aluminum-garnet (YAG) laser lithotripsy for percutaneous nephrolithotomy in a cohort of 349 consecutive procedures. METHODS: We retrospectively reviewed the charts of 334 patients who had undergone 349 percutaneous nephrolithotomy (PCNL) procedures conducted at our hospital from January 2001 to March 2004 in which the holmium:YAG laser with a self-made fiber guider was used for lithotripsy. RESULTS: The average patient age was 54.1 years, and the average stone size was 3.3 +/- 1.8 cm. The average operative time was 99 +/- 38 minutes, and the average postoperative hospital stay was 4.0 +/- 2.3 days. The overall stone-free rate was 83.7%. The postoperative urinary tract infection rate was 7.2%. The postoperative transfusion rate was 2.0%. The holmium:YAG laser was effective against all kinds of stones, but sometimes it was time consuming to use the holmium:YAG laser to disintegrate a very large stone. Thirteen PCNLs (3.7%) to treat large complete staghorn stones were performed in combination with a pneumatic lithotriptor. Of the 349 procedures, 152 (43.6%) had bloodless tracts afterward, and all 152 procedures had been performed with the nephrostomy tube-free modification. CONCLUSIONS: The holmium:YAG laser is an effective and safe lithotriptor for most percutaneous stone surgery. However, in patients with a very large stone burden, the combination of this technology with another, more powerful, intracorporeal lithotriptor may be necessary. Published 22 March 2005 in Urology, 65(3): 454-8.
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