Outcomes of flexible ureteroscopy with holmium laser lithotripsy for upper urinary tract calculi

Flexible ureteroscope and holmium YAG laser have improved our ability to treat intrarenal and proximal ureteric calculi. Current indications for the treatment of patints with upper urinary tract calculi using flexible ureteroscopy include: difficult to visualize stones, body habits that preclude ESWL, bleeding diathesis, morbid obesity, need for stone free state, concomitant stricture, infundibular stenosis, lower calyceal stones and ureteral kinks (3).Flexible ureteroscopy can be used to treat any moderate sized stones because of superior stone free state compared with ESWL. The use of uretral access sheath to facilitate removal of stone fragments, the holmium YAG laser to fragment stones or incise an infundibulum or stricture, and nitinol baskets to displace lower calyceal stones or retrieve fragments has improved stone free rates and reduced access failure.CONCLUSION: Flexible ureteroscopy using holmium laser is a safe and effective option for the treatment of upper urinary tract calculi. In addition, it can be considered an attractive option as salvage therapy after SWL failure or kidney calculi associated with ureteral stones. Stone size larger than 15 mm is associated with single session treatment failure.