Effectiveness of Holmium Laser in Treasing Kidney Stones

Holmium laser lithotripsy is a highly effective treatment for kidney stones, particularly when tailored to the size and complexity of the stone. Below are the key scenarios in which this procedure is commonly used:

For stones smaller than 2cm, flexible ureteroscopy with holmium laser is ideal. The stone can be fragmented into fine dust using the laser, allowing for natural expulsion through the urinary tract or with the help of extracorporeal shock wave lithotripsy (ESWL). In cases where the stone is particularly hard, it can be broken into larger fragments and removed using a stone retrieval basket during the procedure.

For larger stones, typically greater than 2cm, percutaneous nephrolithotomy (PCNL) is often recommended. This method involves accessing the kidney through a small incision in the back, using a nephroscope to locate and remove the stone. The holmium laser can be used in conjunction with PCNL through various tract sizes (16, 18, 20, or even 22 French), which helps reduce complications associated with flexible ureteroscopy and allows for more efficient stone clearance.

In complex cases such as sepsis due to infected stones, a staged approach may be necessary. If multiple tracts during PCNL are not sufficient to remove all stone fragments, follow-up treatment with flexible ureteroscopy can be performed. This two-stage approach ensures thorough clearance of residual stones and reduces the risk of infection or recurrence.

Although bleeding is a known complication of PCNL, with careful surgical technique, this risk can be minimized or avoided entirely. Moreover, in many cases, especially when performed by experienced surgeons, flexible ureteroscopy alone in a single stage can achieve complete stone clearance without the need for more invasive procedures.