Retrograde Holmium:YAG laser disintegration of stones in pelvic ectopic kidneys:: Does it minimize the risk of surgery?

Purpose: To study the safety and efficacy of the holmium: YAG laser for disintegration of stones in pelvic ectopic kidneys. Patients and Methods: Between October 2005 and October 2006 four consecutive patients with large obstructing calculi ( > 3 cm in diameter) in the pelves of pelvic ectopic kidneys were prepared to be treated using retrograde ureterorenoscopy and holmium: YAG laser lithotripsy. All the patients were investigated with x-rays of the kidney, ureters, and bladder (KUB) and intravenous urography (IVU). Holmium: YAG laser lithotripsy was performed in a retrograde manner using energy ranging from 1 to 1.5 J/pulse with a frequency ranging from 15 to 20 Hz. Results: Four patients were included in the study. The average age of the patients was 44 years ( range 35-56 years). The average operative time for the laser lithotripsy procedure was 120 minutes ( range 100-180 minutes). Three of the patients (75%) were rendered stone-free at 3 months. None of the patients developed back-pressure changes, gross hematuria, or abdominal pain during the follow-up period. One of the patients could not be treated endoscopically and required open surgery. Hospital stay ranged between 2 and 3 days. Conclusion: Retrograde ureteroscopy and holmium: YAG laser lithotripsy is efficacious for managing patients with stones in pelvic kidneys. The procedure is safe and effective and avoids the complications of open surgery.