A Review of Studies Reporting on Complications of Upper Urinary Tract Stone Ablation Using the Holmium:YAG Laser

Abstract

Purpose: A review of the literature of studies reporting complications of ureteroscopic urinary tract stone ablation using the holmium:YAG laser was performed. Patients and methods: Electronic databases were searched using specific keywords to identify relevant studies. Reference lists of identified articles were scrutinised for other studies and searches were conducted using the names of authors known to have published widely in this field. Two reviewers assessed retrieved articles for inclusion criteria. Patients <16 years old were excluded. Results: Overall, 48 studies published between 1994 and 2007 were included. Half were published since 2000. In total, 4454 patients were identified. Around half of studies were performed in North America (25). The number of patients per study varied from 8 to 598. The study populations were very heterogeneous in terms of stone position and size, and ureteroscope size and rigidity. Overall, 303 (6.8%) complications were identified. Post-operative ureteric stricture and perforation rates were both 1.0%. There were only six major complications identified (0.1%). The post-operative sepsis rate was 2% and one death was reported. Conclusions: Upper urinary tract stone ablation using the holmium:YAG laser is both safe and reliable. Follow-up imaging to detect procedure-specific complications would not appear to be routinely indicated given this low complication rate.