Holmium yag laser

All emergency primary URS was undertaken with the intent to provide definitive treatment. URS was performed under general anaesthesia with an 8F semirigid ureteroscope (Karl Storz Endoskope, Tuttlingen, Germany) with the aid of fluoroscopy. Stones were either fragmented using a holmium:YAG or removed by an endoscopic basket. Any stone fragmentation was performed with a holmium:YAG laser (Lumenis Ltd., Elstree, UK). When required, stone fragments were removed using an endoscopic basket. The decision to place a ureteric stent following the procedure was left to the operating surgeon’s discretion.

The access sheath used was a 9.5/11F or 12F/14F or 14F/16F Cook Flexor UAS sheath (Cook Medical, USA) wherein a size 45 cm length was used for males, a 35 cm length was used for females and paediatric patients. Flexible ureteroscopy was done using a 7.5F Flex X2 flexible ureteroscopes [Karl Storz Endoscopy (UK) Ltd.,Slough, UK] with a holmium:YAG laser [20 W or 100 W; Lumenis (UK) Ltd., Elstree, UK] using a 272 micron laser fiber (Lumenis, Inc.). Stone fragment was removed for stone analysis using a Cook NGage nitinol stone extractor (Cook Medical, USA). A 6F ureteric stent (Cook Medical or Coloplast) was inserted post-operatively in majority of patients and removed a few weeks postoperatively.