What do you need to know?

• Kidney stones are common and can be lodged anywhere along the urinary tract, including the kidney, bladder and ureter.

• The ureter is a tube that transports urine from the kidneys to the bladder from where it is voided
• If a stone is lodged in the ureter, it can cause a blockage of urine and increase the residual volume of urine in the kidney.
• Sometimes, stones that lodge can also be quite painful and cause infections in the urinary tract
• Laser stone ablation is a process that is used to break apart the stone so that becomes easier through the ureter.
• The smaller pieces will either be removed using a special mechanism or left in place where they will move from the ureter to the bladder.
• These stones are then removed from the body and eliminated
• Laser stone ablation is a good choice if:
  1. Other non-surgical treatments have failed to treat urinary stones
  2. The stones are larger to pass by themselves
  3. The stones are irregular in shape and block a certain region of the tract
  4. Stones are rubbing against the tract and cause bleeding or damage to surrounding tissue

What types of lasers are used for stone ablation?

Two different types of lasers are commonly used for stone ablation:

1. Pulsed-dye laser– The pulsed-dye laser uses an acoustic shock wave that acts as a slamming force such as a hammer to break down the stone. The Pulsed Dye Laser or PDL uses a concentrated beam of light that targets the stones in the urinary system. The light is converted into heat energy that is employed to destroy the stones without any damage to the surrounding tissue. The laser uses yellow light, which has been established safe for medical use.
2. Holmium: Yttrium-aluminum-garnet (YAG) laser– The holmium: YAG laser is also a pulsed laser but it acts through a thermal effect. The YAG laser is effective in fragmenting harder stones and is particularly effective on cystine stones and produces smaller fragments than pulsed-dye lasers
3. Thulium fibre laser: It is a new type of laser that shows promising results for destroying larger stones and is very versatile.

Your urologist will choose the type of laser that is right for you based on:

1. The type of stones
2. Size of the stone
3. Location of the urinary stone
4. The surgeon’s preference for maximum efficiency

What can you expect?

Before the procedure

• A physical examination to assess your health condition and suitability for the procedure
• Blood and urine tests to rule out any infections
• Imaging tests such as ultrasound to help locate the stones
• A chest Xray and an ECG to evaluate the basic parameters
• You may need to stop certain medications as advised by your doctor
• Discuss any allergies that you are aware of, and any medications or supplements you currently take with your doctor.

During the procedure

• A ureteroscope is an instrument that has a long thin tube that is hollow like a straw.
• The urologist will use the ureteroscope to visualize the urinary tract
• The scope enables the doctor to locate kidney stones, and pass instruments that are necessary to remove the stone
• The scope enters the urinary tract and ascends upwards to the urethra
• The scope is passed through the urethra, bladder, and into the ureter or kidney depending upon the location to access the stone.
• Once the surgeon locates the stone, a fibre is introduced through the scope to the stone.
• This fibre generates a laser beam that disintegrates and breaks up the stone
• The smaller fragments are removed using a basket that is also passed through the scope.
• Granular pieces may remain and will be gradually flushed out through the urine
• A temporary stent may be put in place to keep the ureter patent and facilitate expulsion
• The stent will be removed in due course
• Sometimes, the stent is left for a little longer if your surgeon feels it needs to.
• After removing the kidney stones, the surgeon will have to send the sample for analysis.
• Based on the stone’s constituents, your doctor will recommend measures to prevent the recurrence of kidney stones.
• This may include diet and lifestyle changes
• Sometimes, you may need to take medications or supplements