Intracorporeal lithotripsy with the Alexandrite laser.

BACKGROUND AND

OBJECTIVE

The objective of this study was to evaluate clinical use of an Alexandrite laser lithotripter for intracorporeal lithotripsy of urinary calculi.

STUDY DESIGN/MATERIALS AND

METHODS

We prospectively evaluated a flash lamp pumped, Q-switched Alexandrite solid-state laser for use in conjunction with ureteroscopy (30 cases) or percutaneous nephrolithotripsy (2 cases). The laser operates at a wavelength of 755 nm in a pulsed mode with pulses of 150-800 ns duration at energy settings of 30-80 mJ.

RESULTS

The fragmentation rate with the Alexandrite laser alone was 50% (16/32). Failure of the laser was due to equipment malfunction or technical problems in 11 cases and inability to fragment the stone in 5. All cases of failed Alexandrite laser lithotripsy were successfully salvaged with alternative modalities of endoscopic stone destruction and removal. One intraoperative complication, a ureteral perforation, occurred; however, no long-term sequelae related to laser use was documented.

CONCLUSION

Clinical results with the Alexandrite laser appear to be inferior to those reported with Alternative laser systems and other forms of intracorporeal lithotripsy. Whereas some of the inadequacies we have noted may be addressed in the future by modifications in the unit and delivery systems, we would not recommend this device for intracorporeal lithotripsy of urinary calculi in its current form.