# Efficacy of Holmium: Yttrium-Aluminum-Garnet (YAG) Laser in the Treatment of Proximal Ureteral Stones in Adults

## TL;DR

This study shows that Ho:YAG laser treatment is effective for removing upper ureteral stones in adults, especially for smaller stones and non-obese patients.

## Contribution

Demonstrates the efficacy of Ho:YAG laser lithotripsy in a resource-limited setting for proximal ureteral stones.

## Key findings

- Ho:YAG laser achieved an 82% success rate in treating proximal ureteral stones.
- Success rate was higher for stones 7-10 mm (92%) compared to 11-15 mm (70%).
- Non-obese patients had significantly better outcomes (96% success) than obese patients (69%).

## Abstract

Background: Proximal ureteral stones can cause significant morbidity, and their management remains challenging, particularly in cases where conservative treatment fails. Holmium: Yttrium-Aluminum-Garnet (Ho: YAG) laser lithotripsy has evolved as a minimally invasive and efficient management option. Our research aims to evaluate the efficacy of the Ho: YAG laser in treating proximal ureteral stones in adult patients.

Methods: This prospective non-randomized study was conducted in the Department of Urology, Mardan Medical Complex, Pakistan, over a six-month period from January to June 2024. A total of 106 adult patients aged 18-60 years with proximal ureteral stones (7-15 mm) were included through consecutive sampling. All patients underwent Ho: YAG laser lithotripsy using a 550 μm fiber (Karl Storz SE & Co. KG, Baden-Württemberg, Germany), with a pulse frequency of 8-10 Hz and a power setting of 9.6-16 W. Patients were evaluated on the 14th postoperative day to assess stone clearance. Efficacy was defined as the complete absence of residual stones ≥4 mm. Data were analyzed using IBM SPSS Statistics for Windows, Version 23 (Released 2015; IBM Corp., Armonk, New York, United States), with chi-square tests applied for stratified comparisons.

Results: The mean age of patients was 33 ± 12.3 years; 66% were male and 34% female. The overall success rate was 82% (n = 87). Stratified analysis showed significantly higher efficacy in patients with smaller stones (7-10 mm) compared to larger stones (92% vs. 70%, p = 0.003) and in non-obese patients compared to obese individuals (96% vs. 69%, p = 0.0002). No statistically significant differences were observed across gender or age groups.

Conclusion: Ho: YAG laser lithotripsy is a very effective and safe management option for proximal ureteral stones, especially in non-obese patients with smaller stones. Its successful implementation in a resource-limited South Asian setting highlights both the feasibility and clinical value of adopting advanced endourological procedures in low- and middle-income countries, where access to such technologies is often limited.