Benefits of Holmium Laser Lithotripsy surgery

• Holmium laser lithotripsy is the most recommended procedure for the removal of kidney stones, this treatment is used regardless of stone composition, size and location.
• Given the versatility of the holmium laser, there are three techniques for stone removal with this tool: multiple perforation technique, surface cavity ablation technique and direct fragmentation technique.
• Performing the procedure with the holmium laser ensures a 90-95 % chance of success. Given the laser's ability to fragment into very small pieces and remove the stones completely, recurrence is very unlikely.

Urology experts agree that the use of the holmium laser is extremely efficient for the fragmentation of all types of stones, regardless of their composition. Its efficacy is proven even in cases of cystine, calcium oxalate monohydrate or calcium phosphate stones.

The main characteristics that lead to consider the holmium laser as the "Gold standard" in laser lithotripsy, that is to say, as the reference technique, are:

• Its effectiveness in fragmenting any type of stone, regardless of the composition of the stone.
• The maximum control that the surgeon has while performing the intervention. This is due to the fact that the laser applies a minimal type of pulsation or movement on the stone, preventing it from moving inside the organ and making its elimination more effective.
• It is an instrument that adapts to any endoscope, as there are different calibres of fibres, from very small, flexible fibres to larger, more rigid fibres.

The use of holmium laser together with flexible instruments makes it possible to treat more difficult to reach areas such as the ureter and intrarenal sites (internal parts that form the kidney).

Since small diameter and flexible ureteroscopes are key, it is possible to perform treatments for the removal of stones present in areas of the kidney such as the calyx inferir, this area is where the urine passes through, and in this type of case the use of very small diameter fibres with maximum flexibility is required. 

Therefore, it can be said that any type of stone, regardless of its composition or location within the renal system, can be treated with the holmium laser.

Holmium laser lithotripsy procedure consists of keeping the tip of the fibre lightly in contact with the stone throughout the process and not losing direct visualisation of the material during the procedure. 

The surgeon initiates this process by first placing the fibre over the stone and then activating the laser after contact.

There are three techniques for performing lithotripsy with the holmium laser and they are:

Multiple perforation technique

This technique consists of creating multiple holes in the surface of the stone, making use of the drilling effect (perforation effect), in which small pieces of the stone are vaporised, allowing a thin layer of stone powder to be deposited. This makes it easier and more effective to expel the stones through the urine.

Surface cavity ablation technique

This type of technique allows the specialist to work at a greater distance from the stone. This is because the aim is to make a larger hole in the stone, trying to apply the laser to a larger area of the stone.

The ablation technique produces a vaporisation of the stone, to the point of fragmenting the stone. The purpose of this procedure is to weaken the stone and avoid producing too many pieces of stone. It removes all the pieces that formed the stone.

Direct fragmentation technique

Finally, this technique is mainly used in cases where the stones are small in size or are located in places with limited manoeuvrability. This procedure involves the direct fragmentation of the stone into very small pieces and its subsequent elimination through urine.

If you want to know more about the holmium laser lithotripsy operation, you can do so by visiting the following page: Holmium laser lithotripsy for bladder and ureteral stones.

Unlike holmium laser lithotripsy treatment, the alternative procedures, although they solve the problem and do not necessarily cause serious problems, may have some limitations. The limitations of the other procedures are briefly discussed below.

Extracorporeal shockwave lithotripsy

This is the fragmentation of stones by means of the extracorporeal application of energy from shock waves. This procedure is performed under analgesia and sedation of the patient.

The limitations of this treatment are mainly that the total stone clearance rate is very low compared to other techniques such as holmium laser endoureteral lithotripsy or percutaneous nephrolithotomy. 

The degree of removal in these cases depends mainly on the composition and size of the stone, so the patient usually has to undergo several sessions of this treatment.

Percutaneous nephrolithotomy

In this procedure the removal of the stones is performed using an endoscope inserted directly into the renal pelvis and calyces, these parts are part of the kidney and perform the function of transferring urine from the kidney to the ureter.

The main limitation of this procedure is that it is usually used in cases with large stone formation. Since it is a more invasive treatment than other surgeries, its use is not very common.

The risks with this type of treatment are the possibility of infection, bleeding and perforation of neighbouring organs. Although complications are possible, they do not occur frequently. This technique is mostly used for large stones, as they are difficult to encompass and therefore more difficult to fragment and remove in their entirety.

Stone resection

This is a surgery used in cases where the stone is of a size or shape that prevents it from passing and blocks the flow of urine, or when it is causing damage to the kidney or urinary tract. The process involves removing the part of the kidney affected by the stones, exceptionally the kidney is removed completely.

The main risks of this procedure are long-term kidney function problems, with the possibility of total loss of the organ, making the problem of proper kidney function permanent.

This type of treatment is the last option, performed in cases where the size and position of the stone make it difficult to perform another type of procedure; less invasive and with fewer risks.

For all these reasons, the holmium laser operation is the most recommended treatment in lithotripsy, as has already been mentioned, given its effectiveness. This treatment can be performed on stones regardless of their hardness, composition or location. It is characterised by its low incidence of complications, versatility, miniaturisation and flexibility of fibres and instruments.

It is a procedure that can be adapted to any type of case that patients may present, thus ensuring a solution to the discomfort.

The main applications of the holmium laser in urology are laser lithotripsy and the treatment of benign prostatic hyperplasia, being one of the most widely used lasers today for the treatment of this type of problem.

In the case of lithotripsy, the holmium laser is used to fragment stones of any type of composition and location within the renal, ureteral or bladder system.

Laser Lithotripsy lasts approximately 1 hour.

The most important advantages of this type of treatment are:

• The possibility of haemorrhage during the procedure is reduced. This makes the procedure safer for the patient and reduces the possibility of complications both during and after the procedure.
• Greater efficacy in the treatment of any type of stone, i.e. by using the holmium laser for lithotripsy, the specialist can fragment and remove any type of stone present in the organ, thus being a more effective procedure compared to other treatments, such as shockwave treatment, which depends on the composition of the stones in order to be carried out.
• The movement of the stone within the organ during the intervention is reduced, i.e. during the intervention when the specialist proceeds to fragment the stone, the stone does not have to be displaced in order to be reached by the laser, as the instrument can access the stone and proceed to remove it.
• Easier access to the stone thanks to the use of small diameter and more flexible fibres. As in the previous case, this instrument, thanks to its dimensions, allows the surgeon to access the stones lodged in the most complex or narrow parts of the renal system more easily. This facilitates the success of the intervention and the removal of the material lodged in the organ.
• Increased level of success in a single treatment, with the chances being 90-95%. Given the laser's ability to fragment into very small pieces and remove the stones completely, recurrence is very unlikely, so success is assured with this technique.

However, although this type of treatment is effective, it should not be forgotten that the prevention of possible recurrences and care after surgery must be taken into account in order to increase the effectiveness of the procedure. Care such as, for example, hydration and a balanced diet.

In addition to the benefits of the surgery itself, which are those we have mentioned previously, when contracting the holmium laser lithotripsy operation through Operarme, there are a series of advantages that the patient should be aware of. 

Firstly, our price is fixed and all-inclusive, with no last-minute surprises, and you can also request an immediate, free surgical assessment consultation to meet the specialist who will operate on you.

Here are some other benefits that may be of interest to you:

First class hospitals and doctors

We have private hospitals in the main cities of Spain and our own portfolio of doctors with extensive experience and warmth in human treatment, as indicated by the reviews of our patients.

Personalised attention

As a patient of Operarme, you have a personal advisor available at any time to help you and solve any doubts you may have during the process, allowing you to worry about what really matters, your health.

Free surgical assessment consultation

You can meet our specialist in general surgery in your city, we provide you with an immediate and free consultation so that you can bring any tests and medical reports you may have, so that he can determine whether the intervention is necessary and so that you can decide whether you want to solve your medical problem with him.

No upfront fees

At Operarme, you pay nothing until you, together with the doctor, decide to carry out the surgery, lithotripsy in this case, paying only for what you need when you need it.

Transfer Service

On the day of admission to hospital we will send you a taxi at the company's expense to take you to the hospital and the same on the day of discharge (check the conditions of the service here).

Holmium laser lithotripsy surgery is a very common operation, therefore, as long as the doctor has experience, the results are very good. 

At Operarme, we differentiate ourselves by having doctors with extensive experience in the public and private sector, providing a contract for the provision of medical services that guarantees the quality of the process and giving each and every one of our patients a personalised and close attention thanks to the work of our patient service department.

If you need more information about holmium laser lithotripsy operation or would like a pre-surgical assessment consultation with one of our Urology specialists, please request a free consultation by clicking below: