Ureteroscopic Holmium Laser Lithotripsy for Left Mid-Lower Ureteric Calculus: A 31-year-old male, Mr. Nitesh Gurnani, presented with complaints of intermittent left flank pain for the past few days. The pain was colicky in nature and occurred episodically. There were no associated urinary symptoms such as dysuria, frequency, urgency, hematuria, or fever. The patient did report a history of lithuria in the past.
There was no past history of any significant medical illness or previous surgical procedures. The patient also had no known drug allergies.
On clinical examination, the patient was hemodynamically stable, and systemic examination was within normal limits.
Routine laboratory investigations revealed serum creatinine of 1.05 mg/dL, indicating preserved renal function.
Ultrasonography of the abdomen revealed a left mid ureteric calculus measuring approximately 8.5 mm associated with moderate hydroureteronephrosis.
Further evaluation with intravenous pyelography (IVP) demonstrated a normally functioning right kidney, while the left kidney showed evidence of a mid to lower ureteric calculus with mild hydroureteronephrosis.
Preoperative cardiac evaluation with ECG was within normal limits (TWNL). After appropriate preoperative assessment, the patient was deemed fit for surgery.
The patient and his relatives were counselled regarding the nature of the disease, treatment options, the proposed endoscopic procedure, and the expected outcomes. After obtaining informed consent, the patient was planned for cystoscopy, left ureteroscopy (URS), holmium laser lithotripsy, and DJ stenting.
The patient underwent the planned procedure under general anaesthesia.
Cystoscopic examination was performed first and revealed a normal urethra and urinary bladder. Subsequently, left ureteroscopy was performed. During ureteroscopic evaluation, a stone was identified in the lower ureter.
Holmium laser lithotripsy was performed, and the stone was successfully fragmented and powdered using laser energy. After complete fragmentation and clearance of the stone, a Double-J ureteric stent was placed to ensure adequate ureteric drainage and facilitate healing.
At the end of the procedure, the patient was catheterized.
The patient tolerated the procedure well and remained hemodynamically stable throughout the perioperative period.
The postoperative course was uneventful. The patient showed satisfactory recovery with relief of symptoms and stable vital parameters.
This case demonstrates the effective management of mid to lower ureteric calculus using ureteroscopy and holmium laser lithotripsy, which is currently considered the standard minimally invasive treatment for ureteric stones. The addition of DJ stenting ensures proper drainage, reduces postoperative ureteric edema, and facilitates smooth recovery.
Endoscopic laser lithotripsy offers high stone clearance rates with minimal morbidity, allowing rapid recovery and early return to normal activities.
Best Hospital in Jaipur for Treatment of Kidney Stone Diseases – Institute of Urology, Jaipur
The Institute of Urology, Jaipur has developed a strong reputation for the comprehensive management of all forms of kidney stone disease, ranging from simple ureteric calculi to complex and recurrent renal stones. Equipped with advanced endourological technology and modern minimally invasive surgical facilities, the institute routinely performs procedures such as ureteroscopy (URS), retrograde intrarenal surgery (RIRS), percutaneous nephrolithotomy (PCNL), and laser lithotripsy with excellent outcomes. The center is led by experienced urologists including Dr. M. Roychowdhury and Dr. Rajan Bansal, who have extensive expertise in the diagnosis and management of complex urinary stone disease.
Their patient-centric approach, combined with precision-driven minimally invasive techniques, ensures high stone clearance rates, faster recovery, and reduced complications. Through individualized treatment planning and state-of-the-art surgical care, the institute continues to provide effective and advanced management for patients suffering from kidney and ureteric stone disorders.
