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Holmium laser lithotripsy for ureteral calculi: predictive factors for complications and success.

PURPOSE
To define possible predictive factors for success and complications for ureteroscopic holmium laser lithotripsy procedures.


PATIENTS AND METHODS
All 105 ureteroscopic holmium laser lithotripsy procedures performed between 1996 and 2005 were analyzed. Data recorded were sex, age, stone size, stone location, complications, success rate (stone-free rate after 3 months), operative time, and surgeon experience for this procedure. For further analysis, surgeon experience was divided into four groups based on the number of procedures performed. Multivariate analysis was used to define possible predictive factors for complications and successful procedures.


RESULTS
Total success rate was 84.8%. Complications were present in 13 patients (12.4%). Success rate was significantly (P = 0.03) related to surgeon experience, with 92.9% success in the most experienced group and 50% in the least experienced group. Furthermore, significantly more complications occurred with decreased experience (P = 0.03): complication rate was 4.2% in the highest experience group and 41.7% in the least experienced group. In our series, sex, stone location, size, and age did not significantly influence complication and success rates.


CONCLUSION
Surgeon experience is a predictive factor for complications and success for ureteroscopic holmium laser lithotripsy for ureteric calculi. Experienced surgeons have fewer complications, and the success rate is higher. Sex, stone location, size, and age were not significantly related to complication or success rates.