Laser lithotripsy is a minimally invasive procedure used to treat kidney stones, ureteral stones, and bladder stones by breaking them into smaller fragments using laser energy. This procedure is particularly effective for stones that are too large to pass on their own or are causing significant pain, obstruction, or other complications.

Procedure Overview:

1. Preparation:

   • The patient is typically placed under general or spinal anesthesia to ensure comfort during the procedure.

   • Pre-operative imaging, such as an X-ray, ultrasound, or CT scan, is performed to determine the size, location, and composition of the stone(s).

2. Accessing the Stone:

   • A ureteroscope, which is a thin, flexible tube with a camera and light, is inserted through the urethra, passed through the bladder, and advanced into the ureter or kidney to reach the stone. This allows the surgeon to directly visualize the stone.

   • For bladder stones, a cystoscope (similar to a ureteroscope) is used to access and visualize the stone within the bladder.

3. Laser Fragmentation:

   • Once the stone is visualized, a laser fiber (commonly a holmium laser) is passed through the ureteroscope or cystoscope.

   • The laser emits pulses of energy that fragment the stone into smaller pieces. The holmium laser is particularly effective because it can fragment stones of various compositions, including those that are hard and resistant to other treatments.

   • The surgeon can adjust the laser settings to control the size of the fragments produced.

4. Stone Removal:

   • The fragmented stone pieces can either be left to pass naturally through the urine or be removed using a specialized basket device. In some cases, a combination of both methods is used.

5. Stent Placement:

   • A temporary ureteral stent may be placed to help keep the ureter open and ensure proper urine drainage during healing. The stent is usually removed after a few days to a couple of weeks.

6. Completion and Recovery:

   • After the procedure, the ureteroscope or cystoscope is carefully withdrawn, and the patient is monitored as they recover from anesthesia. Most patients are discharged the same day or after an overnight stay.

Indications for Laser Lithotripsy:

• Kidney Stones: Particularly those that are too large to pass naturally, are causing pain or obstruction, or are located in difficult-to-reach areas.

• Ureteral Stones: Stones that have migrated from the kidney into the ureter and are causing blockage or severe pain.

• Bladder Stones: Stones within the bladder that are causing symptoms or complications.

Benefits of Laser Lithotripsy:

• Minimally Invasive: No incisions are required, leading to quicker recovery times and less pain compared to open surgery.

• High Efficacy: The holmium laser can effectively fragment stones of various sizes and compositions, including those resistant to other treatments.

• Outpatient Procedure: Most laser lithotripsy procedures are done on an outpatient basis, allowing patients to go home the same day.

Risks and Complications:

• Infection: As with any procedure involving the urinary tract, there is a risk of infection, which can be managed with antibiotics.

• Bleeding: Minor bleeding may occur but is usually self-limiting.

• Ureteral Injury: There is a small risk of injury to the ureter, which might require additional treatment.

• Residual Stone Fragments: Some stone fragments may not pass and could require additional procedures.

Dr. Saurabh Mishra's Approach to Laser Lithotripsy:

Dr. Saurabh Mishra would likely approach laser lithotripsy with a focus on achieving the highest possible success rates while minimizing patient discomfort and complications. His experience in using advanced holmium laser technology ensures precise and effective stone fragmentation.

Dr. Mishra’s patient-centric care approach would involve thorough pre-procedure consultations to ensure patients fully understand the process and potential outcomes. His attention to detail during the procedure helps ensure that stones are effectively treated with minimal impact on surrounding tissues. Post-procedure, Dr. Mishra would provide clear guidance on recovery and follow-up care, including managing any stents placed and monitoring for potential recurrence of stones.

His expertise in laser lithotripsy makes him a preferred choice for patients seeking effective, minimally invasive treatment for urinary stones.

Laser Lithotripsy