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Effect of Stone Composition on Operative Time During Ureteroscopic Holmium:YAG Laser Lithotripsy With Active Fragment Retrieval
Scott V. Wiener, MD, Levi A. Deters, MD, Vernon M. Pais, Jr., MD.
Dartmouth Medical School, Lebanon, NH, USA.
BACKGROUND:The chemical composition of a calculus has long been known to affect the efficacy with which it is fragmented by devices such as pneumatic, laser, or shockwave lithotripters. Previous studies examining the efficacy of holmium:YAG laser lithotripsy have been performed in vitro, but it is not known if operative time is significantly affected by the chemical composition of a patient's stone. We hypothesized that stone composition influences operative time when performing ureteroscopic holmium:YAG laser lithotripsy.
METHODS: We selected all patients between 7/2008 and 1/2011 who underwent ULL for stone disease for a retrospective chart review. We employed a standardized operative technique of fragmentation and active retrieval of all fragments identified on full inspection of the entire collecting system with rigid and flexible endoscopes. Stone composition was defined as the presence of a single predominant (>51%) component. Statistical analysis was performed on a per-procedure basis relative to stone burden, as measured in minutes of OR time per gram of stone.
RESULTS: A total of 187 cases met inclusion criteria, undergoing unilateral ULL with active retrieval of fragments confirmed to have a single predominant chemical composition. When accounting for weight of recovered stone, there was no difference in operative time between apatite, brushite, cystine, calcium oxalate monohydrate, calcium oxalate dihydrate, and uric acid stones.
CONCLUSIONS: Although stone composition is widely recognized as an important procedural variable, especially in shockwave lithotripsy, it appears to have little effect on the overall operative time in holmium:YAG ULL when employing active fragment retrieval. 
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