Intracorporeal laser lithotripsy

OBJECTIVES: To review the current literature on intracorporeal laser lithotripsy. METHODS: We searched PubMed for relevant reports up to January 2012, using the keywords ‘laser’, ‘lithotripsy’ and ‘intracorporeal’. RESULTS: We studied 125 relevant reports of studies with various levels of evidence. Efficient lithotripsy depends on the laser variables (wavelength, pulse duration and pulse energy) and the physical properties of the stones (optical, mechanical and chemical). The most efficient laser for stones in all locations and of all mineral compositions is the holmium yttrium–aluminium–garnet laser (Ho:YAG). The frequency-doubled double-pulse Nd:YAG laser functions through the generation of a plasma bubble. New laser systems, such as the erbium:YAG and the thulium laser, are under evaluation. Laser protection systems have also been developed for the novel digital flexible ureteroscopes. Although complications are rare, a high relevant clinical suspicion is necessary. CONCLUSIONS: Laser lithotripsy technology is continuously developing, while the Ho:YAG laser remains the reference standard for intracorporeal lithotripsy.