Lasers in Flexible Ureteroscopy

Laser technology has propelled ureteroscopy to become the most common surgical procedure for kidney stones in North America. This chapter begins with a history of lasers in endourology and the mechanistic aspects of fragmentation. The basics of laser settings and parameter selection, laser fiber selection, and the importance of laser fiber to stone distance for fragmentation are covered. Optimal settings for "dusting" and "fragmentation and retrieval" for laser lithotripsy are reviewed. The efficacy of advanced pulse-modulated holmium lasers and new systems such as the thulium fiber laser is covered, including aspects on laser settings and heat generation, to ensure safe use of lasers in patients.