Treatment guide
Laser Lithotripsy
Also known as: Holmium laser lithotripsy, Thulium fibre laser lithotripsy, Laser stone fragmentation
In brief
Laser lithotripsy is a technique that uses laser energy, delivered through a thin fibre inside an endoscope, to break urinary stones into small fragments or fine dust. It is most often performed during ureteroscopy and requires no skin incision.
Medically reviewed by Dr. Atip Chatsudthipong, MD on
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What is laser lithotripsy?
"Lithotripsy" means breaking stones. In laser lithotripsy, a fibre thinner than a millimetre is passed through the working channel of an endoscope until its tip touches the stone. Pulses of laser light are absorbed by water at the stone's surface, breaking the stone apart.
The holmium:YAG laser has been the standard for many years. The newer thulium fibre laser is also widely used. Settings can be adjusted to produce larger fragments that are removed with a basket ("fragmenting") or very fine particles that wash out with the urine ("dusting").
What conditions does it treat?
- Kidney stones and ureteric stones, usually during ureteroscopy
- Large kidney stones during percutaneous nephrolithotomy (PCNL)
- Bladder stones, through a cystoscope
Lasers are also used for some prostate operations, such as holmium laser enucleation of the prostate (HoLEP). That is a different procedure and is not covered on this page.
Who may be suitable?
Laser lithotripsy is suitable for most people who need a stone treated endoscopically. Because the laser works on stones of any hardness or composition, it is useful when stones are dense, when shock wave lithotripsy is unlikely to succeed, or when direct removal of fragments is desirable.
How is laser lithotripsy performed?
- Under anaesthesia, the urologist reaches the stone with a ureteroscope (or a nephroscope during PCNL).
- The laser fibre is positioned on the stone under direct vision.
- The stone is fragmented or dusted, with care taken to protect the lining of the urinary tract.
- Fragments are removed with a basket or left to pass if they are very small.
- A temporary stent may be placed to help drainage.
How should I prepare, and what anaesthesia is used?
Preparation is the same as for the procedure used to reach the stone: a urine culture, a review of your medicines (especially blood thinners), fasting instructions and an anaesthetic assessment. Most procedures are done under general or spinal anaesthesia.
What are the potential benefits?
- Effective on stones of all compositions, including very hard stones
- Precise — the stone is treated under direct vision
- No skin incision when performed with ureteroscopy
- Fragments can be retrieved for stone analysis to guide prevention
What are the risks?
- Residual fragments, which may pass naturally or occasionally need further treatment
- Infection, bleeding and stent discomfort, as with ureteroscopy
- Rarely, injury to the ureter or kidney lining
What are the alternatives?
Alternatives include observation for small stones, shock wave lithotripsy, and mechanical (pneumatic or ultrasonic) lithotripsy during PCNL. Your urologist will explain which is most appropriate — see Kidney stone treatment options explained.
What is recovery like after laser lithotripsy?
Recovery mirrors that of the access procedure — for ureteroscopy, usually a few days. Mild blood in the urine and passing small gritty fragments are common. Follow-up imaging confirms stone clearance, and stone analysis helps plan prevention.
Laser lithotripsy with Dr. Atip
Dr. Atip will explain whether laser treatment is suitable for your stone and how it fits into your overall plan, including steps to reduce the risk of future stones.
Frequently asked questions
Is laser lithotripsy the same as shock wave lithotripsy?
No. Shock wave lithotripsy (SWL) focuses energy from outside the body. Laser lithotripsy applies laser energy directly to the stone through an endoscope passed inside the urinary tract.
Will I pass stone fragments afterwards?
You may pass small, sand-like fragments for a few days or weeks. This is usually painless or only mildly uncomfortable. Larger fragments are generally removed during the procedure.
References
- 1.Assimos D, et al. Surgical Management of Stones: American Urological Association/Endourological Society Guideline, Part I. J Urol. 2016;196(4):1153–1160. (opens in a new tab)
- 2.European Association of Urology. EAU Guidelines on Urolithiasis. (opens in a new tab)
- 3.NIDDK. Treatment for Kidney Stones. (opens in a new tab)
This information is for general education and does not replace a consultation with a qualified doctor. If you have severe symptoms, seek emergency care (in Thailand, call 1669). See our medical disclaimer.