Last updated: August 15, 2026
If you have a stone that will not pass on its own, laser surgery is one of the two main ways of dealing with it. The idea sounds alarming — a laser, inside the urinary tract — but in practice it is a keyhole procedure with no cuts at all, and it has become the standard treatment for good reasons.
How the operation works
A thin telescope — flexible or semi-rigid — is passed along the natural urinary passage, through the urethra and bladder and up the ureter, until the stone is in view. A laser fibre is then passed down the scope and used to break the stone into fragments small enough to pass, or into dust. There is no incision anywhere on the body. It is done under general or spinal anaesthesia, so you feel nothing during it.
Why the holmium laser specifically
Endoscopic laser stone surgery was first reported by German and British researchers in 1988, with a success rate of around 84%. Its weakness was retropulsion — the laser’s energy pushing the stone back up into the kidney before it could be broken — which sometimes meant converting to open surgery to retrieve it.
Three decades of development later, the Holmium:Yttrium-Aluminium-Garnet (Ho:YAG) laser is the gold standard for endoscopic stone treatment.
- It is strongly absorbed by water, so its energy dissipates within a fraction of a millimetre and does not heat the surrounding urinary tract — the problem that limited some earlier lasers.
- Modern generators cut retropulsion sharply, using pulse-shaping technology that fragments the stone faster while pushing it far less.
- It cannot travel more than about 5 cm in air, which is why it is safe for the surgical team, with no reported eye injuries.
- Reported success of 95–96% for stones at any position in the urinary tract — kidney, ureter or bladder alike. That versatility is what makes it the default.
Laser surgery or shockwave treatment?
This is the choice most stone patients actually face. Shockwave lithotripsy (ESWL) breaks the stone from outside the body with no instrument entering it at all, and at Bangkok Hospital Headquarters it is a daycare treatment — you go home the same day. Laser surgery is more invasive but clears the stone in a single sitting far more reliably, and works on stones that shockwave struggles with.
Which suits you depends on the stone’s size, position and hardness, on your kidney anatomy, and on how quickly the stone needs to be gone. It is a decision worth making with your urologist rather than by reading success rates — the headline figures come from different patient groups.
What to expect afterwards
Most patients go home the same day or the next. Mild burning, urinary frequency and some blood in the urine are normal for the first few days.
The part worth preparing for is the ureteric (DJ) stent, which is often left in place to keep the ureter draining while it settles. It is removed at a follow-up visit after 1–2 weeks, and until then it commonly causes urinary frequency, urgency and a dragging discomfort in the flank. This surprises patients who expected to feel completely better the moment the stone was gone — the stent, not the surgery, is usually what they notice.
Normal daily activity resumes within 1–3 days and full activity within 1–2 weeks. Follow-up imaging confirms the stone has cleared and looks for any residual fragments.
One last thing worth saying: clearing a stone does not stop the next one forming. If this is not your first, it is worth reading about how recurrence is prevented.
If you have a kidney stone or ureteral stone and would like to discuss minimally invasive Holmium laser treatment, Dr. Soarawee Weerasopone offers specialist consultations at Bangkok Hospital Headquarters. Book a Consultation. Appointments at Samitivej Sriracha Hospital can be arranged by calling the Urology department on 088-022-1445.
Frequently Asked Questions about Holmium Laser Kidney Stone Surgery
Holmium laser ureteroscopy, also called retrograde intrarenal surgery (RIRS), is a minimally invasive endoscopic procedure where a thin flexible or semi-rigid scope is passed through the urethra and ureter to reach the stone. A Ho:YAG laser fiber is then used to fragment the stone into small pieces or dust, which can pass naturally or be extracted. It is the gold standard for treating ureteral and kidney stones with a reported success rate of 95–96%.
The Ho:YAG laser is highly absorbed by water, which limits thermal spread and protects surrounding urinary tract tissue from heat damage. It cannot penetrate more than 5 cm in air, making it safe for surgeons. Modern Ho:YAG systems incorporate anti-retropulsion technology and high-frequency pulse modes that fragment stones more efficiently and reduce the chance of stones being pushed back into the kidney during the procedure.
The procedure is performed under general or spinal anesthesia, so there is no pain during the operation. Post-operatively, patients may experience mild urinary discomfort, frequency, or occasionally blood in urine, which typically resolves within a few days. A temporary ureteral stent is often placed after the procedure to ensure drainage and is removed in a follow-up visit. Most patients are discharged the same day or the following day.
Holmium laser ureteroscopy can treat stones of virtually any size. Current guidelines still list percutaneous nephrolithotomy (PCNL) as first-line for stones larger than 2 cm, but PCNL requires a tract created through the flank into the kidney and is considerably more invasive. Dr. Soarawee’s approach is to attempt retrograde intrarenal surgery (RIRS) with the holmium laser wherever it is feasible, since modern flexible ureteroscopy handles stones of almost any size through the natural urinary passage with no incision. For very small stones under 4–5 mm, spontaneous passage is usually expected without surgical intervention.
Recovery is typically rapid. Most patients resume normal daily activities within 1–3 days and return to full activities within 1–2 weeks. A ureteral stent, if placed, is removed in an outpatient procedure after 1–2 weeks. Post-operative follow-up imaging is scheduled to confirm stone clearance and monitor for any residual fragments.
Disclaimer: This content is written and reviewed by Dr. Soarawee Weerasopone, a board-certified urologist at Bangkok Hospital Headquarters. It is intended for educational purposes only and does not constitute medical advice. No medical advice, diagnosis or prescription is provided through personal messaging channels. Always consult a qualified healthcare professional before starting any medical treatment.
Medically written & reviewed by: Dr. Soarawee Weerasopone (Dr. Pom) — Board-Certified Urologist, Bangkok Hospital Headquarters, in urological practice since 2016. Fellowship: Robotic Surgery, Chang Gung Memorial Hospital, Taiwan (2019) · Observership: Endourology, Juntendo University Hospital, Tokyo (2022) · Research Scholar & Clinical Observer, Scott Department of Urology, Baylor College of Medicine, USA (2025–2026).
Dr. Soarawee Weerasopone (Dr. Pom) is a board-certified urologist at Bangkok Hospital Headquarters, specializing in Men’s Health, Robotic Surgery (da Vinci Xi) and Kidney Stone treatment. He is currently a Research Scholar and Clinical Observer at the Scott Department of Urology, Baylor College of Medicine (2025–2026), under Prof. Mohit Khera. He completed a Robotic Surgery Fellowship at Chang Gung Memorial Hospital, Taiwan (2019) and an Endourology Observership at Juntendo University Hospital, Tokyo (2022).
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