Dernière mise à jour : 15 août 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.
Si vous avez une calcul rénal ou une calcul urétéral et souhaitez discuter du traitement au laser Holmium mini-invasif, le Dr Soarawee Weerasopone propose des consultations spécialisées au siège de l'hôpital de Bangkok. Prendre rendez-vous. Les rendez-vous au Samitivej Sriracha Hospital peuvent être pris en appelant le service d'urologie au 088-022-1445.
Questions fréquemment posées sur la chirurgie des calculs rénaux au laser Holmium
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%.
Le laser Ho:YAG est fortement absorbé par l'eau, ce qui limite la dispersion thermique et protège les tissus environnants des voies urinaires des dommages dus à la chaleur. Il ne peut pas pénétrer plus de 5 cm dans l'air, ce qui le rend sûr pour les chirurgiens. Les systèmes Ho:YAG modernes intègrent une technologie anti-rétropulsion et des modes d'impulsion à haute fréquence qui fragmentent les calculs plus efficacement et réduisent le risque que les calculs soient repoussés dans le rein pendant l'intervention.
La procédure est réalisée sous anesthésie générale ou rachidienne, il n'y a donc aucune douleur pendant l'opération. Après l'opération, les patients peuvent ressentir une légère gêne urinaire, une fréquence ou occasionnellement du sang dans les urines, ce qui disparaît généralement en quelques jours. Un sonde urétérale temporaire est souvent placée après la procédure pour assurer le drainage et est retirée lors d'une visite de suivi. La plupart des patients sortent le jour même ou le lendemain.
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.
La récupération est généralement rapide. La plupart des patients reprennent leurs activités quotidiennes normales dans un délai de 1 à 3 jours et retrouvent toutes leurs activités dans un délai de 1 à 2 semaines. Un sonde urétérale, si elle a été placée, est retirée lors d'une procédure ambulatoire après 1 à 2 semaines. Des examens d'imagerie de suivi post-opératoire sont programmés pour confirmer l'élimination des calculs et surveiller d'éventuels fragments résiduels.
Avertissement : Ce contenu a été rédigé et relu par Dr. Soarawee Weerasopone, urologue certifié au Bangkok Hospital Headquarters. Il est destiné uniquement à des fins éducatives et ne constitue pas un avis médical. Aucun avis médical, diagnostic ou prescription n'est fourni par le biais de messageries personnelles. Consultez toujours un professionnel de santé qualifié avant de commencer tout traitement médical.
Rédigé et examiné par un médecin : Dr Soarawee Weerasopone (Dr. Pom) — Urologue certifié par le conseil d'administration, Bangkok Hospital Headquarters, en pratique urologique depuis 2016. Bourse : Chirurgie robotique, Chang Gung Memorial Hospital, Taïwan (2019) · Stage d'observation : Endourologie, Juntendo University Hospital, Tokyo (2022) · Chercheur invité et observateur clinique, Scott Department of Urology, Baylor College of Medicine, États-Unis (2025-2026).
Le Dr Soarawee Weerasopone (Dr Pom) est urologue certifié par le Board au Bangkok Hospital Headquarters, spécialisé en santé masculine, en chirurgie robotique (da Vinci Xi) et dans le traitement des calculs rénaux. Il a effectué deux fellowships cliniques au Chang Gung Memorial Hospital, à Taïwan (2019), en andrologie et en chirurgie robotique et urologie mini-invasive, une observership en endo-urologie au Juntendo University Hospital, à Tokyo (2022), ainsi qu’un poste de Research Scholar and Clinical Observer au Scott Department of Urology du Baylor College of Medicine, sous la direction du Pr Mohit Khera (2025–2026).
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