Holmium Laser Stone Surgery: What It Is and What to Expect

마지막 업데이트: 8월 15, 2026

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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.

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