Buckshot colic: Utilizing holmium: Yag laser for ureteroscopic removal of a bullet fragment within the proximal ureter

Buckshot colic is a rare phenomenon, presenting as firearm-induced urinary tract obstruction. We present a case of gunshot-induced ureteral obstruction in a 49-year-old male, treated endoscopically with the holmium:YAG (holmium) laser. CT revealed a 1 cm bullet fragment within the left proximal ureter. A percutaneous nephrolithotomy was performed utilizing the holmium laser to fragment the metal into basket-retrievable pieces. At 4 month follow up the patient is without evidence of stricture. To our knowledge, this is the first reported utilization of the holmium laser to treat "buckshot colic". Endoscopy with holmium laser appears a feasible and safe treatment option.