Cystolithotripsy using the Holmium laser: Evolving uses for the laser lithotrite

Abstract

Objective: The optimal management of bladder stones remains unclear, with a range of approaches described. We aim to describe our results using Holmium:YAG laser lithotripsy for the management of bladder stones. Patients and methods: Data were collected prospectively on 20 (19 male, one female) patients undergoing laser lithotripsy for bladder calculi at a single centre from February 2013 to February 2014. The mean patient age was 69.75 years (range 51–87). Patient demographics, stone size, operative details and post-operative events and hospital stay were recorded. A 365 or 550 micron Holmium:YAG laser fibre, with a power setting of 1.0J and a frequency of 10Hz was used in all cases. Results: The mean stone size was 2.2cm (1–4cm). The mean operative time was 32.85 min (15–70 min). Operative time correlated positively with stone size ( r=0.74). Three patients underwent laser stone fragmentation followed by transurethral resection of the prostate (TURP) during the same anaesthetic. Visibility remained clear in all these patients during lithotripsy, allowing complete fragmentation and stone clearance. Intra-operative bleeding was noted during the TURP procedure as expected. There were two episodes of self-limiting post-operative pyrexia but no reported cases of post-operative sepsis. Apart from the three patients undergoing TURP, there were no cases of post-operative bleeding and no cases required blood transfusion. Stone clearance was complete after a single procedure in 100% of cases. The mean hospital stay was 2.5 days (1–7 days), with a mean post-operative stay of 1.8 days. Conclusion: Laser lithotripsy offers a safe and effective management option for bladder stones, including those which are large and hard. It offers the key benefit of lithotripsy under direct vision, with no recorded mucosal injury in our series and thus no intra-operative or post-operative haematuria (outside of the TURP group).