Outpatient transurethral cystolithotripsy of large bladder stones by holmium laser

Introduction: To assessment of the efficacy and safety of transurethral Cystolithotripsy of large bladder stones by holmium laser in the outpatient setting

Methods: In a prospective study 48 consecutive adult patients with large bladder stones, were enrolled for transurethral Cystolithotripsy. Patients older than 18 years, with bladder stones larger than 2 cm were enrolled. Urethral stricture, active urinary infection, and any anesthetic contraindications for operation, were the exclusion criteria. Demographic characteristics of patients, outcomes and complications related to operation and post operation period, were recorded

Results: Patients mean age was 46 +/- 7.3 years. Male to female ratio was 45/3. Mean body mass index of patients was 28.5 +/- 3.5. Mean stone size was 3.7 +/- 1.6 cm. Mean operation time was 43.5 +/- 15.5 minutes. Nearly complete stone clearance [98.5%] was achieved in all patients. Mean hospital stay was 6.5 +/- 1.3 hours. No major complications were seen. Mean visual analog pain score [VAS] was 4.2 +/- 2.1 and 1.4 +/- 0.6, during and 1 hour after operation, respectively. During follow up of 22.4 +/- 12.5 months, recurrence of bladder stone was not seen. No case of urethral stricture was detected

Conclusion: Transurethral holmium laser lithotripsy is an effective and safe alternative in selected patients with large bladder stones. This procedure can be easily performed in the outpatient setting

Direct vision internal urethrotomy with application of holmium: YAG laser

Male urethral stricture is a complicated urologic disease that could be successfully treated using internal urethrotomy. Laser internal urethrotomy has been used in many cases with favorable outcome in many studies. Holmium: YAG laser with its incisional properties on tissue is one of the laser types applied for internal urethrotomy. We present a 19 year-old male with history of aortic valve stenosis and metallic aortic valvoplasty on prescription of oral anti-coagulant therapy [Warfarin] who was a candidate for internal urethrotomy due to bulbar urethral stricture. Holmium laser core-through urethrotomy was performed for him. Internal urethrotomy was done using the ablative 50-watt Holmium: YAG laser 2140 nm [manufactured by the Atomic Energy Organization of Iran [AEOI]]. No complication was observed intra- and post-operatively. After 6 months of followup no evidence of urethral stricture was observed. According to our study, Ho-YAG laser core through urethrotomy is a safe and effective procedure. It is a less invasive alternative to more complex urethroplasty procedures for patients with post-traumatic urethral stricture with high risk of urethral bleeding due to anti-coagulant therapy