Holmium:yttrium-aluminum-garnet laser cystolithotripsy of large bladder calculi

Objectives. Patients with large bladder calculi (4 cm or larger) have traditionally been managed with open cystolithotomy. Endoscopic management with cystolitholapaxy or electrohydraulic lithotripsy risks complications. In an effort to spare patients the morbidity of open cystolithotomy, the results of holmium:yttrium-aluminum-garnet (YAG) laser cystolithotripsy for bladder calculi 4 cm or larger were reviewed. Methods. Consecutive patients with bladder calculi of 4 cm or larger were managed with holmium:YAG laser cystolithotripsy. Laser energy was delivered using either the 365-mu m end-firing fiber or the 550-mu m side-firing fiber. Results. Fourteen consecutive patients were managed with holmium:YAG cystolithotripsy. All patients were rendered stone free, regardless of stone composition or size. Median anesthesia time was 57 minutes. Twelve of 14 patients were discharged by the first postoperative day. The procedure times normalized for stone size (mean +/- standard deviation) for the end-firing versus the side-firing fibers were 13 +/- 6 min/cm versus 6 +/- 1 min/cm, respectively; P = 0.04. Conclusions. Holmium:YAG laser cystolithotripsy of large bladder calculi is effective, technically facile, and safe. The 550-mu m side-firing fiber may be better suited for large bladder calculi compared with the 365-mu m end-firing fiber. Holmium:YAG cystolithotripsy may obviate open cystolithotomy in selected patients. (C) 1997, Elsevier Science Inc. All rights reserved.