Transurethral Cystolithotripsy With Holmium Laser Under Local Anesthesia in Selected Patients

Objectives

To evaluate the feasibility and effectiveness of transurethral holmium:yttrium-aluminum-garnet (YAG) laser cystolithotripsy under local anesthesia in selected patients.

Methods

Thirteen consecutive male patients with large bladder calculi (3 cm or greater) caused by benign prostatic hyperplasia underwent transurethral cystolithotripsy using holmium:YAG laser under local anesthesia. The operation was performed with all the patients in the lithotomy position (except 3 with pelvic prosthesis). All patients underwent transurethral holmium laser cystolithotripsy (HLC) with a flexible cystoscope under local anesthesia by 1 surgeon. A urethral Foley catheter was placed postoperatively.

Results

Thirteen patients with a mean age of 58.2 years were managed with HLC. All patients were rendered stone-free, regardless of stone size. No patient underwent transurethral resection of the prostate at the completion of the procedure. The mean stone size was 3.6 cm (range 3-5) and the mean operative time was 51 minutes (range 45-65). The whole procedure was well tolerated and no significant differences were found in the mean pain score between the HLC group and a group of male patients who underwent flexible cystoscopy under local anesthesia (2.15 vs 1.86, respectively; P = .467). No major intraoperative complication occurred. The mean hospitalization was 2.3 days. After a mean follow-up of 16.6 months, no recurrent stone, urinary retention, or urethral stricture developed.

Conclusions

Transurethral holmium:YAG laser lithotripsy under local anesthesia appears to be a safe and effective technique for the large bladder calculi. Thus, it may be used as an alternative treatment option in selected patients.