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.
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-micron end-firing
fiber or the 550-micron side-firing fiber.
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.
Holmium:YAG laser cystolithotripsy of large bladder calculi is effective, technically
facile, and safe. The 550-micron side-firing fiber may be better suited for large
bladder calculi compared with the 365-micron end-firing fiber. Holmium:YAG cystolithotripsy
may obviate open cystolithotomy in selected patients.