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 manage ment with cystolitholapaxy or electrohydraulic lithotripsy risks compl ications. In an effort to spare patients the morbidity of open cystoli thotomy, the results of holmium:yttrium-aluminum-garnet (YAG) laser cy stolithotripsy for bladder calculi 4 cm or larger were reviewed. Metho ds. Consecutive patients with bladder calculi of 4 cm or larger were m anaged with holmium:YAG laser cystolithotripsy. Laser energy was deliv ered using either the 365-mu m end-firing fiber or the 550-mu m side-f iring fiber. Results. Fourteen consecutive patients were managed with holmium:YAG cystolithotripsy. All patients were rendered stone free, r egardless of stone composition or size. Median anesthesia time was 57 minutes. Twelve of 14 patients were discharged by the first postoperat ive day. The procedure times normalized for stone size (mean +/- stand ard deviation) for the end-firing versus the side-firing fibers were 1 3 +/- 6 min/cm versus 6 +/- 1 min/cm, respectively; P = 0.04.Conclusio ns. Holmium:YAG laser cystolithotripsy of large bladder calculi is eff ective, technically facile, and safe. The 550-mu m side-firing fiber m ay be better suited for large bladder calculi compared with the 365-mu m end-firing fiber. Holmium:YAG cystolithotripsy may obviate open cys tolithotomy in selected patients. (C) 1997, Elsevier Science Inc. All rights reserved.