Simultaneous transurethral cystolithotripsy with holmium laser enucleation of the prostate: a prospective feasibility study and review of literature

Abstract

peri-operative and follow-up data were analysed. Complications during and after surgery were identified to assess the morbidity of procedure. RESULTSThe mean (range) size of bladder calculi was 34.6 (12-70) mm and the preoperative weight of the prostate was 51.9 (11-172) g. Combined HoLEP with transurethral HLC was technically feasible in all patients, and all were stone-free after surgery. The mean operative duration was 97.7 (40-230) min, the weight of prostate tissue removed 34.6 (5-88) g, and the duration of catheterization and hospital stay 29.3 h and 34.8 h, respectively. Complications during and after surgery occurred in 12.5% and 15.6% of patients, respectively; all complication were minor and none caused any residual disability to the patient. No patient required a blood transfusion or developed clot retention. CONCLUSIONSManaging bladder stones and BOO with simultaneous transurethral HLC and HoLEP should be considered the treatment of choice for such cases. Stones of any size and composition, and prostates of practically any size can be treated endoscopically using the holmium laser, with acceptable morbidity once the technique is mastered. The review of previous reports suggested a need for a prospective study comparing endoscopic management of BOO and associated bladder stones, with medical management of BOO and extracorporeal shock wave lithotripsy/endoscopic lithotripsy for bladder stone.

Holmium laser enucleation of the prostate: a review of the clinical trial evidence

“…The clinical efficacy of the holmium laser for fragmentation of urinary tract stones is well established and it is no surprise that HoLEP combined with laser cystolitholapaxy for bladder stones [Shah et al 2007] or HoLEP combined with ureteroscopy and laser stone fragmentation is effective, feasible, and safe [Kim et al 2004]. Other reported combinations in the literature include sequential HoLEP with laparoscopic bladder diverticulectomy [Shah et al 2006], percutaneous nephrolithotomy and insertion and removal of ureteric stents [Kim et al 2004].…”

Tratamento cirúrgico da litíase vesical: revisão de literatura

“…The mean duration of anesthesia was 57 minutes, all patients were free of calculi and were discharged on the first postoperative day. Shah et al 20 described their experience with simultaneous TURP and endoscopic cystolithotripsy with holmium laser. Thirty-two men with bladder calculus of average size of 3.5 cm and an average of 52 grams prostate underwent the combined procedure.…”

Management of bladder stones: the move towards non-invasive treatment

“…Intracorporeal lithotripsy had also been commonly performed simultaneously with trans-urethral resection of prostate (TURP) in male patients of older population with history of bladder outlet obstruction caused by benign enlargement of prostate glands. 5 Nevertheless, it is still being questioned whether performing TURP simultaneously with transurethral cystolitholapaxy is superior to medical therapy for benign prostate hyperplasia (BPH) alone. 16 Both sectio alta and transurethral approach of stone evacuation are more advantageous than ESWL in the fragmentation of larger bladder stones.…”

“…These include mechanical stone crusher, ultrasound, pneumatic and electrohydraulic lithotriptors, and combined ultrasonic/pneumatic lithotripsy device and laser energy sources, each of them with its own advantages and disadvantages. 2,[4][5][6] Alternatively, extracorporeal shock wave lithotripsy (ESWL) also presents a promising management for bladder stones due to its simplicity and tolerability. It is especially indicated in high-risk patients who are poorly tolerant to operative procedures.…”