• Logo
  • SBMUJournals

Outpatient Transurethral Cystolithotripsy of Large Bladder Stones by Holmium Laser

Hosein Karami, Moahammad Reza Razaghi, Babak Javanmard, Mohammad Yaghoobi, Amin Hasanzadeh Hadad, Maryam Amani, Amin Golmohammadi Taklimi




Introduction: To assessment of the efficacy and safety of transurethral cystolithotripsy of large bladder stones by holmium laser in the outpatient setting.

Methods: In a prospective study, 48 consecutive adult patients with large bladder stones, were enrolled for transurethral cystolithotripsy. Patients older than 18 years, with bladder stones larger than 2 cm were enrolled. Urethral stricture, active urinary infection, and any anesthetic contraindications for operation, were the exclusion criteria. Demographic characteristics of patients, outcomes and complications related to operation and post operation period, were recorded.

Results: Patients mean age was 46 ± 7.3 years. Male to female ratio was 45/3. Mean body mass index of patients was 28.5 ± 3.5. Mean stone size was 3.7 ± 1.6 cm. Mean operation time was 43.5 ± 15.5 minutes. Nearly complete stone clearance (98.5%) was achieved in all patients. Mean hospital stay was 6.5 ± 1.3 hours. No major complications were seen. Mean visual analog pain score (VAS) was 4.2 ± 2.1 and 1.4 ± 0.6, during and 1 hour after operation, respectively. During follow up of 22.4 ± 12.5 months, recurrence of bladder stone was not seen. No case of urethral stricture was detected.

Conclusion: Transurethral holmium laser lithotripsy is an effective and safe alternative in selected patients with large bladder stones. This procedure can be easily performed in the outpatient setting.


Transurethral; Bladder stone; Holmium laser


Schwartz BF, Stoller ML. The vesical calculus. Urol Clin North Am. 2000;27(2):333-346.

Miller DC, Park JM. Percutaneous cystolithotomy using a laparoscopic entrapment sac. Urology. 2003;62(2):333-336.

Philippou P, Moraitis K, Masood J, Junaid I, Buchholz N. The management of bladder lithiasis in the modern era of endourology. Urology. 2012;79(5):980-986. doi:10.1016/j. urology.2011.09.014.

Bhatia V, Biyani CS. Vesical lithiasis: open surgery versus cystolithotripsy versus extracorporeal shock wave therapy. J Urol. 1994;151(3):660-662.

Delakas D, Daskalopoulos G, Cranidis A. Experience with the Dornier lithotriptor MPL 9000-X for the treatment of vesical lithiasis. Int Urol Nephrol. 1998;30(6):703-712.

Sofer M, Kaver I, Greenstein A, et al. Refinements in treatment of large bladder calculi: simultaneous percutaneous suprapubic and transurethral cystolithotripsy. Urology. 2004;64(4):651-654. doi:10.1016/j.urology.2004.04.067.

Tzortzis V, Aravantinos E, Karatzas A, Mitsogiannis IC, Moutzouris G, Melekos MD. Percutaneous suprapubic cystolithotripsy under local anesthesia. Urology. 2006;68(1):38-41. doi:10.1016/j.urology.2006.01.073.

Wollin TA, Singal RK, Whelan T, Dicecco R, Razvi HA, Denstedt JD. Percutaneous suprapubic cystolithotripsy for treatment of large bladder calculi. J Endourol. 1999;13(10):739-744.

Kara C, Resorlu B, Cicekbilek I, Unsal A. Transurethral cystolithotripsy with holmium laser under local anesthesia in selected patients. Urology. 2009;74(5):1000-1003. doi:10.1016/j.urology.2009.05.095

Gould DL. Holmium:YAG laser and its use in the treatment of urolithiasis: our first 160 cases. J Endourol. 1998;12(1):23- 26.

Teichman JM, Rogenes VJ, McIver BJ, Harris JM. Holmium:yttrium-aluminum-garnet laser cystolithotripsy of large bladder calculi. Urology. 1997;50(1):44-48. doi:10.1016/S0090-4295(97)00201-X.

Ashworth M. Endemic bladder stones. BMJ.1990;301(6756):826-827.

Douenias R, Rich M, Badlani G, Mazor D, Smith A. Predisposing factors in bladder calculi. Review of 100 cases. Urology. 1991;37(3):240-243.

Papatsoris AG, Varkarakis I, Dellis A, Deliveliotis C. Bladder lithiasis: from open surgery to lithotripsy. Urol Res. 2006;34(3):163-167. doi:10.1007/s00240-006-0045-5.

Kostakopoulos A, Stavropoulos NJ, Makrichoritis C, Picramenos D, Deliveliotis C. Extracorporeal shock wave lithotripsy monotherapy for bladder stones. Int Urol Nephrol. 1996;28(2):157-161.

Bhatia V, Biyani CS. Extracorporeal shock wave lithotripsy for vesical lithiasis: initial experience. Br J Urol. 1993;71(6):695-699.

Papatsoris A. Twin amplatz sheath method: a modified technique of percutaneous cystolithotripsy for large bladder stone in females. J Surg Tech Case Rep. 2013;5(2):111-112. doi:10.4103/2006-8808.128755.

Teichman JM, Vassar GJ, Bishoff JT, Bellman GC. Holmium:YAG lithotripsy yields smaller fragments than lithoclast, pulsed dye laser or electrohydraulic lithotripsy. J Urol. 1998;159(1):17-23.

Wollin TA, Denstedt JD. The holmium laser in urology. J Clin Laser Med Surg. 1998;16(1):13-20.

Wiener SV, Deters LA, Pais VM, Jr. Effect of stone composition on operative time during ureteroscopic holmium:yttrium-aluminum-garnet laser lithotripsy with active fragment retrieval. Urology. 2012;80(4):790-794. doi:10.1016/j.urology.2012.05.040

Shah HN, Hegde SS, Shah JN, Mahajan AP, Bansal MB. Simultaneous transurethral cystolithotripsy with holmium laser enucleation of the prostate: a prospective feasibility study and review of literature. BJU Int. 2007;99(3):595-600. doi:10.1111/j.1464-410X.2006.06570.x

DOI: https://doi.org/10.22037/jlms.v7i1.8464