title: Holmium:yttrium-aluminum-garnet laser cystolithotripsy of large bladder calculi.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Urology, University of Texas Health Science Center, San Antonio 78284-7845, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Teichman
authors.forename: V J
authors.initials: VJ
authors.lastname: Rogenes
authors.forename: B J
authors.initials: BJ
authors.lastname: McIver
authors.forename: J M
authors.initials: JM
authors.lastname: Harris
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006801:Humans; D017602:Lithotripsy, Laser / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D001744:Urinary Bladder Calculi / Q000628:therapy*