Application of the holmium laser lithotripsy for bladder stones under local anaesthesia: a prospective analysis

Purpose: The purpose of this study is to determine the feasibility and the results of intracorporal holmium laser (HL) lithotripsy in patients with bladder calculus under local anaesthesia. Materials and Methods: From January 2009 to August 2012, 46 patients underwent HL lithotripsy for bladder calculus under local anaesthesia. Twelve patients who had associated medical comorbidity also underwent the procedure. The pain was evaluated with 10-point visual analogue scale during and 1 h after completion of the procedure. Foley catheter was inserted at the end of procedure in all the patients. Results: In the present study, the mean stone size was 2.1 cm (1.1-4.2 cm) and the mean operative time was 43 min (range 23-57 min). All patients were rendered stone-free in a single sitting except one patient. The mean pain score intraoperatively and in the postoperative period was 3.84 and 1.47, respectively. There was no major complication during surgery. The procedure was well tolerated and most of the patients were discharged on the same day. After the follow-up period of 3 months, all patients were asymptomatic except one patient who developed a soft stricture in the bulbar urethra and was managed by internal urethrotomy. Conclusions: Bladder stones can be safely managed by HL lithotripsy under local anaesthesia with a high success rate and minimal morbidity. The procedure is even feasible in high-risk patients with medical comorbidities without extra risk.