Moses Augmented Holmium Laser Cystolitholapaxy Is an Effective Safe Method for Treatment of Intravesical Calculi

Abstract

Introduction: Management of intravesical calculi is not uncommon at the time of bladder outlet surgery. 1 With advancement of endourologic surgery and laser technology for lithotripsy, holmium laser cystolitholapaxy (HLC) was first reported in 1997 that helped transform a traditionally open procedure into an endoscopic one. 2 HLC can be effectively performed at the time of benign prostatic hyperplasia (BPH) treatment by holmium laser enucleation of the prostate (HoLEP) and has been shown to be safe. [3][4][5] Moses laser technology has been demonstrated to have improved efficiency of lithotripsy for contact and distance modes. 6 A unique mode, Moses Optimized for BPH, has been developed to optimize this performance for tissue and had been shown beneficial with HoLEP. 7,8 This mode has not been studied for intravesical lithotripsy. Herein, we present our Moses augmented HLC (m-HLC) experience using Moses Optimized for BPH. Materials and Methods: We performed a retrospective review of patients at our institution undergoing HoLEP using Moses laser with concomitant cystolitholapaxy. Moses Optimized for BPH was used for all cases and laser settings of 2 J and 40-60 Hz were utilized for both m-HLC and enucleation. All HoLEPs were performed through a ''bottom-up'' approach per our standard procedure. 9 Patient demographics, operative characteristics, and postoperative outcomes are presented. Results: Twenty patients are included in our cohort from December 2018 through January 2020 who underwent concomitant HoLEP and m-HLC. Median age was 69.6 (interquartile range 62.9-73.0) years, preoperative prostate volume was 96.5 (60-139.5) mL, and bladder stone burden was 3.0 (1.9-4.5) cm. Five (25%) of patients had an indwelling catheter preoperatively. Median procedure time Downloaded by 44.224.250.200 from www.liebertpub.com at 05/09/21. For personal use only.was 103 (80-130) minutes, enucleation time was 48.5 (38.3-58.8) minutes, morcellation time was 7 (3-16) minutes, and enucleated tissue was 63.5 (38.3-100) g. Three (15%) patients underwent concomitant upper tract calculus surgery and six (30%) had a history of nephrolithiasis. There were no intraoperative complications. Nine procedures (45%) were performed as same day dismissal. Eighteen (90%) underwent voiding trial on postoperative day 1. There was one Clavien II complication of spontaneous urinary retention requiring catheterization 10 weeks after HoLEP. The catheter was removed 3 days after placement and patient has had no voiding issues for 6 months. Conclusions: m-HLC is safe and feasible, with excellent lithotrite abilities for intravesical calculi. Moses for BPH is effective for lithotripsy as well as HoLEP. Bladder stones should not require open surgical management if undergoing HoLEP. D.K.A. and C.U.N. have no disclosures. A.E.K. and M.E.R. are paid consultants of Boston Scientific and Lumenis. T.L. is Boston Scientific's paid consultant. This study was IRB approved. Authors have received and archived patient consent for video recording/publication before video ...