Safety and Efficacy of Holmium: Yag Laser Lithotripsy in Patients With Bleeding Diatheses

Watterson, James; Girvan, Andrew R.; Cook, Albert John; Beiko, Darren; Nott, Linda; Auge, Brian K.; Preminger, Glenn M.; Denstedt, John D.

doi:10.1016/s0022-5347(05)64654-x

Cited by 135 publications

(49 citation statements)

References 22 publications

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“…Eight studies were then retrieved for further assessment, of which three were included in the review (7,8,12). All the included studies were published between 1998 and as recent as 2008, reflecting the continued debate of how to treat stones in patients with bleeding diathesis.…”

Section: Resultsmentioning

confidence: 99%

Flexible ureteroscopy and Holmium:YAG laser lithotripsy for stone disease in patients with bleeding diathesis: a systematic review of the literature

Aboumarzouk¹,

Somani²,

Monga³

2012

Int. braz j urol.

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INTRODUCTION AND OBJECTIVES: The management of urolithiasis in patients on anticoagulants presents a challenge to the endourologist. Due to multiple comorbidities, it may be impossible to safely discontinue the anticoagulant treatment. Other modalities such as shock wave lithotripsy and PCNL are contraindicated in these patients, so ureteroscopic treatment may be the only option. We conducted a systematic review of the literature to look at the safety and efficacy of ureteroscopic management in these patients. METHODS: Systematic review and quantitative meta-analysis was performed using studies identified by a systematic electronic literature search from January 1990 to August 2011. All articles reporting on treatment for stones in patients with a bleeding diathesis using ureteroscopy and a Holmium:YAG laser were included. Two reviewers independently extracted the data from each study. The data was included into a meta-analysis and discussed. RESULTS: Three studies were identified reporting on 70 patients (73 procedures). All patients had stone fragmentation using Holmium laser. The mean stone size was 13.2mm with a range of 5-35mm. The quality of the included studies was modest. Stone free status was achieved in sixty-four patients (87.7%). There were no major complications and only 11% of the patients developed minor complications with only 4% rate of minor bleeding. CONCLUSIONS: Retrograde stone treatment using ureteroscopy and holmium laser lithotripsy can be safely performed in patients with bleeding diathesis with a low complication rate

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Section: Resultsmentioning

confidence: 99%

Flexible ureteroscopy and Holmium:YAG laser lithotripsy for stone disease in patients with bleeding diathesis: a systematic review of the literature

Aboumarzouk¹,

Somani²,

Monga³

2012

Int. braz j urol.

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“…This is because endoscopic procedures with (17). Thus, URS and HLL may be the only option for these patients with coagulopathies since they are often poor candidates for SWL or PCNL due to hemorrhagic and thromboembolic complications (10,13). In the present study, 6 out of 9 patients (patients 1, 2, 4, 5, 8, 9) in Group I undergoing URS and laser lithotripsy had significant stone burden (Table-1).…”

Section: Discussionmentioning

confidence: 58%

“…One patient only had a postoperative bleeding complication related to the procedure, involving an episode of oliguria secondary to a small ureteral clot that was resolved with diuretics. Watterson et al reported on a series of 25 patients who were anticoagulated either pharmacologically or by underlying systemic diseases (13). The overall stone-free rate after a single ureteroscopic procedure was 93%.…”

Section: Discussionmentioning

confidence: 99%

“…However, despite pre-operative correction and apparently normal clotting parameters, patients with coagulopathy have a higher rate of complications and lower efficacy of SWL (12). The safety of URS and holmium laser lithotripsy in patients with coagulopathies without correction of the abnormality have been reported in 3 retrospective studies (10,13,14). Therefore, the aim of the present study was to expand the indications for URS in patients with coagulopathies and compare their outcome with concurrent patients with normal clotting parameters.…”

Section: Introductionmentioning

confidence: 97%

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Ureteroscopy in patients with coagulopathies is associated with lower stone-free rate and increased risk of clinically significant hematuria

2012

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“…[15][16][17][18][19] Other possible indications include prior SWL failure in stones with computed tomography (CT) attenuation value above 1000 Hounsfield units, which portends for lower fragmentation rates with SWL. The increased role of URS in treatment of intrarenal calculi paved the way for the second phase of the Lower Pole Study, which incorporated ureteroscopic management into a randomized trial with SWL and PCNL for lower pole calculi.…”

mentioning

confidence: 99%

Percutaneous nephrolithotomy for the treatment of lower pole renal calculi

Al-Bareeq

Denstedt

2008

CUAJ

Self Cite

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Point / Counterpoint T he management of lower pole renal stones continues to evoke debate, and the ideal treatment remains controversial although several comparative studies have been conducted to evaluate various approaches. In an Internet and postal survey of 205 urologists, 88% preferred shock wave lithotripsy (SWL) for lower pole stones smaller than 10 mm in diameter, 65% for stones between 10 and 20 mm and 21% for stones greater than 20 mm.1 Current practice, however, may not reflect the efficacy of any particular modality. Lower pole calyceal stones continue to pose a dilemma owing to the dependent anatomical location and difficulty in clearance of stone fragments. Sampaio and Aragao 2 first described the anatomical factors that would impede gravity-dependent drainage of stones from the lower pole calices. By performing endocasts of the collecting system of cadaveric kidneys, this group postulated that the infundibulopelvic angle, infundibular length and spatial distribution of the lower pole calices all represented potential contributing features in the equation related to stone clearance. Sampaio and colleagues 3 conducted a prospective trial to determine stone-free rates after SWL, aligned to these anatomical features. They found that 72% of patients were rendered stone-free when the lower pole infundibulopelvic angle was greater than 90 degrees, and only 23% of patients achieved a stone-free state when the angle was less than 90 degrees. Although SWL is less invasive, its limitations for lower pole calculi are outlined in an earlier study by McDougall and associates 4 that retrospectively compared SWL to percutaneous nephrolithotomy (PCNL) for patients with lower pole stones. Overall, there was a significantly lower stone-free rate in patients treated with SWL (56%) compared with the stone-free rate of those undergoing PCNL (85%).Lingeman and coworkers 5 conducted an analysis comparing the 2 modalities including outcomes of more than 3000 patients treated with SWL and 100 with PCNL. Stone-free rates for PCNL were significantly higher (90%) compared with SWL (59%). The authors recommended SWL as a first-line treatment for lower pole calculi measuring 10 mm or less in diameter and PCNL for larger stones. These retrospective studies formed the basis for a multicentre lower pole study group, 6 which conducted the first prospective randomized trial with the aim of determining the optimal treatment of lower pole calculi. The group compared stone-free rates in 52 patients undergoing SWL and 55 randomized to PCNL. Overall stonefree rates for PCNL were far superior to that of SWL (95% v. 37%), retreatments were more common in the SWL group (16% v. 9%) and auxillary procedures were more frequent with SWL patients (16% v. 2%). Stratification by stone size was also consistent with prior studies [7][8][9] demonstrating SWL stone-free rates of 68% for stones smaller than 10 mm in diameter, 55% for stones 10-20 mm and 29% for stones larger than 20 mm. The corresponding stone-free rates for PCNL were 100%, 93% an...

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Safety and Efficacy of Holmium: Yag Laser Lithotripsy in Patients With Bleeding Diatheses

Cited by 135 publications

References 22 publications

Flexible ureteroscopy and Holmium:YAG laser lithotripsy for stone disease in patients with bleeding diathesis: a systematic review of the literature

Flexible ureteroscopy and Holmium:YAG laser lithotripsy for stone disease in patients with bleeding diathesis: a systematic review of the literature

Ureteroscopy in patients with coagulopathies is associated with lower stone-free rate and increased risk of clinically significant hematuria

Percutaneous nephrolithotomy for the treatment of lower pole renal calculi

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