Transurethral holmium-YAG laser lithotripsy for large symptomatic prostatic calculi: initial experience

Abstract

Symptomatic prostatic calculi are a rare clinical entity with wide range of management options, however, there is no agreement about the preferred method for treating these symptomatic calculi. In this study we describe our experience of transurethral management of symptomatic prostatic calculi using holmium-YAG laser lithotripsy. Patients with large, symptomatic prostatic stones managed by transurethral lithotripsy using holmium-YAG laser over 3-year duration were included in this retrospective study. Patients were evaluated for any underlying pathological condition and calculus load was determined by preoperative X-ray KUB film/CT scan. Urethrocystoscopy was performed using 30° cystoscope in lithotomy position under spinal anesthesia, followed by transurethral lithotripsy of prostatic calculi using a 550 μm laser fiber. Stone fragments were disintegrated using 100 W laser generators (VersaPulse PowerSuite 100 W, LUMENIS Surgical, CA). Larger stone fragments were retreived using Ellik's evacuator while smaller fragments got flushed under continuous irrigation. Five patients (median age 42 years) with large symptomatic prostatic calculi were operated using the described technique. Three patients had idiopathic stones while rest two had bulbar urethral stricture and neurogenic bladder, respectively. Median operative time was 62 min. All the patients were stone free at the end of procedure. Median duration of catheterization was 2 days. Significant improvement was observed in symptoms score and peak urinary flow and none of the patient had any complication. Transurethral management using holmium-YAG laser lithotripsy is a safe and highly effective, minimally invasive technique for managing symptomatic prostatic calculi of all sizes with no associated morbidity.

Urethral Steinstrasse following Laser Lithotripsy of Prostatic Urethral Calculi

“…Review of the literature indicates that transurethral holmium-YAG laser lithotripsy offers an attractive approach, specifically for symptomatic prostatic calculi. It is relatively safe without long-term complications [ 1 , 4 ]. This operation pulverizes stones and eliminates fragments until they can pass spontaneously into the bladder.…”

“…Symptomatic and obstructive calculi of the prostatic urethra are an uncommon clinical entity. They are usually seen in older men and are typically incidental findings on digital rectal examination, CT, or other forms of radiological investigation [ 1 ]. The exact prevalence of prostatic calculi is not known, with reports suggesting a range of 7% to 70%.…”

“…Prostatic calculi may be found in association with normal glands, benign prostatic hyperplasia, chronic bacterial prostatitis, or prostate adenocarcinoma and may vary in number from a single calculus to several hundred [ 2 ]. Traditionally, prostatic calculi were managed by open surgery [ 3 ]; however, transurethral laser lithotripsy has been shown to be a less invasive and more effective method [ 1 , 4 ]. Steinstrasse, or “street of stones,” is a known, albeit uncommon, complication of extracorporeal shock wave lithotripsy (ESWL) when incomplete fragmentation occurs, leaving behind residual stone fragments that obstruct urinary flow [ 5 ].…”

The burden of prostatic calculi is more important than the presence

“…Surgical removal of large prostatic calculi is another alternative to reduce calculi burden. Several small series and case reports have been published regarding surgical removal of prostatic calculi 282930. However, well-controlled clinical trials are needed to develop specific prostatic calculi therapy.…”

Large prostatic stones with staghorn renal calculus in a 61-year-old man: an unusual presentation of uncommon disease

“…Residual prostatic cavities after complete stone removal usually result in stasis and infection,13 predisposing to growth of residual fragments or recurrent stone formation. There is currently no available treatment for such residual cavities.…”