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A prospective evaluation of high- and low-power holmium laser settings for transurethral lithotripsy in the management of adults with large bladder calculi

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Abstract

Purpose

To prospectively investigate the efficacy and safety of high-power (100 W) vs low-power (20 W) laser settings for transurethral laser lithotripsy in the management large vesical calculi (> 4 cm).

Methods

All patients with vesical calculi > 4 cm in the maximum dimension and scheduled for transurethral holmium laser lithotripsy were invited to participate in the study. Every alternate patient was treated with either the low- or high-power laser settings. We used a continuous irrigation resectoscope with laser bridge or a laser working element (Karl Storz) for laser lithotripsy of bladder stones. We compared the operative time, intra-operative/post-operative complications (up to 1 year), and stone-free rates between the treatment groups using IBM SPSS Statistics 24 software. Comparisons between treatment groups for continuous variables were assessed using the Welch test, while categorical variables were compared with either the Chi-square or Fisher’s exact test. A p value < 0.05 was considered statistically significant.

Results

Twenty patients with ten in each cohort were recruited. Preoperative data and mean bladder stone size were comparable in both groups. The duration of surgery was significantly reduced from 70.80 ± 25.28 min in low-power cohort to 40.90 ± 15.01 min in the high-power group (p = 0.005). There were no significant intra-operative complications in either group. All patients were stone-free following the procedure.

Conclusion

High-power laser setting of up to 100 W results in a significant reduction in duration of surgery without any increase in the complication rate for treatment of large bladder stones.

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Availability of data and materials

The raw data were lost in a laptop crash in Jan 2020. However, the tables made from same were available.

Abbreviations

Ho:YAG:

Holmium YAG laser

HoLEP:

Holmium laser enucleation of prostate

LL:

Laser lithotripsy

BOO:

Bladder outlet obstruction

BC:

Bladder calculi

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Funding

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Authors and Affiliations

  1. Department of Urology, Miller School of Medicine, University of Miami, Miami, USA

    Abhishek Bhat, Jonathan E. Katz, Indraneel Banerjee, Ruben Blachman-Braun, Kevin Alter, Nicholas Anthony Smith & Hemendra N. Shah

  2. Urolap Superspeciality Clinic and S. L. Raheja (Fortis Associate Hospital), Mumbai, India

    Rashmi H. Shah

Authors
  1. Abhishek Bhat
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  2. Jonathan E. Katz
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  3. Indraneel Banerjee
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  4. Ruben Blachman-Braun
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  5. Kevin Alter
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  6. Rashmi H. Shah
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  7. Nicholas Anthony Smith
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  8. Hemendra N. Shah
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Contributions

AB writing original draft. NAS manuscript editing and review of literature. JK manuscript preparation and review. IB writing review and editing, and resources. RHS resources and data curation. RBB statistical analysis and manuscript editing. KA manuscript preparation and review of literature. SHN conceptualization, methodology, visualization, resources, statistical analysis, and writing review and editing.

Corresponding author

Correspondence to Hemendra N. Shah.

Ethics declarations

Conflict of interest

The authors declare no competing financial interests for this study. Hemendra Shah received $ 1000.00 from Lumenis for mentoring urologist for HoLEP in 2019. All other authors have nothing to disclose.

Ethics approval

Ethics committee approval was not necessary for this study.

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Every patient consented to participate in study.

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Every patient consented to participate in study.

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Supplementary Information

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345_2021_3617_MOESM1_ESM.jpg

Supplementary Figure 1: Scatter plot showing influence of stone size on duration of surgery from various published series in literature grouped in accordance to laser power: low (<20 W), medium (20-40 W) and high power (> 80 W) (JPG 60 KB)

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Bhat, A., Katz, J.E., Banerjee, I. et al. A prospective evaluation of high- and low-power holmium laser settings for transurethral lithotripsy in the management of adults with large bladder calculi. World J Urol 39, 3481–3488 (2021). https://doi.org/10.1007/s00345-021-03617-5

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  • DOI: https://doi.org/10.1007/s00345-021-03617-5

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