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Safety and efficacy of holmium: YAG laser lithotripsy in patients with bleeding diatheses.
J Urol. 2002 Aug; 168(2):442-5.JU

Abstract

PURPOSE

We assessed the safety and efficacy of ureteroscopy and holmium:YAG laser lithotripsy for treating upper urinary tract calculi in patients with known and uncorrected bleeding diathesis.

MATERIALS AND METHODS

We retrospectively reviewed the charts at 2 tertiary stone centers to identify patients with known bleeding diathesis who were treated with holmium:YAG laser lithotripsy for upper urinary tract calculi. A total of 25 patients (29 upper urinary tract calculi) underwent ureteroscopic holmium laser lithotripsy. Bleeding diathesis involved warfarin administration for various conditions in 17 patients, liver dysfunction in 3, thrombocytopenia in 4 and von Willebrand's disease in 1. The mean international normalized ratio, platelet count and bleeding time were 2.3, 50 x 109/l. and greater than 16 minutes in patients on warfarin and in those with liver dysfunction, thrombocytopenia and von Willebrand's disease, respectively.

RESULTS

Overall the stone-free rate was 96% (27 of 28 cases) and 29 of 30 procedures were completed successfully without significant complication. In a patient treated concomitantly with electrohydraulic lithotripsy significant retroperitoneal hemorrhage required blood transfusion.

CONCLUSIONS

Upper tract urinary calculi in patients with uncorrected bleeding diathesis can be safely managed by contemporary small caliber ureteroscopes and the holmium laser as the only modality of lithotripsy. Ureteroscopic holmium laser lithotripsy without preoperatively correcting hemostatic parameters limits the risk of thromboembolic complications and costs associated with an extended hospital stay. Avoiding electrohydraulic lithotripsy is crucial for decreasing bleeding complications in this cohort of patients.

Authors+Show Affiliations

Division of Urology, University of Western Ontario, London, Ontario, Canada.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

12131284

Citation

Watterson, James D., et al. "Safety and Efficacy of Holmium: YAG Laser Lithotripsy in Patients With Bleeding Diatheses." The Journal of Urology, vol. 168, no. 2, 2002, pp. 442-5.
Watterson JD, Girvan AR, Cook AJ, et al. Safety and efficacy of holmium: YAG laser lithotripsy in patients with bleeding diatheses. J Urol. 2002;168(2):442-5.
Watterson, J. D., Girvan, A. R., Cook, A. J., Beiko, D. T., Nott, L., Auge, B. K., Preminger, G. M., & Denstedt, J. D. (2002). Safety and efficacy of holmium: YAG laser lithotripsy in patients with bleeding diatheses. The Journal of Urology, 168(2), 442-5.
Watterson JD, et al. Safety and Efficacy of Holmium: YAG Laser Lithotripsy in Patients With Bleeding Diatheses. J Urol. 2002;168(2):442-5. PubMed PMID: 12131284.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Safety and efficacy of holmium: YAG laser lithotripsy in patients with bleeding diatheses. AU - Watterson,James D, AU - Girvan,Andrew R, AU - Cook,Anthony J, AU - Beiko,Darren T, AU - Nott,Linda, AU - Auge,Brian K, AU - Preminger,Glenn M, AU - Denstedt,John D, PY - 2002/7/20/pubmed PY - 2002/8/17/medline PY - 2002/7/20/entrez SP - 442 EP - 5 JF - The Journal of urology JO - J Urol VL - 168 IS - 2 N2 - PURPOSE: We assessed the safety and efficacy of ureteroscopy and holmium:YAG laser lithotripsy for treating upper urinary tract calculi in patients with known and uncorrected bleeding diathesis. MATERIALS AND METHODS: We retrospectively reviewed the charts at 2 tertiary stone centers to identify patients with known bleeding diathesis who were treated with holmium:YAG laser lithotripsy for upper urinary tract calculi. A total of 25 patients (29 upper urinary tract calculi) underwent ureteroscopic holmium laser lithotripsy. Bleeding diathesis involved warfarin administration for various conditions in 17 patients, liver dysfunction in 3, thrombocytopenia in 4 and von Willebrand's disease in 1. The mean international normalized ratio, platelet count and bleeding time were 2.3, 50 x 109/l. and greater than 16 minutes in patients on warfarin and in those with liver dysfunction, thrombocytopenia and von Willebrand's disease, respectively. RESULTS: Overall the stone-free rate was 96% (27 of 28 cases) and 29 of 30 procedures were completed successfully without significant complication. In a patient treated concomitantly with electrohydraulic lithotripsy significant retroperitoneal hemorrhage required blood transfusion. CONCLUSIONS: Upper tract urinary calculi in patients with uncorrected bleeding diathesis can be safely managed by contemporary small caliber ureteroscopes and the holmium laser as the only modality of lithotripsy. Ureteroscopic holmium laser lithotripsy without preoperatively correcting hemostatic parameters limits the risk of thromboembolic complications and costs associated with an extended hospital stay. Avoiding electrohydraulic lithotripsy is crucial for decreasing bleeding complications in this cohort of patients. SN - 0022-5347 UR - https://www.unboundmedicine.com/medline/citation/12131284/Safety_and_efficacy_of_holmium:_YAG_laser_lithotripsy_in_patients_with_bleeding_diatheses_ L2 - https://www.jurology.com/doi/10.1016/s0022-5347(05)64654-x?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -