Safety and efficacy of holmium: YAG laser lithotripsy in patients with bleeding diatheses.

Published

Journal Article

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.

Full Text

Duke Authors

Cited Authors

  • Watterson, JD; Girvan, AR; Cook, AJ; Beiko, DT; Nott, L; Auge, BK; Preminger, GM; Denstedt, JD

Published Date

  • August 2002

Published In

Volume / Issue

  • 168 / 2

Start / End Page

  • 442 - 445

PubMed ID

  • 12131284

Pubmed Central ID

  • 12131284

International Standard Serial Number (ISSN)

  • 0022-5347

Digital Object Identifier (DOI)

  • 10.1016/s0022-5347(05)64654-x

Language

  • eng

Conference Location

  • United States