Laser Treatment for Kidney Stones
| Particulars | HoLEP | TURP |
|---|---|---|
| Size of Gland | Any Size | Not greater than 80 grams |
| Hospitalization | 1 - 2 days | More then 4 days |
| Catheter | Less than 24 hours | 48 - 72 hours |
| Irrigation | Normal saline | Glycine |
| Blood Loss | Minimal loss (15 ml o 50 ml] | More than 300 ml |
| Patients on anticoagulants, aspirin and with heart valves and coronary stents | Safe | High Risk |
| Recovery | Very Soon | Few Weeks |
| Risk of stricture, bladder neck contracture & impotence | Insignificant | High Risk |
| Particulars | HoLEP | Other Lasers (Greenlight,PVP, Thulium, etc.) |
|---|---|---|
| Biopsy to detect Prostate Cancer | Possible | Not Possible |
| Published Laser RCT | 8 | 2 (Greenlight); 0 (Thulium) |
| Amount of Enlarged | 82 – 91% | 32 – 51 % |
| Treatment Cost | Economical | Expensive |
Extracorporeal Shock Wave Lithotrispy (ESWL) uses highly focused electro magnetic waves projected from outside the body to crush kidney stones anywhere in the urinary system. The stone is reduced to sand-like particles that can pass in the urine. Large stones may require more than one sessions. It can be used for patients of all age groups and those who have heart and breathing problems. However, the procedure is contraindicated for pregnant women. ESWL by 4th generation “SIEMENS LITHOTRIPTER” with ultrasound attachment helps to treat even radioluscent stones, which are not visible in normal fluoroscopy Lithotripters.
Percutaneous Nephrostolithotomy (PCNL) is performed under epidural or spinal anaesthesia. Percutaneous ( through skin) removal of kidney stones (lithotomy) is accomplished through the most direct route. A telescope along with the mechanical lithotripter in inserted to break the stone into fine particles so as to achieve a stone-free status in large and complicated stones. This procedure usually requires hospitalization, and most patients resume normal activity within 2 weeks.
Ureterorenoscopic Lithotrispy with Holmium Laser is performed under epidural and spinal anaesthesia to treat stones located in the middle or lower ureter. A small, fiberoptic instrument (ureteroscope) is passed into the ureter. Large stones are fragmented using 100-Watt Coherent Holmium Laser. The laser fragments the stone into sand like particles, which are then flushed out through the natural urinary passage. The advantage of Holmium Laser is its ability to fragment stones of all compositions with precision. Thus, it is the most effective laser for the treatment of urinary stones. Patients are generally admitted on the same day of the treatment and are discharged next day, which means only 24 hours of hospitalization is required.
