In-situ holmium laser lithotripsy for impacted urethral calculi

Urethral calculi usually present as acute retention of urine. The issues in this rare clinical problem are its emergency management scenario, small urethral caliber, and long-term risk of stricture formation. In this retrospective study, the positive experience with the safety and efficacy of holmiumlaser lithotripsy for ureteral calculi was applied to the management of urethral calculi, and the initial results were analyzed.

From October 1999 to June 2003, 42 patients presented with symptomatic urethral calculi. Under anesthesia, an attempt was made to push the calculus back in the bladder using lidocaine jelly. In 18 patients in whom this attempt failed, in-situ intracorporeal holmium lasertripsy was performed under cystourethroscopic guidance.

All the patients were rendered stone free after a single endoscopic procedure. There were no intraoperative or postoperative complications. At a mean follow-up of 22.28 months (range 5-35 months), 17 of the patients having lasertripsy were asymptomatic with no evidence of development of urethral stricture.

Intracorporeal intraurethral holmium lasertripsy is a feasible, safe, and effective minimally invasive alternative for the treatment of impacted male urethral calculi.