A Meta-Analysis and Systematic Review of Holmium Laser Treatment of Bladder Stones

Jie Lv; Ning Wang; Yongsheng Zhu; Qian Luo; Yongxian Li; Jian Li


Transl Androl Urol. 2021;10(8):3465-3475. 

In This Article

Abstract and Introduction


Background: Holmium lasers have been used to treat bladder stones and achieve good therapeutic effects, but its efficacy remains to be explored.

Methods: The PubMed, Embase, Medline, Ovid, Springer, and Web of Sciences databases were searched from their establishment to December 31, 2020. Studies of randomized control trials (RCTs) examining the treatment of vesical calculi by holmium laser lithotripsy were identified. The Cochrane Handbook for Systematic Reviews of Intervention 5.0.2 was used to assess risk bias, and Rev Man5.3 was used to conduct the meta-analysis.

Results: A total of 10 studies, comprising 1,642 subjects, were included. The meta-analysis results showed that the surgery time and the hospitalization time of patients treated with holmium laser lithotripsy decreased, and the calculus removal rate increased. The experimental group had a lower incidence of adverse reactions, such as postoperative urinary tract infection, mucosal damage, vesical perforation, residual calculi, hematuria, and abdominal pain than the control group; however, no notable difference was observed in relation to surgery time, hospital stay, the calculus removal rate, mucosal damage, bladder perforation, hematuria, and abdominal pain between the 2 groups.

Discussion: Holmium laser lithotripsy significantly reduced the hospitalization time of patients treated with holmium laser lithotripsy and elevated the removal rate.


Vesical calculi form in the bladder. In relation to the pathogenesis of vesical calculi, with the exception of cases of malnutrition, the disease is secondary to lower urinary tract obstruction, infection, foreign bodies in the bladder, and metabolic diseases.[1] Clinically, it mainly manifests as pain and hematuria, and its severity depends on the location, size, and the presence or absence of complications.[2]

The principle of clinical treatment is to remove the calculi and prevent them from recurring. Small calculi can be expelled spontaneously through the urethra; however, larger stones that cannot be expelled spontaneously should be treated with surgery.[3] Surgical lithotripsy is the traditional suprapubic cystotomy and lithotripsy; however, due to the extensive damage it causes, it is not conducive to patient recovery.[4] Extracorporeal lithotripsy is a new method that mainly includes extracorporeal shock wave lithotripsy, hydroelectric shock lithotripsy, ultrasonic lithotripsy, and lithotripter lithotripsy. Holmium laser lithotripsy is a new type of treatment for urinary calculi.[5] With yttrium aluminum garnet as the activation medium, the pulsed solid laser device, doped with sensitized ion chromium, energy transfer ion thulium, and activated ion holmium, produces a new type of laser that can vaporize the water between the end of the fiber and the calculus. The energy is then transferred to the calculus to crush it into powder. The water absorbs a great deal of energy, reducing damage to surrounding tissue. Additionally, the holmium laser only penetrates the body tissue by 0.4 mm, and thus has a high level of safety.[6] However, to date, very little research appears to have been conducted on the efficacy of holmium laser lithotripsy on vesical calculi. To confirm the efficacy of this technology, relevant randomized control trials (RCTs) were retrieved, and a meta-analysis was conducted to undertake a systematic analysis. We present the following article in accordance with the PRISMA reporting checklist (available at https://dx.doi.org/10.21037/tau-21-563).