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


Vesical calculi can be divided into primary and secondary vesical calculi.[15] The former refers to stones formed in the bladder that mostly arise due to malnutrition and occur more frequently in children.[16] The latter refers to stones from upper urinary tract or secondary to lower urinary tract obstruction, infection, bladder foreign body, or neurogenic bladder . In developed countries, vesical calculi mainly occur in elderly men who often suffer from prostatic hyperplasia or urethral stricture.[17] Conversely, in developing countries, the disease is more common in children and less common in women than men. If not treated in time, it will cause urinary tract infection and obstruction, resulting in poor drainage, and even leading to kidney failure in severe cases. Errors can occur in traditional lithotripsy treatments, and there are always residual stones that can cause a secondary blockage. Further, as the recovery effects are poor, it has limited clinical use.[18] Developments in medical technology led to the introduction of the holmium laser lithotripsy treatment method, which has significantly improved the therapeutic effects and safety of patients, and reduced patients' adverse reactions after the surgery.[19–21]

A total of 10 studies were included. It was found that the experimental group had shorter the surgery time and hospital stay, and a higher calculus removal rate. Studies have shown that, holmium laser lithotripsy demonstrates good safety and has been extensively used.[22]

Extracorporeal shock wave lithotripsy uses hydroelectric or electromagnetic shock wave generators to emit high-energy shock waves that penetrate the human body, and crush the stones. The stone fragments are naturally discharged. However, the shock waves also cause tissue damage, such as the destruction of glomeruli and tubules, and ureteral stenosis.[23] Similarly, when pneumatic lithotripsy is used to treat middle and lower ureteral calculi, it is easy to flush stones back into the upper ureter or kidney, and as the method can only be used under rigid ureteroscopy, it cannot be used to treat upper ureteral calculi and kidney stones.[24] Compared with the 2 methods mentioned above, holmium laser lithotripsy demonstrates better therapeutic effects. As the stones rarely move during the lithotripsy process and the backlash rate is very low, its efficiency is high.[25] The cystoscopy, ureteroscopy, and percutaneous nephroscope can directly crush the stones without causing tissue damage. Additionally, the holmium laser fiber is flexible and can not only be inserted through a rigid ureteroscope, but also through a flexible ureteroscope for lithotripsy.[26] Thus, it can effectively crush stones in any part of the body.