Safety and efficacy of laser lithotripsy for treatment of bladder calculi: evidence from a systematic literature review.

Abstract

Purpose of review: Bladder stones account for 5% of all urinary tract calculi. Contributing factors include bladder outflow obstruction, infections, foreign bodies, or neurogenic voiding dysfunction. This necessitates an effective treatment modality, and with advances in medical technology, minimally invasive techniques using lasers are being widely adopted. This systematic review aims to assess the efficacy and safety of laser lithotripsy for treating bladder stones.

Recent findings: A thorough literature review (PROSPERO: CRD 42024551910) was conducted using appropriate search terms up to March 2024. Only original studies written in English, with at least 10 patients with bladder stones treated with laser, were considered with inclusion. A total of 8 studies (411 patients) were identified on screening with a mean age of 59.6 ± 8.5 years and a male: female ratio of 326 : 14. These reviews covered a geographical area of Asia, Europe, and the USA. The mean stone size was 3.7 ± 0.7 cm, and an overall stone-free rate (SFR) postlaser lithotripsy was 96%. Mean operation time was calculated to be 76.36 ± 47.10 min and an overall complication rate of 16.5% (n = 68), with the most common being haematuria (n = 22), followed by UTI (n = 18), incontinence (n = 8), urosepsis (n = 6), clot retention (n = 4), mucosal injury (n = 3) and urinary retention (n = 3). All complications were minor and there were no Clavien >II complications.

Summary: Laser lithotripsy for bladder stone achieves an excellent success rate in the form of SFR, combined with a low risk of major complications, and allows concomitant treatment of enlarged prostate, and should be considered in all patients.