Cystoscopic & urethroscopic laser lithotripsy
Laser lithotripsy provides a minimally invasive way to remove stones from the bladder and urethra
The American College of Veterinary Internal Medicine recommends removing both bladder and urethral stones associated with clinical signs by minimally invasive procedures such as laser lithotripsy and/or percutaneous cystolithotomy (PCCL) instead of conventional surgery (cystotomy)
A cystoscope is placed into the urethra and subsequently into the bladder. A laser fiber is passed through the working channel of the cystoscope and when activated, the laser causes evaporation of fluid used to fill the bladder/urethra, then a bubble, and subsequently a shockwave forms leading to fragmentation of the stone.
Laser lithotripsy in a large bladder calculus
Laser lithotripsy is commonly associated with a procedure called percutaneous cystolithotomy (PCCL). Laser lithotripsy done endoscopically does not require an incision. All of the stone fragments are removed via basket and flushing at the end of the procedure. The cystoscope is passed back and forth to remove the fragments via basket. In high stone burden cases, this means that the scope will go in and out through the urethra many times. This can lead to some edema of the urethra and discomfort urinating post-procedure. In order to minimize any discomfort, we recommend doing a PCCL approach. In this approach, the cystoscope goes directly into the bladder, bypassing the urethra and thus eliminating any trauma to the urethra. The urethra will still be inspected with the cystoscope and any urethral calculi will still be eliminated, but the fragments will go through the 6 mm Entotip port that is used to enter into the bladder.
In the example above, the stone fragments were removed via PCCL.
Laser lithotripsy in a lodged urethral calculus
Besides being minimally invasive, laser lithotripsy plays a key role in patients with urethral stones that are stuck in the urethra. The treatment options for patients with urethral stones that are causing an obstruction include cystotomy tube placement, rerouting the urethra, or cutting into the urethra. Cutting into the urethra should be avoided at all costs given the possible development of urethral stricture (narrowing of the urethra secondary to healing and scar tissue formation post-surgery.
Laser lithotripsy on calculi outside urethra
This dog underwent a cystotomy for bladder and urethral calculi struvite calculi, and concurrent urinary tract infection. One of the stones became lodged in the urethra and was torn during attempts to dislodge the calculus. The stone was lasered in the peri-urethra area. The fragments were then removed via urethra.
Urethral calculus embedded in the urethra
