Our experience of laser lithotripsy under local anesthesia in the treatment of bladder stones in obese male patients

Abstract

Introduction: Our century has witnessed a significant increase in obesity, which in its turn, bears several major risks in management of systemic anesthesia. In this context, use of this treatment without general or regional anesthesia is of critical importance for patients under this group. Aim: In present study, it was aimed to analyze the efficacy and safety of holmium laser lithotripsy (HLL) under local anesthesia in obese male patients with bladder stones. Material and Method: In our study, we evaluated a total of 64 obese male patients with body mass index (BMI) ≥ 30 kg/m2, diagnosed with bladder stones and treated HLL under local anesthesia. Demographic data, stone size, operative time, urethral catheterization time and length of hospital stay of the patients were analyzed. Visual Analogue Scale (VAS) scores was calculated for each patient during the procedure. Complications were graded according to modified Clavien classification system. Results: The mean age of patients was 50.58 ± 13.04 years and BMI was 33.46 ± 2.59 kg/m2. Mean stone size was 2.51 ± 1.04 cm and operative time was 43.91 ± 15.92 minutes. None of the patients had severe pain and the mean VAS score was calculated as 2.31 ± 1.02. Mean length of hospital stay was 1.25 ± 1.04 days. Grade 3 or higher complications were not observed according to modified Clavien classification system. Mean urethral catheterization time was 1.56 ± 1.45 days, although varying due to underlying etiological factor. All patients were stone-free and there was a marked improvement in clinical findings. Conclusion: Use of HLL under local anesthesia is a safe and efficacious approach in obese male patients with bladder stone.

Keywords

• obesity
• male
• local anesthesia
• holmium laser
• lithotripsy

References

1. 1. Yosuke I, Bo Q, Jennifer P, Rebeccah S, Penny GL. Epidemiology of Obesity in Adults: Latest Trends. Curr Obes Rep 2018; 7: 276–88.
2. 2. Yu S, Xing L, Du Z, et al. Prevalence of Obesity and Associated Risk Factors and Cardiometabolic Comorbidities in Rural Northeast China. Biomed Res Int 2019; 2019: 6509083.
3. 3. Uludağ Ö, Türktan M. Anesthetic Management of Patients with Obesity. Archives Medical Review Journal 2016; 25: 406-19.
4. 4. Trinchieri A. Epidemiology of urolithiasis. Arch Ital Urol Androl 1996; 68: 203-49.
5. 5. Cicione A, DE Nunzio C, Manno S, et al. Bladder stone management: an update. Minerva Urol Nefrol 2018; 70: 53-65. 6. Charlson M. Wells MT, Ullman R, King F, Shmukler C. The Charlson comorbidity index can be used prospectively to identify patients who will incur high future costs. PLoS ONE 2014: 3: e112479.
6. 7. Çam K, Müezzinoğlu T, Kayıkçı A, Aydemir Ö. Validity and Reliability of Turkish Version of Quality of Life Scale Specific for Partners of Patients with Benign Prostatic Hyperplasia. Turkiye Klinikleri J Nephrol 2010; 5: 1-5.
7. 8. Downie WW, Leatham PA, Rhind VW, Wright V, Branco JA, Anderson JA. Studies with pain rating scales. Ann Rheum Dis 1978; 37: 378-81.
8. 9. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey. AnnSurg 2004: 240: 205–13.

9. 10. Douenias R, Rich M, Badlani G, Mazor D, Smith A. Predisposing factors in bladder calculi Review of 100 cases. Urology 1991; 37: 240-3.
10. 11. Tzortzis V, Aravantinos E, Karatzas A, Mitsogiannis IC, Moutzouris G, Melekos MD. Percutaneous suprapubic cystolithotripsy under local anesthesia. Urology 2006; 68: 38-41.
11. 12. Childs MA, Mynderse LA, Rangel LJ, Wilson TM, Lingeman JE, Krambeck AE. Pathogenesis of bladder calculi in the presence of urinary stasis. J Urol 2013; 189: 1347-51.
12. 13. Aydoğdu O. Urinary stone disease and obesity: Different pathologies sharing common biochemical mechanisms. World J Nephrol 2012; 1: 12-5.
13. 14. Juvin P, Lavaut E, Dupont H, et al. Difficult tracheal intubation is more common in obese than in lean patients. Anesth Analg 2003; 97: 595-600.
14. 15. Baltieri L, Peixoto-Souza FS, Rasera-Junior I, Montebelo MI, Costa D, Pazzianotto-Forti EM. Analysis of the prevalence of atelectasis in patients undergoing bariatric surgery. Rev Braz J Anesthesiol 2016; 66: 577–82.
15. 16. Pouwels S, Buise MP, Twardowski P, Stepaniak PS, Proczko M. Obesity Surgery and Anesthesiology Risks: a Review of Key Concepts and Related Physiology. Obes Surg 2019; 29: 2670-7.
16. 17. Adam JP, Murphy PG. Obesity in anaesthesia and intensive care. British Joumal of Anaesthesia 2000; 85: 91-108.
17. 18. Torricelli FCM, Mazzucchi E, Danilovic A, Coelho RF, Srougi M. Surgical management of bladder stones: literature review. Rev Col Bras Cir 2012; 40: 227-33. 19. Demirdağ Ç, Özman O, Çitgez S, Selçuk B, Önal B, Talat Z. Are the Complication Rates for the Open Approach in the Surgical Treatment of Bladder Stones Higher Than Rates for Endoscopic Approaches? A Comparative Multivariate Analysis Study. Journal of Urological Surgery 2018; 5: 165-9.
18. 20. D’Souza, Verma A. Holmium laser cystolithotripsy under local anaesthesia: Our experience. Arab J Urol 2016; 14: 203–6.
19. 21. Papatsoris AG, Varkarakis I, Dellis A, Deliveliotis C. Bladder lithiasis: from open surgery to lithotripsy. Urol Res 2006; 34: 163-7. 22. Kara C, Resorlu B, Cicekbilek I, Unsal A. Transurethral cystolithotripsy with holmium laser under local anesthesia in selected patients. Urology 2009; 74: 1000-3. 23. Gücük A, Kemahlı E. Urolithiasis and Laser. Turk Urol Sem 2011; 2: 142-5.
20. 24. Teichman JM, Rogenes VJ, McIver BJ, Harris JM. Holmium:yttrium-aluminum-garnet laser cystolithotripsy of large bladder calculi. Urology 1997; 50: 44-8.
21. 25. Shah HN, Hegde SS, Shah JN, Mahajan AP, Bansal MB. Simultaneous transurethral cystolithotripsy with holmium laser enucleation of the prostate: a prospective feasibility study and review of literature. BJU Int 2007; 99: 595-600.
22. 26. Garg M, Kumar M, Goel A, Sankhwar SN. Application of the holmium laser lithotripsy for bladder stones under local anaesthesia: a prospective analysis. Urologia 2015; 82: 219-22.
23. 27. Nameirakpam S, Naorem S, Faridi MS, Akoijam KS, Sinam RS. Transurethral Cystolithotripsy of Large Bladder Stones by Holmium Laser as a Day Care Procedure. J Clin Diagn Res 2016; 10: 1-2.
24. 28. Uzun H, Tomak Y, Zorba OU, Bostan H, Kalkan M. Transurethral cystolithotripsy with a ureteroscope under local urethral anaesthesia and sedoanalgesia. J Pak Med Assoc 2013; 63: 961–4.
25. 29. O'Connor RC, Laven BA, Bales GT, Gerber GS. Nonsurgical management of benign prostatic hyperplasia in men with bladder calculi. Urology 2002; 60: 288-91.
26. 30. Philippou P, Volanis D, Kariotis I, Serafetinidis E, Delakas D. Prospective comparative study of endoscopic management of bladder lithiasis: is prostate surgery a necessary adjunct? Urology 2011; 78: 43-7.