Laser Lithotripsy at AVS
AVS is now offering cystoscopic guided laser lithotripsy as an alternative to cystotomy for urolith and urethrolith removal. The procedure is performed using a rigid cystoscope in female dogs and a flexible cystoscope in male dogs. A Holmium:YAG laser fiber is directed into the bladder through the cystoscope and then used to fragment the stones to a size <3 mm. The stone fragments are then removed with basket forceps and/or voiding urohydropulsion. Stone removal is assessed by ultrasound and/or radiographs at the end of the procedure. Most patients are able to be discharged the same day. Cystoscopy guided laser lithotripsy is ideal for dogs with a low stone burden composed of small stones. The number and size of stones that is “ideal” varies between dogs based on weight and gender. Generally, the most ideal stone burden is one to three stones with the stones measuring less than 2 cm in diameter. There are limits to the size of the patient that can have this procedure. Most female dogs that weigh more than 10 pounds (5 kg) are candidates. Male dogs should weigh more than 15 lbs (7 kg) to be considered a candidate. Considering the flexible cystoscopehas a limited length, larger male dogs are not candidates for cystoscopy guided laser lithotripsy. If owners are still interested in a “less invasive” procedure, percutaneous cystolithotomy can be performed. This procedure involves making a small abdominal incision to access the bladder. A small incision is then made in the bladder; a threaded cannula is inserted into the bladder to allow back flushing of stones as well as passage of the cystoscope to be introduced into the bladder. Via the cystoscope, remaining calculi can be removed with basket forceps. This procedure can also be considered for dogs with large stone burdens and/or larger stone size. Female cats may also be considered candidates if they have 1-2 stones that are 1 cm or less. If you are interested in pursuing laser lithotripsy or percutaneous cystolithotomy for one of your patients, you may call us to discuss the case or have the patient come in for a referral appointment. Before you call to discuss the case, you can email us radiographs at firstname.lastname@example.org.