Endoscopic-assisted disruption of urinary calculi using a holmium:YAG laser in standing horses.
Authors: Judy Carter E, Galuppo Larry D
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Endoscopic-assisted holmium:YAG laser lithotripsy in standing horses Urinary calculi in horses present a significant clinical challenge, particularly in males where ischial urethral obstructions can be life-threatening; Carter and Galuppo's 2002 work evaluated whether a holmium:YAG laser could safely fragment these stones whilst the horse remained standing and sedated, avoiding general anaesthesia and its inherent risks. Six horses (four geldings, one stallion, one mare) with naturally occurring calculi underwent ischial urethrotomy to create an endoscopic portal, through which the laser was directed at calcium carbonate stones up to 15 cm in diameter; stone fragments were subsequently removed via lavage, basket snare, forceps, and digital manipulation. All six cases resolved without major operative or postoperative complications, though one mare experienced transient dysuria lasting one month, and two calculi required combined laser ablation with manual lithotrite disruption for complete fragmentation. With mean follow-up of 306 days, the technique proved effective for calculi of the size encountered in this series, offering practitioners a minimally invasive alternative to traditional surgical approaches that reduces anaesthetic risk and may improve recovery outcomes—though the authors appropriately acknowledge uncertainty regarding efficacy for particularly large or densely mineralised stones.
Read the full abstract on PubMed
Practical Takeaways
- •Holmium:YAG laser offers a minimally invasive standing procedure option for urinary calculi in horses, avoiding general anesthesia risks and reducing patient morbidity
- •Technique is most predictable for calculi up to 15 cm and calcium carbonate composition; efficacy for larger or denser stones remains unknown
- •Post-operative dysuria may occur but appears self-limiting; ensure close post-operative monitoring and owner communication about expected recovery timeline
Key Findings
- •Holmium:YAG laser successfully fragmented calcium carbonate urinary calculi up to 15 cm diameter in 6 horses with no major operative or postoperative complications
- •Technique performed in standing, sedated horses using ischial urethrotomy approach with endoscopic guidance
- •Fragment removal achieved through combined lavage, basket snare, forceps, and digital manipulation with mean follow-up of 306 days
- •One mare experienced postoperative dysuria that resolved within 1 month; ischial urethrotomies healed by second intention without infection