Holmium:YAG laser lithotripsy for urolithiasis in horses.
Authors: Grant D C, Westropp J L, Shiraki R, Ruby A L
Journal: Journal of veterinary internal medicine
Summary
# Editorial Summary: Holmium:YAG Laser Lithotripsy for Equine Urolithiasis Grant and colleagues evaluated holmium:YAG laser lithotripsy as a minimally invasive alternative to surgical cystotomy for removing bladder and urethral stones in horses, examining six client-owned horses treated between 2006 and 2008 with procedural success defined as complete stone fragmentation and removal. All horses underwent general sedation followed by laser lithotripsy, with quantitative analysis of collected uroliths and detailed microstructural examination of stones from two cases—one successfully fragmented and one resistant to treatment. Five of seven procedures (71%) achieved complete success with no iatrogenic complications attributable to the laser itself, though one horse did develop uroabdomen following manual lithotrite use after laser lithotripsy failure, highlighting the risks of adjunctive mechanical techniques. Microstructural analysis revealed meaningful differences between successfully fragmented and laser-resistant stones, suggesting that urolith composition and crystal architecture significantly influence fragmentation outcomes. For practitioners considering non-surgical stone removal, laser lithotripsy offers promise as an effective option in selected cases, though predicting individual stone responsiveness remains challenging without pre-procedure mineralogical assessment—information that could improve case selection and help clinicians counsel owners on realistic success rates before pursuing this technique.
Read the full abstract on PubMed
Practical Takeaways
- •Laser lithotripsy is a viable non-surgical alternative for equine uroliths with a success rate around 70%, offering potential to avoid more invasive surgical procedures
- •Stone composition and microstructure vary in resistance to laser fragmentation—some stones may require alternative management strategies
- •The procedure itself is safe when performed properly, but iatrogenic complications from alternative techniques following laser failure underscore the importance of proper case selection and technique
Key Findings
- •Laser lithotripsy was successful in 5 of 7 procedures (71.4% success rate) for removal of equine uroliths
- •No complications directly resulted from laser lithotripsy itself
- •Urolith microstructure differences were identified between successfully fragmented and laser-resistant stones
- •One horse developed uroabdomen from manual lithotrite-induced bladder disruption following laser lithotripsy failure