Laser lithotripsy vs cystolitholapaxy: bladder stone equipment for the OR

What cystolitholapaxy requires in the OR

Every endoscopic bladder stone set-up shares the same building blocks: an access scope and sheath, optics and a camera, an irrigation system, a stone-fragmentation device and a way to remove fragments. The choice of each block depends on the stone burden, the scopes the department owns and local practice.

Stones in the bladder are typically approached with a cystoscope, a resectoscope sheath or a larger rigid sheath that allows free fragment evacuation. If your list also includes prostate procedures, the same resectoscope set can often be reused, which reduces the number of items to buy.

Access: cystoscope, resectoscope sheath or nephroscope

Wider channels simplify evacuation, so some departments use a resectoscope sheath for bladder stone work. The Richard Wolf SHARK offers continuous-irrigation double sheaths in 22/24 Fr and 24/26 Fr with enlarged irrigation taps, and its inner sheath rotates through 360°. Check the working channel diameter against the fibre or probe you plan to use.

Larger stones or percutaneous routes call for a nephroscope-type rigid instrument with a wide working channel; see our guide on what a nephroscope is for sizes and accessories. Which route is suitable is decided by the surgeon.

Check the continuity of irrigation between the scope and the pump tubing, and ensure the department has the connectors that match its sheaths. Mismatched fittings are a common cause of delays on the day of surgery.

Fragmentation: laser, pneumatic, ultrasonic and mechanical

Laser lithotripsy uses a fibre through the working channel. The MegaPulse 70+ is a 70 W holmium:YAG laser with Lithotripsy, Soft Tissue and Expert modes, pulse width selectable from 50 to 1100 µs in Expert mode, RFID detection of the sterile fibre and a double-pedal footswitch. It is described for stone treatment and soft-tissue work in endourology.

Other methods that appear in cystolitholapaxy instruments lists include pneumatic probes, ultrasonic probes with suction and mechanical crushing lithotrites. Each has different channel, power and consumable needs. Our comparison of pneumatic and laser lithotripsy equipment sets out the framework for choosing.

• Laser: console, fibres, protective eyewear, laser-safety signage.
• Pneumatic: compressed-air console, handpiece, rigid probes.
• Ultrasonic: generator, probe with suction, collection system.
• Mechanical: lithotrite or crushing forceps with compatible sheath.

Irrigation and fragment evacuation

Good visibility depends on irrigation that is both sufficient and controlled. The FLUID CONTROL 2225 pump handles gynecology, urology and general surgery, with up to 1800 ml/min irrigation flow, up to 2000 ml/min suction, an integrated vacuum function for fast fluid exchange and continuous fluid-deficit display with the optional balancing module.

Fragments are removed with a bladder evacuator, suction through a wide sheath or graspers and baskets, depending on size. Plan for the evacuator, collection containers and a way to send fragments for analysis according to the hospital's policy.

Fragment analysis is part of many hospital protocols, so label containers at the point of collection and agree with the laboratory how specimens are transported and recorded.

Reprocessing, safety and buying questions

Scopes, sheaths and graspers follow validated cleaning and sterilization steps, while fibres may be single-use or reusable depending on the model. Laser rooms need warning signs, eye protection and trained staff in line with IEC 60825-1 principles.

Ask suppliers for registration papers, compatible scope lists, service coverage and loan options. Beckfinity's specialists can propose a configuration for your stone list; contact us via our contact page.

A short pre-list checklist helps: scope and sheath assembled, light and camera checked, fibre or probe present, irrigation primed, evacuator available, and laser eyewear within reach of every team member.