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Holmium laser lithotripsy reduces complications and relieves postoperative pain in elderly patients with urinary calculi.

OBJECTIVE
To investigate the effectiveness of ureteroscopic holmium laser lithotripsy (HLL) and pneumatic lithotripsy (PL) in elderly patients with ureteral calculi.


METHODS
In this retrospective study, clinical data of 220 elderly patients with urinary calculi hospitalized in Zhumadian Central Hospital from March 2018 to December 2019 were analyzed. Among the 220, 104 patients were treated with PL (PL group) and the other 116 were treated with HLL (HLL group). The two groups of patients were compared regarding surgical conditions, postoperative complications, physiologic stress response, pain level, and restoration of cognitive and renal function.


RESULTS
Compared with the PL group, the HLL group had significantly shorter surgical duration, earlier time to first ambulation, shorter hospital stay, lower intraoperative bleeding, and higher stone-free rate. No significant differences were observed between two groups in complications. The norepinephrine (NE), cortisol (COR) and C-reactive protein (CRP) levels were all reduced postsurgically, but those in the HLL group were lower than those for PL. The VAS and MMSE scores in the HLL group were lower than those in the PL group at 6, 12, 36 and 48 hours after surgery. The blood urea nitrogen (BUN) and serum creatinine (SCr) levels decreased after surgery, and the decrease was greater in the HLL group. The WHOQOL-BREF scores in HLL group were higher than those of the PL group (P<0.05).


CONCLUSION
Ureteroscopic HLL was shownhighly effective in promoting postoperative rehabilitation and reducing postoperative complications, pain, and physiological stress response, as well as crushing stones, with little impact on cognitive function.