Endoscopic Technology in Cystolithotomy: Systems and Lasers
Cystolithotomy Cluster · Endoscopy Silo · Colombia 2026
Endoscopic technology in cystolithotomy: current systems, lasers, and equipment
Endoscopic cystolithotomy uses high-definition cystoscopes, Holmium/Thulium laser energy, and continuous irrigation systems to fragment and extract bladder stones without open surgery — the complete technical guide
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GSMED Imaging technical team — urological endoscopy Colombia
Based on: EAU Guidelines on Urolithiasis 2025, AUA Stone Guidelines 2023, Olympus Medical (Karl Storz and Olympus cystoscope), Dornier Ho:YAG laser, and endoscopic cystolithotomy clinical literature (Journal of Endourology 2024).
Endoscopic cystolithotomy — also called endoscopic cystolithotripsy or transurethral lithotripsy — is the standard treatment for bladder stones in modern urology. The key to its success is technology: a high-definition cystoscope that perfectly visualizes the stone inside the bladder, and an energy source (laser, ultrasound, or electrohydraulic) that fragments it into extractable particles without incision.
1. The endoscopic system in cystolithotomy
The complete endoscopic cystolithotomy system integrates four technological components that must work in coordination:
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Rigid or flexible cystoscope
The 17–26 French rigid cystoscope with rod lens (Hopkins) provides the highest quality image and the widest working channel for cystolithotomy. The rigid design allows the introduction of larger diameter working instruments and facilitates fragmentation. Olympus and Karl Storz HD cystoscopes offer sufficient resolution to clearly visualize the stones and the surrounding bladder mucosa.
→ 17–26 French · Wide working channel · HD/4K
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HD/4K video tower
The HD or 4K camera connected to the rigid cystoscope projects the image on the operating room monitor in real time. The HD image (1080p) is sufficient for standard cystolithotomy; 4K allows for visualizing fragmentation in greater detail and detecting residual fragments. The Olympus EVIS X1 and Karl Storz IMAGE1 S systems are references in 4K cystoscopy.
→ Standard 1080p HD · 4K in high complexity · Surgical monitor
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Continuous irrigation system
The bladder needs to be distended with fluid throughout the procedure to maintain visibility. The continuous irrigation system provides 1.5% glycine, saline solution, or sterile water (depending on the type of energy used) at controlled flow and pressure. Excessive irrigation pressure increases the risk of bladder reabsorption syndrome.
→ 1.5% Glycine or saline solution · Controlled flow and pressure
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Energy source (laser / US / EH)
The energy source is the component that fragments the stone. The options available in Colombia are: Holmium laser (Ho:YAG), Thulium fiber laser (TFL), pneumatic ultrasonic lithotritor, electrohydraulic lithotritor. Each has different technical characteristics that determine its efficacy and safety depending on the size and hardness of the stone.
→ Ho:YAG Laser · TFL · Ultrasound · Electrohydraulic
2. Fragmentation technologies — technical comparison
| Technology | Mechanism | Ideal stone size | Dust effect | Availability Colombia |
|---|---|---|---|---|
| Holmium Laser (Ho:YAG) | Photothermal — stone vaporization | All sizes | Yes (with Moses configuration) | Available |
| Thulium Fiber Laser (TFL) | Photothermal — greater absorption in water | All sizes | Excellent — very fine dust | Available in advanced centers |
| Pneumatic Lithotritor (Swiss LithoClast) | Pneumatic energy — mechanical fragmentation | Large stones >1 cm | No — fragments that must be extracted | Available |
| Ultrasonic Lithotritor | Ultrasonic vibration — progressive erosion | Medium stones | Partial — small fragments | Available |
| Electrohydraulic (EHL) | Hydraulic shock wave — impact | Soft stones | No — risk of mucosal damage | Available — less used |
3. The Holmium laser with Moses technology — the current standard
Moses Technology (Lumenis) — the evolution of the Ho:YAG laser The Moses technology of the Holmium laser (Lumenis Pulse 120H with Moses 2.0) modulates the shape of the laser pulse to reduce the "recoil" effect of the stone during fragmentation — one of the biggest problems in laser cystolithotomy. The stone tends to move away from the fiber tip with each shot ("ping-pong effect"), lengthening the procedure time. Moses reduces recoil by 80% and increases ablation efficiency. The EAU 2025 guidelines mention Moses as a relevant improvement in ureteroscopy and laser cystolithotomy.
4. Accessory instruments of endoscopic technology
- Nitinol baskets (Dormia): to capture and extract stone fragments during or at the end of the procedure. Nitinol baskets are thermostable and can be used with the laser without risk of melting.
- Foreign body forceps: to extract large fragments that do not pass through the working channel.
- Ellik evacuator: pulsating suction device that connects to the cystoscope at the end of the procedure to evacuate the fragments and residual stone "dust" from the bladder.
- Disposable laser fibers: the 200–550 micron Ho:YAG fibers and the 150–272 micron TFL fibers are introduced through the working channel of the cystoscope. Smaller diameter fibers produce a better "dust" effect and less recoil.
- Three-way urethral catheter: at the end of the procedure, a three-way catheter is left that allows continuous irrigation of the bladder during the first 12–24 hours to prevent obstruction by clots.
What size of bladder stone can endoscopic cystolithotomy treat?
The EAU 2025 guidelines establish endoscopic cystolithotomy as the treatment of choice for bladder stones of up to 3–4 cm. For stones between 1 and 4 cm, the Holmium laser with Moses technology or the TFL with "dust" mode are the most effective. For giant stones (>4 cm), percutaneous cystolithotomy or open cystolithotomy can be more efficient alternatives in terms of total surgical time. However, with a powerful laser (120–180 W) and expert technique, stones of up to 5–6 cm can be fragmented endoscopically in multiple sessions or in one long session.
Urological endoscopy systems available in Colombia — GSMED
Olympus and Karl Storz HD and 4K cystoscopes with local technical support — guidance for endoscopic cystolithotomy.
View cystoscopy systems →
