A Comparison between Pneumatic and Laser Lithotripsy in Ureteral stones less than 15 mm
Seyed Mohammadreza Rabani; Associate Professor of Urology and Renal Transplantation; Beheshti Teaching Hospital; Yasuj University of Medical Sciences; Yusuj; Iran firstname.lastname@example.org; 00989177411389
Seyed Mohammadreza Rabani; Associate Professor of Urology and Renal Transplantation; email@example.com
Aim: Ureteroscopic lithotripsy has traditionally been the favored approach for ureteral stones (1). The aim of this study was to compare the efficacy and safety of pneumatic lithotripsy (PL) and Holmium: Yttrium – Aluminum – Garnet (Ho: YAG) laser lithotripsy (LL) in ureteral stones less than 15 mm.
Methods: Between December 2013 and February 2015, 208 adult patients underwent transurethral lithotripsy (TUL) for ureteral stones less than 15 mm. They were randomly categorized in 2 groups. Group 1, 104 patients underwent TUL with pneumatic lithotripter (PL), using an 8 – 9.8 F semi rigid ureteroscope and group 2, 104 patients underwent TUL with Ho: YAG laser lithotripsy using the same ureteroscope. All of the patients underwent TUL by the same surgeon. Pregnant patients, patients with history of previous operation on the ureter or with ureteral anomaly and cases with failed to access the stone, were excluded from the study. Follow up KUB and sonography was done in both groups the day after operation and again one week later to assess the success rates.
Results: The patient characters (mean age, sex, stone size and location) were almost the same in both 2 groups without statistical significance. Mean operation time for PL group was 25 minutes ( +_6 minutes) and for LL group was 35 minutes ( +_8 minutes). Final stone free rate in pneumatic group was 89.42% and in laser group was 98.07%. Large stone fragments escaped upward and disappeared in the kidney in 11 patients (10.57%) in pneumatic group and in 2 patients (1.92%) of laser group. for the patients with escaped stones DJ stents were inserted with accessory treatment. No major complication was detected in both groups excluding fever, hematuria and pain in early post operative period.
Discussion: Both PL and LL are safe and effective options for ureteral stones less than 15 mm in size. The priority of PL is its more cost effectiveness and saving time and for LL is less possibility of stone migration rate, related to irrigation pressure, and more stone clearance rate.
Key Words: pneumatic lithotripsy, Laser lithotripsy, ureteroscopy