Impacted ≥ 10-mm pelvic ureteric stone treatment: laser lithotripsy alone or in combination with pneumatic lithotripsy—a prospective, comparative study

Now lithoclast has become more popular tool than various intracorporeal lithotripters for the treatment of ureteric stones. Recently the Holmium:YAG laser has been used with a wide range of potential urological applications, including intracorporeal lithotripsy of ureteric stones. This study was conducted to compare the use of Forceps and Dormia basket in the management of ureteric stone between Holmium: YAG Laser and Pneumatic Lithotripsy. It was a longitudinal follow-up comparative study conducted at Combined Military Hospital, Dhaka. All the respondents were admitted patients in Combined Military Hospital Dhaka, under Urology Ward. A total of 100 patients were enrolled for this study under convenient purposive sampling method. They all were admitted with the complaints of upper ureteric stone who underwent ureteroscopic lithotripsy from October 2010 to September 2012. In 50 patients, Laser Lithotripsy (LL) was used and in other 50 patients Pneumatic Lithotripsy (PL) was used. Same ureteroscope, video monitor, baskets and irrigation devices were used in both the samples. Patients were followed up after 1st and 3rd months interval. Lithotripsy follow-up was done with radiograph and ultrasonography of kidney, ureter and bladder. Patients with migrated fragments or incomplete clearance were underwent an auxiliary procedure such as shock wave lithotripsy. Mean stone size was 1.36 ± 0.36 cm in group Laser lithotripsy (LL) and 1.37± 0.36 cm in group Pneumatic lithotripsy (PL). The immediate stone clearance rate was significantly higher in Group LL (94.0%) than Group PL (76.0%). Proximal migration of fragments were 6.0% in LL group and 24.0% in PL group. Use of stone retrieval equipment (baskets, forceps) was 16.0% and 64.0% in LL and PL group respectively (p<0.05). On the other hand stone fragments clearance requiring auxiliary procedures were 6% and 24% in LL and PL group respectively. The mean lithotripsy time was 40.46 ± 19.25 min and 36.86 ± 14.83 min the LL and PL group respectively. Use of stone retrieval equipment(baskets, forceps) was significantly lower in Holmium: YAG assisted ureteroscopy than pneumatic lithotripsy group. Bangladesh Med J. 2019 Jan; 48 (1): 26-30

Download Full-text

Ureteroscopic Laser Lithotripsy versus Ballistic Lithotripsy for Treatment of Ureteric Stones: A Prospective Comparative Study

Urologia Internationalis ◽

10.1159/000209369 ◽

2009 ◽

Vol 82 (3) ◽

pp. 341-345 ◽

Cited By ~ 22

Author(s):

S. Garg ◽

A.K. Mandal ◽

S.K. Singh ◽

A. Naveen ◽

M. Ravimohan ◽

...

Keyword(s):

Comparative Study ◽

Laser Lithotripsy ◽

Prospective Comparative Study

Download Full-text

Outcome of Lower Ureteric Stone Fragmentation by Laser in Comparison with Pneumatic Lithotripsy

Bangladesh Journal of Urology ◽

10.3329/bju.v23i2.50310 ◽

2020 ◽

Vol 23 (2) ◽

pp. 169-175

Author(s):

SA Anowar Ul Quadir ◽

Khan Nazrul Islam ◽

Md Mostafizur Rahman ◽

Md Shafiqul Alam Chowdhury ◽

SM Mahbub Alam

Keyword(s):

Laser Lithotripsy ◽

Medical College Hospital ◽

Ureteric Stone ◽

College Hospital ◽

Operation Theatre ◽

Medical College ◽

Pneumatic Lithotripsy ◽

Stone Fragmentation ◽

Group A ◽

Group B

Background: Several different modalities are available for ureteral stone fragmentation. From them pneumatic and holmium: yttrium-aluminum-garnet (Ho: YAG) lithotripsy have supportive outcomes. Aims: To see the outcome of lower ureteric stone fragmentation by laser in comparison with pneumatic lithotripsy. Methods: The prospective clinical study was conducted during the period from July 2012 to June 2014 in Dhaka Medical College Hospital. From the patient admitted in Dhaka medical college hospital a total of 60 patient were selected using purposive sampling methods. Selected patients were numbered chronologically and odd number group as group A (laser lithotripsy) and even number group B (pneumatic lithtripsy). Cystoscopy followed by ureterescopy with the help of guide wire was done and stone fragmentation done by either laser lithotripsy (done in general operation theatre in Dhaka Medical College Hospital) or pneumatic lithotripsy (done in Urology operation theatre in Dhaka Medical College Hospital). Collected data were processed and analyzed using computer software SPSS (statistical package for social science), version-18. Un-pair t-test, chisquare test and Fishers Exact probability test were used to analyze the data. The findings of the study showed age and sex are almost identically distributed in both groups. Results: The mean age of group A and group- B were 35.63±11.66 and 38.90±11.21 years respectively. A male predominance was observed in both groups with 70% male in group- A and 53.3% in group-B. Stone size was also observed identically in both groups. 43% of stone are larger than 10mm in group- A and 47% stone are larger than 10mm. None of other baseline variable found very between groups. Immediate stone clearance was much higher in group-A (96.7%) then that in group- B (80%). Although both the groups demonstrated 100% clearance after 1 month. Immediate complications were higher in group B then those of group- A. Ureteral perforation in group B was found 6.7% as opposed to none in group-A. Fever in group A (6.7%) was observed to be more than 3 times higher than in group- B (23.3%). Comparison of complications after 1 and 3 months shows some differences (higher in group-B) but that is not significant. Ureteral stricture developed in 3 patients in group- B compared to nil in group- A. More than 90% of patients of group-A were released from the hospital within 3 days after operation, in contrast about 40% in group-B left the hospital within 3 days. Conclusion: So, laser lithotripsy is better option for the management of lower ureteric stone by using semi rigid ureteroscope, in term of stone migration, rate of stone fragmentation and clearance, operation time, hospital stay and complication. Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.169-175

Download Full-text

Outcome of Uretero Renoscopic Lithotripsy (URSL) with Holmium LASER Vs Pneumatic Lithotripter for Lower Ureteric Stones, Experience from University Hospital of Nepal

Kathmandu University Medical Journal ◽

10.3126/kumj.v18i1.33360 ◽

2020 ◽

Vol 18 (1) ◽

pp. 49-53

Author(s):

H.N. Joshi ◽

A.K. Singh ◽

N. Koirala ◽

R.M. Karmacharya

Keyword(s):

Operation Time ◽

Laser Lithotripsy ◽

University Hospital ◽

Ureteric Stone ◽

Pneumatic Lithotripsy ◽

Stone Free Rate ◽

Stone Migration ◽

And Gender ◽

Free Rate

Background There are various methods of endoluminal ureteral stone fragmentation. Among various modalities Laser lithotripsy and Pneumatic lithotripsy are commonly used and have shown comparable outcomes. Objective To compare the efficacy and outcome of laser and pneumatic lithotripsy in a patient with lower ureteric calculi. The comparison will be done in stone free rate, migration of stone and complication of the procedure. Method This is a prospective comparative study in a cohort of patients at University Hospital with Lower Ureteric stone. Ninety patients were randomized in to two groups (Laser Lithotripsy Vs Pneumatic Lithotripsy) during the study period. The purpose of this study was to measure the immediate stone free rate, intra-operative complications, mean operative time, post-operative complication and if any stone retention after six weeks follow up. Result Both the groups were similar in Age and Gender. Immediate stone free rate was slightly higher in Laser lithotripsy group (97.77%) in comparison to Pneumatic lithotripter group (84.44%) with p=0.507 which is not statistically significant. There was statistical difference in terms of stone migration rate, mean operation time in favor of Laser Lithotripsy group (p<0.01, in both parameters). There were no immediate complications in both the group however there were three cases of short segment ureteric strictures (6.66%) in case of Pneumatic lithotripsy on six weeks follow up which was managed conservatively. Conclusion Both LASER lithotripter and Pneumatic lithotripter are equally efficacious modality of endoluminal URSL in lower ureteric stone with similar Stone Free Rate. Laser lithotripsy showed lower frequency of stone migration and had shorter procedure time.

Download Full-text