scholarly journals Comparison of pneumatic lithotripsy versus laser lithotripsy for upper ureteral calculi

2021 ◽  
Vol 8 (9) ◽  
pp. 2644
Author(s):  
Ershad Hussain Galeti ◽  
Saqib Shahab ◽  
Mriganka Deuri Bharali
Keyword(s):  
Yttrium Aluminum Garnet ◽  
Randomized Study ◽  
Laser Lithotripsy ◽  
Ureteral Calculi ◽  
Pneumatic Lithotripsy ◽  
Stone Fragmentation ◽  
Stone Free Rate ◽  
Mean Size ◽  
Second Procedure ◽  
Free Rate

Background: Several modalities are available for upper ureteric stone fragmentation. From them pneumatic and holmium: yttrium-aluminum-garnet lithotripsy has favourable outcomes. In this study we studied 50 patients who underwent ureteroscopic pneumatic lithotripsy or laser lithotripsy. This study aims to to compare the outcome of PL and LL in the management of upper ureteric calculi.Methods: This is a prospective, randomized study of 50 cases; 25 cases of TUL with pneumatic lithotripter and 25 cases of TUL with laser lithotripter over two years. The purpose of this study was to analyze the factors predicting the stone-free rate, assess the complications following PL and LL, and assess the need for a second procedure if retropulsion of calculi occurs.Results: Two groups were similar in age, gender, mean size of stones, retropulsion and complications. There was a statistical difference in terms of stone free rate in favour of LL group (p≤0.05) and mean operative time in favor of the PL group (p≤ 0.05). Conclusions: In conclusion, we found that both the PL and LL approaches were effective and safe for upper ureteric calculi, but the LL method had advantages, especially in stone free rate, over the PL treatment. Another advantage of the LL method was safe stone fragmentation in upper ureteral calculi due to lower retropulsion rate in contrast with the PL method.

scholarly journals Pneumatic Lithotripsy Versus Laser Lithotripsy for Ureteral Stones

2018 ◽  
Vol 9 (4) ◽  
pp. 233-236 ◽  
Author(s):  
Amir Reza Abedi ◽  
Mohammad Reza Razzaghi ◽  
Farzad Allameh ◽  
Fereshte Aliakbari ◽  
Morteza FallahKarkan ◽  
...  
Keyword(s):  
Yttrium Aluminum Garnet ◽  
Operation Time ◽  
Laser Lithotripsy ◽  
Ureteral Stones ◽  
Pneumatic Lithotripsy ◽  
Stone Free Rate ◽  
Yttrium Aluminum ◽  
Stone Migration ◽  
Mean Size ◽  
Free Rate

Introduction: Several different modalities are available for ureteral stone fragmentation. From them pneumatic and holmium: yttrium-aluminum-garnet (Ho: YAG) lithotripsy have supportive outcomes. In this study we studied 250 subjects who had ureteroscopic pneumatic lithotripsy (PL) or laser lithotripsy (LL). Methods: Two-hundred fifty patients with ureteral stones underwent ureteroscopic lithotripsy (115 subjects in the PL group, 135 subjects in the LL group) from August 2010 to April 2016. The purpose of this investigation was to evaluate stone-free rate (SFR), mean operation time (MOT), mean hospital stay (MHS), stone migration and complications. Results: Two groups were similar in age, gender, mean size of stones, side of stone, and complications. There was a statistical difference in terms of SFR, stone migration and MHS in favor of the LL group (P ≤ 0.05, P ≤ 0.05 respectively), and MOT in favor of the PL group (P ≤ 0.05). Conclusion: Both the PL and LL techniques were effective and safe for ureteral stones, however a slightly higher SFR was found in the LL group.

scholarly journals Outcome of Rirs for Renal Pelvic Stones 1.5 to 2.0 cm using Semi-Rigid Uretero-Renoscopy

2021 ◽  
Vol 2 (2) ◽  
pp. 73-76
Author(s):  
Harris Hassan Qureshi
Keyword(s):  
Renal Pelvis ◽  
Yttrium Aluminum Garnet ◽  
Operating Time ◽  
Renal Stones ◽  
Flexible Ureteroscopy ◽  
Retrograde Intrarenal Surgery ◽  
Stone Fragmentation ◽  
Recommended Treatment ◽  
Stone Free Rate ◽  
Mean Size

Background Retrograde Intrarenal Surgery (RIRS) is among the recommended treatment modality for stones located in renal pelvis and is of less than 2 cm. Renal Stones with Hounsfield units more than 1000 have low stone free rate with ESWL. Objective To determine the outcome of retrograde intrarenal surgery using semirigid ureteroscope in fragmentation of renal pelvic stone. Methods Patients with 1.5-2.0 cm stone located in renal pelvis of more than 1000 HU who underwent retrograde intrarenal surgery as primary procedure at Sindh Institute of Urology And Transplantation were included. Stone fragmentation was achieved with holmium-yttrium aluminum garnet laser. Secondary procedure was performed if complete stone fragmentation was not achieved. Statistical analysis was performed by SPSS version 20. Result Total 82 patients with mean size of pelvic renal stones 1.7 ± 0.53 cm were included. The mean operating time was 32.1±12.9 mins. The stone clearance rate at six weeks after the first procedure was 79.3%. Minor complications including flank pain, fever and hematuria were reported. Conclusion Retrograde intrarenal surgery performed with semi rigid ureteroscope in renal pelvic stones of more than 1000 HU is a technically safe and effective procedure. Keywords: Retrograde intrarenal surgery; Pelvic stone; Flexible ureteroscopy and holmium laser.

scholarly journals COMPARISON OF EFFICACY BETWEEN LASER AND PNEUMATIC LITHOTRIPSY FOR URETERAL STONE MANAGEMENT: A SYSTEMATIC REVIEW AND META-ANALYSIS

2021 ◽  
Vol 28 (2) ◽  
pp. 187-193
Author(s):  
Dillon Martino Wicaksono ◽  
Doddy Moesbadianto Soebadi ◽  
Wahjoe Djatisoesanto ◽  
Fikri Rizaldi
Keyword(s):  
Ureteral Stone ◽  
Meta Analysis ◽  
Laser Lithotripsy ◽  
Forest Plot ◽  
Screening Process ◽  
Pneumatic Lithotripsy ◽  
Plot Analysis ◽  
Stone Free Rate ◽  
Dj Stent ◽  
Free Rate

Objective: This study aimed to evaluate the efficacy of ureteroscopy lithotripsy (URS) using laser lithotripsy compared to pneumatic lithotripsy for ureteral stone management. Material & Methods: A systematic search was conducted in PubMed and ScienceDirect. The search and screening process in this study followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guideline to include relevant RCTs. The included studies were assessed for their risks of bias using the Cochrane risk of bias tool 2 (RoB 2). The comparison of outcomes, which includes stone-free rate, DJ-Stent use, and mean fragmentation time between laser and pneumatic lithotripsy was analyzed using Review Manager 5.4. Results: A total of 11 RCTs evaluating a total of 235 patients with ureteral stone were analyzed in this review. Compared to pneumatic lithotripsy, laser lithotripsy has a significantly higher stone-free rate (OR 2.39, 95% CI 1.78-3.21, p < 0.001), longer mean fragmentation time (MD 4.11, 95% CI 3.17-5.04, p < 0.001), and lower DJ stent use rate (OR 0.53, 95% CI 0.36-0.76) based on the forest plot analysis. Conclusion: Patients undergoing laser lithotripsy have a higher stone-free rate, a lower DJ stent use rate, and albeit a longer mean fragmentation time compared to pneumatic lithotripsy.

scholarly journals A Comparative Study between Holmium Laser, Pneumatic Lithotripsy and Shock Pulse in Terms of Efficacy and Safety in Percutaneous Nephrolithotomy (PCNL) : A Prospective Randomised Study.

2020 ◽  
Vol 3 (1) ◽  
pp. e1-e8
Author(s):  
Rajeev T P ◽  
Sarbartha Kumar Pratihar ◽  
Debanga Sarma ◽  
Saumar Jyoti Baruah ◽  
Sasanka Kumar Barua ◽  
...  
Keyword(s):  
Success Rate ◽  
Holmium Laser ◽  
Shock Pulse ◽  
Efficacy And Safety ◽  
Stone Clearance ◽  
Pneumatic Lithotripsy ◽  
Stone Fragmentation ◽  
Stone Free Rate ◽  
Significant Difference ◽  
Free Rate

Background and ObjectivesPercutaneous nephrolithotomy (PCNL) occupies an essential place in the treatment of upper urinary tract calculi. PCNL also accomplishes higher stone-free rates and requires fewer auxiliary procedures than shock wave lithotripsy (SWL) and ureterorenoscopy (URS) for renal stones between 1–2 cm. There are different intracorporeal lithotripter devices available. This study aims to compare the efficacy and safety of holmium laser, pneumatic lithotripsy and Shock Pulse in PCNL. Materials and MethodsA prospective randomized study was performed in Gauhati Medical College & Hospital, Guwahati, Assam, India, between October 2016 to November 2018. Patients of renal calculi and upper ureteric calculi less than or equal to 2.5cms and functioning kidney on the ipsilateral side were included. 300 patients were randomized according to a random number generator. In the holmium laser, pneumatic and Shock Pulse groups’ number of patients was 96, 102, 102 respectively. Stone disintegration time (SDT), stone-free rate, failure rate, success rate, irrigant used, mean hematocrit drop were evaluated. Statistical analysis was done to compare and predict any significant difference. ResultsPatients were divided into groups depending on the lithotripter used: group A (n=96), group B (n=102), group C (n=102) were holmium laser, pneumatic lithotripsy, and Shock Pulse respectively. No significant difference in stone location (p=0.785),Hounsfield unit (p=0.115),complication rates between the groups. Stone free rate in laser, pneumatic lithotripter, and Shock Pulse were 81.25%, 67.65%, 82.35% (highest in Shock Pulse and lowest in the Pneumatic group) and failure rate were 6.25%, 14.7%, 5.89% respectively. A significant difference was found in terms of stone-free, success rate, clinically insignificant residual fragments(CIRF)and failure rates between the groups(p<0.001). Irrigant requirement (litre/mm3) between the groups is statistically significant (p<0.001) with the highest in Shock Pulse and lowest in the Pneumatic group. Mean hematocrit drop: 4.19%, 4.20%, 5.46% in Laser, Pneumatic and Shock Pulse respectively. No significant difference between Laser and Pneumatic group (p=0.907), but in Shock Pulse group it is significantly higher. (p< 0.001) ConclusionEfficacy of energy sources used in PCNL for stone fragmentation vary in terms of stone clearance, failure rates, SDT, irrigant requirement and mean hematocrit drop. In our study, we found stone clearance signifi-cantly higher in Shock Pulse than Pneumatic and Laser groups. Stone fragmentation volume per unit time highest in Shock Pulse and lowest in Laser. Irrigant requirement highest in Shock Pulse group and compa-rable between Laser and Pneumatic group. The higher irrigant requirement in the Shock Pulse group may be the cause for higher hematocrit drop in this group. Complications between the groups are comparable.  

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

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.

The clinical efficacy of novel vacuum suction ureteroscopic lithotripsy in the treatment of upper ureteral calculi

2021 ◽  
Author(s):  
LvWen zhang ◽  
Yan Song ◽  
Xiang Fei
Keyword(s):  
Clinical Efficacy ◽  
Subgroup Analysis ◽  
Ureteral Calculi ◽  
The Novel ◽  
Total Treatment Cost ◽  
Ureteroscopic Lithotripsy ◽  
Vacuum Suction ◽  
Stone Free Rate ◽  
Total Treatment ◽  
Free Rate

Abstract This study investigated the clinical efficacy of a novel vacuum suction ureteroscopic approach in the treatment of upper ureteral calculi. A total of 160 patients with impacted upper ureteral calculi were included in this study. 50 patients underwent rigid ureteroscopic lithotripsy, 54 patients underwent flexible ureteroscopic lithotripsy, and 56 patients underwent vacuum suction ureteroscopic lithotripsy. The operative time, length of hospitalization, stone-free rate, complication rate and total treatment cost were compared among the three groups. Subgroup analysis was performed based on the stone diameter over and below 1.5 cm. Compared with the other two groups, the vacuum suction ureteroscopy group had higher stone-free rate at 3–5 days (90.0% vs. 61.9% vs. 55.6%, P < 0.05) and 1 month (96.4% vs. 77.7% vs. 74.0%, P < 0.05) postoperatively. In subgroup analysis, the stone-free rate of the vacuum suction ureteroscopy group was significantly higher when the stone diameter was > 1.5 cm at 1 month postoperatively ( P < 0.05); however, there were no differences in postoperative complications.( P > 0.05). In conclusion, the novel vacuum suction ureteroscopic lithotripsy has significantly improved the stone-free rate especially in complicated cases; however the complication and cost was not increased.

scholarly journals Intraductal Pneumatic Lithotripsy after Extended Transoral Duct Surgery in Submandibular Sialolithiasis

2018 ◽  
Vol 160 (1) ◽  
pp. 63-69 ◽  
Author(s):  
Michael Koch ◽  
Mirco Schapher ◽  
Konstantinos Mantsopoulos ◽  
Miguel Goncalves ◽  
Heinrich Iro
Keyword(s):  
Central Element ◽  
Success Rates ◽  
Tertiary Referral Center ◽  
Pneumatic Lithotripsy ◽  
Submandibular Duct ◽  
Stone Free Rate ◽  
Study Setting ◽  
Difficult Part ◽  
Free Rate ◽  
Residual Stones

Objective Persistent, residual, or recurrent stones after transoral duct surgery are always associated with hilar to intraparenchymal and/or multiple sialolithiasis, causing difficulties in the treatment. This study was performed to assess the value of intraductal lithotripsy in the treatment of persistent, residual, or recurrent sialolithiasis after extended duct surgery in the submandibular gland. Study Design Retrospective study covering February 2015 to June 2018. Study Setting Tertiary referral center for salivary gland diseases. Subjects and Methods After extended ductal surgery, 39 patients presenting with persistent, residual, or recurrent stones were treated. Four patients had persistent stones; 16 had residual stones; and 19 presented with recurrent stones. Among these patients, 50 stones were treated with intraductal pneumatic lithotripsy. Fragmentation rate, stone-free rate, and symptom-free rate after treatment with intraductal lithotripsy were outcome measures. Results Of the 39 patients, 97.4% became stone-free, and all were symptom-free. Ninety-eight percent of the stones were completely fragmented. For 23.1% of the patients, >1 stone was treated with intraductal lithotripsy. All patients with persistent stones, 93.7% of those with residual stones, and all with recurrent stones became stone-free and symptom-free. No severe complications developed. Conclusions This study shows that patients presenting with difficult and/or multiple sialolithiasis after extended transoral submandibular duct surgery can be treated with success rates >97%. For multiple sialolithiasis in particular, a multimodal treatment approach with interventional sialendoscopy and intraductal lithotripsy as a central element is a prerequisite for success, as this enables the most difficult part to be performed with high success rates.

Intracorporeal techniques of stone fragmentation

2017 ◽  
Author(s):  
Gastón M. Astroza ◽  
Michael E. Lipkin ◽  
Glenn M. Preminger
Keyword(s):  
Renal Calculi ◽  
Laser Lithotripsy ◽  
Ureteral Stones ◽  
Pneumatic Lithotripsy ◽  
Stone Fragmentation ◽  
Intracorporeal Lithotripsy ◽  
Ultrasonic Lithotripsy ◽  
Laser Fibres ◽  
Power Generation Systems ◽  
Percutaneous Nephrolithotripsy

The use of intracorporeal lithotripsy for the management of larger ureteral and intrarenal calculi has dramatically improved. Although the choice of intracorporeal fragmentation is frequently based on the location and composition of the stone to be treated, the experience of the clinician and availability of equipment often dictates this decision. Several different modalities of intracorporeal lithotripsy are currently available. Ultrasonic lithotripsy is mainly used for the fragmentation of large renal calculi during percutaneous nephrolithotripsy procedures. Ultrasound is used rarely via an ureteroscopic approach. Significant advances in laser fibres and power generation systems have propelled laser lithotripsy to the treatment of choice for fragmentation of most ureteral stones. Pneumatic lithotripsy consists of a pneumatically driven piston which will fragment stones by direct contact.

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