An insight into predominance of pulmonary complications on right side in supracostal percutaneous nephrolithotomy

Purpose: To analyse pulmonary complications following supracostal percutaneous nephrolithotomy especially after right sided supracostal punctures, both in initial and relook PCNL. Material and methods: From February 2016 till date, 90 patients underwent PCNL in Government Medical College, Jammu through supracostal puncture – 53 on right side and 37 on left side. All supracostal punctures were made about 7–8.5 cm from midline. Tract dilatation was done using metal dilators and calculi were fragmented using pneumatic lithotripsy. Patients with supracostal superior calyceal punctures were evaluated for chest complications intraoperatively by fluoroscopy, X-ray chest on evening of postoperative day 0 and repeated thereafter on third and seventh postoperative days. Results: Stone configuration included complete staghorn in 16, partial staghorn in 23, multiple stones in 16 and pelvic stone in 35 cases. Age range of patients was 07–76 years. There was 14.4% (13 out of 90) incidence of early or delayed chest complications – 20.8% (11 out of 53) on right side and 5.4% (2 out of 37) on left side. Conclusion: Pulmonary complications in supracostal punctures; especially on right side should not be underestimated. There are always chances of delayed hydrothorax after supracostal puncture. A chest X-ray should be repeated after 1 week in patients with supracostal PCNL punctures.

Comparative Study between Pneumatic and Holmium Laser Lithotripsy in Treatment of Ureteric Stones

Objective The aim of this study was to compare the efficacy & safety of holmium laser and pneumatic lithotripsy used in the ureteroscopic treatment of ureteral stones. Materials and Methods A prospective randomized clinical study was done using the data of patients to whom ureteroscopic lithotripsy (URL) was applied for ureter stones in our clinic. Then these patients were separated into 2 groups according to the type of lithotriptor used in stone fragmentation as laser lithotripsy (Group 1) and pneumatic lithotripsy (Group 2). Results Statistically, the two groups were similar in respect of the number of stones, stone burden and the number of double J stents applied intra-operatively. Mean operating time was calculated as 62.9 (±7.69) minutes in Group 1 and 50.98 (±6.63) minutes in Group 2. The mean operating time was found to be higher in group 1 than group 2 (P = 0.000). On postoperative day 1 after the URL, the SFR of Group 1 79.0% found to be significantly high compared to the SFR of Group 2 (64.0%) (P = 0.019), while at postoperative month 1, the SFR of both groups (Group 1 84%, Group 2 80%) was found to be similar (P = 0.462). Conclusions Compared to the pneumatic lithotripter, the Ho: YAG laser seems to have a statistically significant higher SFR in the early postoperative period (1 day), even though there are statistically insignificant success rate (after 1 month) and complications (hematuria, mucosa injury, stone migration, stricture and perforation avulsion).

Comparison of pneumatic lithotripsy versus laser lithotripsy for upper ureteral calculi

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.

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

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.

A Novel Approach for the Treatment of Sialolithiasis that Preserves Salivary Duct Anatomy

Objective: The sialendoscopy era in the treatment of salivary gland stones has reduced the use of classical surgical methods. However, the miniature ducts and tools may cause difficulties in removing large sialoliths. Therefore, invasive combined oral surgeries or gland resection may be considered. We searched for the most suitable method in order to stay in line with the minimally invasive approach that preserves the ductus anatomy, and that can reduce the surgical fears of patients. Materials and Methods: The study included 84 cases (23 parotid and 61 submandibular) in whom stones were fragmented by pneumatic lithotripsy and removed between January 2015 and January 2020. The parotid cases comprised 7 females and 16 males, and the submandibular cases comprised 25 females and 36 males. Intraductal lithotripsy was performed using pneumatic lithotripter. This study has fourth level of evidence. Results: Based on total number of cases (n = 84), success rate was 67/84 (79.7%) immediately after sialendoscopy, and overall success rate was 77/84 (91.6%). Based on number of stones treated (n = 111), our immediate success rate was 94/111 (84.6%), and overall success rate was 104/111 (93.7%). The success criteria were complete removal of the stone and fragments in a single sialendoscopy procedure and resolution of symptoms. Conclusions: We successfully treated salivary gland stones, including L3b stones, in our patient cohort with sialendoscopy combined with pneumatic lithotripsy. The lithotripsy method that we have adapted seems to be more useful and cost-effective compared to its alternatives. We were also able to preserve the ductus anatomy and relieve patients’ concerns. Level of Evidence: Level IV

COMPARISON OF SAFETY AND EFFICACY OF PNEUMATIC VERSUS LASER LITHOTRIPSY IN URETERIC STONES

BACKGROUND & OBJECTIVE: Treatments for ureteral calculi evolve, over the past decades from open ureterolithotomy to minimally invasive procedures. Objective of this study is to compare the efficacy of pneumatic versus laser lithotripsy in ureteric stones. METHODOLGY: A RCT study was conducted in Department of Urology Sir Ganga Ram Hospital, Lahore from 1st March 2018 to 31st August 2018. Patients were divided into two groups. In group A, 2 Fr pneumatic probe was used for pneumatic lithotripsy, while in group B, 550 μm fiber probe was used for laser lithotripsy. RESULTS: Efficacy of Group A (pneumatic lithotripsy) was seen in 57 (77.63%) patients while in Group B (laser lithotripsy) was seen in 71 (93.42%) patients with p-value of 0.006 CONCLUSION: Laser lithotripsy in ureteric stones is better as compared to pneumatic lithotripsy.

Comparison of mean operative time in patients undergoing Ho: YAG laser lithotripsy and pneumatic lithotripsy in ureterorenoscopy for ureteric calculus

Objective: To compare the mean operative time (MOT) in patients undergoing Ho: YAG laser lithotripsy (LL) and pneumatic lithotripsy (PL) for ureteric stones. Methods: This randomized study was conducted at Armed Forces Institute of Urology (AFIU) Rawalpindi, Pakistan from July 2016 to November 2018. Non probability consecutive sampling technique utilized to enroll 60 patients of both gender aged 18-60 years, having ureteric calculus ≤1.5cm. Randomization was done into group I (LL) and II (PL) via computer generated number tables. Six Consultant Urologists performed surgeries under spinal anesthesia utilizing Swiss Lithoclast® Master (EMS+ S.A. Switzerland) in group II and holmium laser fiber (365μm, 8-10Hz, 9.6-16W, 2100nm wavelength) in group I respectively. MOT was noted from insertion of cystoscope till removal out of meatus. Data obtained was analyzed through IBM SPSS 24.0. Results: Analysis involved 60 patients (30 each group) having similar baseline characteristics (age, gender, laterality, location). There was statistically significant different MOT between LL & PL (25.48±6.99 vs 34.83±7.47 minutes, p < 0.001). Data stratification with respect to age, gender, laterality and stone location revealed similar trend. Lithotripsy technique significantly affected MOT (p < 0.001) on Multiple Linear Regression Analysis. Conclusions: Ho: YAG LL is an efficient technique when compared with PL in terms of MOT for ureteric stones. doi: https://doi.org/10.12669/pjms.37.2.3049 How to cite this:Sajid MT, Ameen M, Murtaza B, Alvi MS, Khan Z, Kiani F. Comparison of mean operative time in patients undergoing Ho: YAG laser lithotripsy and pneumatic lithotripsy in ureterorenoscopy for ureteric calculus. Pak J Med Sci. 2021;37(2):---------. doi: https://doi.org/10.12669/pjms.37.2.3049 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.