Ureteroscopic lithotripsy of ureteric stones; holmium: Yag laser versus pneumatic lithoclast

ABSTRACT

To compare efficacy and safety of pneumatic lithoclast [PL] and Holmium YAG laser lithotripsy [LL]. From May 2004 to October 2006, ninety patients with single ureteric stones of 10 - 20 mm size underwent a single session of ureteroscopic lithotripsy with either pneumatic lithoclast [40 patients] or holmium YAG laser [50 patients]. A 9/ 9.8 Fr semi rigid ureteroscope was used in all patients. Holmium YAG laser with 365m probe was employed in LL group and pulse frequency was set between 5-10 HZ at a power of 10 - 12W. Pneumatic lithoclast with single or continuous pulse mode was used accordingly in PL group. Success is defined by fragmentation of the stone into fragment not bigger than 3 mm with stone free status achieved 6 weeks postoperatively by single session lithotripsy without retrograde stone migration to pelvicalyceal system. Patients were followed by plain KUB X ray or plain helical CT all stone free status. Then underwent TVP evaluation 3 months postoperatively. Both groups were demographically homogenous. Fragmentation into small that can be removed easily with stone basket or forceps or pass eventually was higher in LL than PL group [96% versus 80%] and the stone free status was achieved in 94% in LL and 75% in PL group. Partial ureteral perforation was detected in 7.5% versus 2% in PL and LL group. Hospital stay was 2.9 versus 1.7 days in PL and LL group, respectively. Time to achieve stone free status was shorter in LL than PL group [22 versus 37 days]. Holmium YAG lasertripsy is superior to pneumatic lithotripsy since it effectively fragments all stone types and sizes into smaller fragments even if impacted and if used with care, operative and postoperative complications is negligible