A Prospective Randomized Trial Comparing Pneumatic Lithotripsy and Holmium Laser for Management of Middle and Distal Ureteral Calculi

Li, Linjin; Pan, Yue; Weng, Zhiliang; Bao, Wenshuo; Yu, Zhixian; Wang, Feng

doi:10.1089/end.2014.0856

Cited by 45 publications

(30 citation statements)

References 21 publications

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“…Any reduction in favor of LL was post- operative ureteral stricture rate. However, this result was mainly driven by the study by Li et al [11], which reported much more postoperative ureteral stricture patients (n = 29) than the other studies (n = 5). However, postoperative ureteral stricture could be due to factors associated with surgical technique, rate of impaction and chronicity of stone presence that were not explicitly reported in their trial.…”

Section: Summary Of Main Findingsmentioning

confidence: 87%

“…Figure 1 shows the process of study selection. All included 8 studies were randomized controlled studies published in 2008-2015 [3,7,[11][12][13][14][15][16] ( table 2 ). According to Cochrane handbook, 1 study was graded as A and 7 studies were graded as B ( table 1 ).…”

Section: Discussionmentioning

confidence: 99%

“…I 2 score for mean operative time rate, postoperative gross hematuria rate and early stone-free rate were 76, 56 and 47%, respectively. The high heterogeneity might be attributed to the following reasons: (1) included trials incorporated different segment ureteral stones -5 studies [3,12,[14][15][16] including proximal, middle, distal ureteral stones; 2 studies [11,13] including middle and distal ureteral stones; and 1 study [7] including upper ureteral stones only. As proximal ureteral stones are more difficult for ureteroscopic lithotripsy, mean operative time should be longer than that of middle and distal ureteral stones.…”

Section: Limitations Of Included Studiesmentioning

confidence: 99%

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Comparison of Holmium: YAG Laser and Pneumatic Lithotripsy in the Treatment of Ureteral Stones: An Update Meta-Analysis

et al. 2016

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Purpose: Holmium YAG laser lithotripsy (LL) and pneumatic lithotripsy (PL) are the most commonly used procedures in the treatment of ureteral calculi. In a previous meta-analysis examining the treatment effect of the 2 modalities, the authors highlighted the need for large sample size and high quality trials to provide more uncovered outcome. Recently, several randomized controlled trials (RCTs) evaluating the same issue with larger patient number and more complicated data have been published. Therefore, we conducted this meta-analysis to update and synthesize evidence on the efficacy and safety of the 2 procedures in the treatment of ureteral calculi. Methods: The relevant studies were identified by searching Medline, EMBASE and Cochrane Library Database from January 1990 to November 2015. RCTs assessing the efficacy and safety of Holmium YAG laser and PL for ureteral stones were included. Two reviewers independently screened studies and extracted data. Results: A total of 8 studies were identified including 1,555 patients. Compared with PL, Holmium YAG LL significantly reduced the mean operative time (weighted mean difference = -11.52, 95% CI -17.06 to -5.99, p < 0.0001) and increased the early stone-free rate (OR 2.69, 95% CI 1.91-3.78, p < 0.00001) and the delayed stone-free rate (OR 2.12, 95% CI 1.40-3.21, p = 0.0004). However, a higher postoperative ureteral stricture rate (OR 3.38, 95% CI 1.56-7.31, p = 0.002) was observed in LL group over PL group. There was no statistical significance in the ureteral perforation rate (OR 1.19, 95% CI 0.65-2.16, p = 0.58), the stone migration rate (OR 0.64, 95% CI 0.41-1.00, p = 0.05), the postoperative gross hematuria rate (OR 0.71, 95% CI 0.40-1.25, p = 0.23) and the postoperative fever rate (OR 0.73, 95% CI 0.50-1.09, p = 0.12). Conclusions: Our data reconfirmed that Holmium LL for ureteral stones can achieve shorter mean operative time, better early and delayed stone-free rate with larger sample size and more high quality studies. And further trials are unlikely to considerably alter this conclusion. In terms of higher risk of postoperative ureteral stricture in LL group over PL group observed in our review, more high quality, multicenter RCTs with long-term follow-up outcome are warranted to better assess this issue.

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Section: Summary Of Main Findingsmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Limitations Of Included Studiesmentioning

confidence: 99%

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Comparison of Holmium: YAG Laser and Pneumatic Lithotripsy in the Treatment of Ureteral Stones: An Update Meta-Analysis

et al. 2016

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“…6,12,13 However, the efficiency of the holmium laser lithotripsy is partially limited by two main factors: stone retropulsion and energy transmission through water, which depends on fiber-stone distance. 8 Since stone retropulsion leads to increased fiber-stone distance, these two factors are combined to reduce efficiency of laser lithotripsy using the conventional Regular mode.…”

Section: Discussionmentioning

confidence: 99%

Moses technology in a stone simulator

Ibrahim

Badaan

Elhilali

et al. 2017

CUAJ

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“…There was no significant difference between the 2 disintegration procedures investigated in this study in terms of our 2 endpoints. According to the latest published international reports, both laser and ballistic lithotripsy are safe and effective means of disintegrating stones -the difference between them being marginal regarding patient safety and therapeutic efficacy [18][19][20][21][22][23]. Li et al [23] compared the pneumatic and laser-assisted disintegration of medium and distal ureteral stones.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Ureteral Damage in Ureteroscopic stone Treatment: Results of the German Prospective Multicentre Benchmarks of Ureterorenoscopic Stone Treatment-Results in Terms of Complications, Quality of Life, and Stone-Free Rates Project

et al. 2018

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Background: The Post-Ureteroscopic Lesion Scale (PULS) is a validated, standardised scale that classifies iatrogenic ureteral lesions during ureteroscopy (URS). Objective: To determine risk factors for the various PULS-grades caused by URS. Method: We prospectively investigated the independent influence of various risk factors in correlation with PULS-Grade 1+ and 2+ on 307 patients with ureterorenoscopic stone treatment from 14 German urologic departments. Results: The following are the outcomes of the study: 117 (38.4%) and 188 (61.6%) of the calculi (median stone size 6 mm) were found in the kidney or ureter; 70% and 82.4% underwent preoperative or postoperative ureteral stenting; 44.3 and 7.2% received laser or ballistic lithotripsy; 60% of the patients presented with PULS grade 1+ and 8% with PULS grade of 2+. Only intracorporal lithotripsy revealed a significant independent risk factor for PULS grade 1+ or 2+. Both laser and ballistic therapies raised the probability of PULS grade 1+ by the factors 3.6 (p < 0.001) and 3.9 (p = 0.021), respectively. The ORs in conjunction with PULS grade 2+ were 3.1 (p = 0.038) and 5.8 (p = 0.014) respectively. Neither endpoint exhibited a significant difference regarding the lithotripsic procedure (laser vs. ballistic). Conclusion: Intracorporal lithotripsy is associated with a significant increase in damage to the ureter; further research is needed to determine its long-term effects.

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A Prospective Randomized Trial Comparing Pneumatic Lithotripsy and Holmium Laser for Management of Middle and Distal Ureteral Calculi

Abstract: Both PL and LL are effective in the management of middle and distal impacted stones. Ho:YAG laser has advantages in better efficacy of stone fragmentation and a higher early stone-free rate but seems to have to face the increased risks of postoperative stricture.

Cited by 45 publications

References 21 publications

Comparison of Holmium: YAG Laser and Pneumatic Lithotripsy in the Treatment of Ureteral Stones: An Update Meta-Analysis

Comparison of Holmium: YAG Laser and Pneumatic Lithotripsy in the Treatment of Ureteral Stones: An Update Meta-Analysis

Moses technology in a stone simulator

Risk Factors for Ureteral Damage in Ureteroscopic stone Treatment: Results of the German Prospective Multicentre Benchmarks of Ureterorenoscopic Stone Treatment-Results in Terms of Complications, Quality of Life, and Stone-Free Rates Project

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