Comparison of Efficacy and Complications of Holmium Laser and Pneumatic Lithotripters Used in the Ureterorenoscopic Treatment of Proximal Ureter Stones, a Multi-Center Study of Society of Urological Surgery Aegean Study Group

Abstract

What's known on the subject? and What does the study add?Objective: The aim of this study is to compare the efficacy and complications of holmium laser and pneumatic lithotripsy used in the ureterorenoscopic treatment of proximal ureteral stones. Materials and Methods: Data of 638 patients, who underwent ureterorenoscopy (URS) due to proximal ureteral stones in different centers, were obtained from patient files. The patients were divided into two groups according to the type of lithotripter used: group 1; laser lithotripter (n=324; 50.8%) and group 2; pneumatic lithotripter (n=314; 49.2%). URS was considered successful upon determination stone-free status with the imaging methods after treatment. The effectiveness and the complications of holmium:yttrium-aluminum-garnet laser and pneumatic lithotripsy were compared. Results: The total success rate of URS was 82.6% and the complication rate was 8.1%. The mean age of patients was similar between the groups; however, the body mass index values, stone surface area and stone Hounsfield unit were significantly higher in group 1. Although the mean operative time, complication rate and the mean length of hospital stay were similar between the groups; the URS success and postoperative ureteral Turkiye is an endemic region for urinary system stone disease and the incidence rate is 14.8%. Currently, ureterorenoscopy, where laser and pneumatic energy sources are used as lithotripter, is the first choice in the treatment of ureteral stones. The aim of this multi-centered study was to compare the efficacy of holmium laser and pneumatic lithotripters used in the ureterorenoscopic treatment of proximal ureteral stones and investigate their complications.

A retrospective observational study compared the efficacy of pneumatic and holmium laser ureteroscopic lithotripsy for treatment of ureteral stones

“…In the literature, the success rate of LL in proximal ureteral stones ranges between 81.8% and 96% [26][27][28][29][30]. In this study, we found that LL was superior to PL in the treatment of proximal ureteral stones, consistent with the literature.…”

“…According to the literature, the reason for the high overall success rate in our study is that the number of patients in the mid and distal ureteral stones was considerably higher than the number of patients in the proximal ureter, and the stone migration rate is low in stones at this level. The success rate of PL in proximal ureteral stones varies between 75% and 90.5% in the literature [5,19,[22][23][24][25][26].…”

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

“…In this study, we widen the indications of DJ stenting, so we fix it even when the mucosal injury is not extensive to allow ordered ureteral healing and avoid stricture development. DJ stenting was significantly less in the combined relative to laser group, 51.1% versus 64.4%, respectively, which matches the finding of Irer et al who reported that DJ stenting was significantly lower in their pneumatic group versus laser [13]. The goal of lithotripsy process is to produce small stone chunks that can be passed out spontaneously or easily retrieved, this goal is still easily achieved in both groups, and the lithotripsy time and operative time (mean ± SD) were nearly the same in laser and combined groups (15.5 ± 12.2 vs. 17.3 ±7.2) and (40.7 ± 26.3 vs. 43.2 ± 21.6) minutes, respectively.…”

“…EAU recommended Ho:YAG laser lithotripsy as a gold standard procedure for ureteroscopic intracorporeal lithotripsy because of its efficiency to fragment all stone types, ablative effect and stone dusting [9]. However, pneumatic energy is stronger and cheaper than Ho:YAG laser with minimal tissue trauma [10][11][12][13]. These different lithotripter mechanisms (mechanical vs. photothermal) affect the stone-free and upward migration.…”

Comparison of Safety and Efficacy of Pneumatic Versus Laser Lithotripsy in Ureteric Stones

“…Sophistication of medical instrumentation and miniaturization of scopes has changed urological practice [20,21] . Although several energy sources are available but pneumatic and laser energy are favored because of their high SFRs (>90%) and lower complications rates [22,23] . Laser energy is now more favored to treat ureteric stones.…”