Comparison of the Safety and Efficacy of Laser Versus Pneumatic Intracorporeal Lithotripsy for Treatment of Bladder Stones in Children

Abstract

This study aimed to compare the safety and efficacy of laser lithotripsy and pneumatic lithotripsy, the two most commonly used transurethral lithotripsy methods for treating bladder stones in children in Iraq. Between January 2013 and December 2016, 64 children with bladder stones were included in this prospective randomized study, after ethical committee approval and written consent from the children’s parents or caregivers were obtained. Patients were assigned randomly by computer software to two groups treated with either pneumatic cystolithotripsy or laser lithotripsy. A 9 Fr. semirigid ureteroscope was used to pass the lithotripter through and fragment the stone. A catheter of 8–12 Fr. was then introduced and kept in place for 24 h. All children were hospitalized for 24 h, and the catheter was removed the next morning. Outpatient follow-up was maintained for 6–12 months. In terms of operation outcomes and complications, the laser lithotripsy group had a significantly longer duration of operation (74.5 ± 26.6 min vs. 51.5 ± 17.2 min, p = 0.001), whereas the number of patients requiring an extended hospital stay was significantly higher in the pneumatic lithotripsy group (48.5% vs. 16.1%, p = 0.006). Moreover, pneumatic lithotripsy was associated with a significantly greater risk of having at least one adverse effect (64% greater than that in the laser group). Stone clearance rates did not significantly differ between treatment groups. In conclusion, both pneumatic and laser lithotripters can be used to treat children with bladder stones with high efficacy and safety.

High-power Holmium:Yag lithotripsy in bladder urolithiasis: Is it safe and effective? A combined clinical and experimental study

“…Laser lithotripsy is considered an effective, minimally invasive and fast procedure for the management of BL as it is associated with improved stone removal and shorter hospitalization [ 7 ]. Moreover, it seems to be a feasible alternative in the pediatric population, in which the presence of bladder stones is mainly associated with metabolic or genetic factors [ 8 ]. However, controversy exists regarding the power settings that should be used for safe, fast, and effective bladder lithotripsy.…”

Minimally Invasive Urological Procedures and Related Technological Developments—Series 2

“…Lasers have evolved with the advent of high-power holmium lasers, thulium fiber laser (TFL), and pulse modulation such as Moses technology [3][4][5]. There are four papers involving the use of lasers in endourology [6][7][8][9][10]. Laser efficiency and safety were compared between Holmium YAG and TFL lasers, with the latter showing higher efficiency [6].…”

“…Current evidence shows no difference in outcomes between the two and that low-power HoLEP is safe, feasible, and effective. The last paper looked at a comparison of the safety and efficacy of laser vs. pneumatic intracorporeal lithotripsy for the treatment of bladder stones in children [9]. In this prospective randomised study of 64 children, while the stone treatment was similar between groups, pneumatic lithotripsy was associated with a significantly greater risk of having at least 1 adverse effect.…”