Direct Comparison of Pneumatic and Ho:YAG Laser Lithotripsy in the Management of Lower Ureteric Stones

Abstract

Introduction: Besides extracorporeal shockwave lithotripsy, semi-rigid ureteroscopy (URS) has become an equal therapy of choice for the treatment of most distal ureteric stones. Before the wide availability of laser lithotripsy as a tool for stone fragmentation, pneumatic lithotripsy was, and still is, widely used. In a country like Iraq, availability and affordability are the huge questions asked. Besides the capital investment for a laser machine, the pneumatic device is reusable, whereas the laser fibers are limited in their reusability. This makes pneumatic lithotripsy a more cost-effective option, at least in our setting. The question remains whether both options, compared in our setting with our limited resources, are equally effective and beneficial to our patients. Patients and Methods: Fifty patients were included in our prospective study who underwent URS for the treatment of a distal ureteric stone. Half each (n = 25) underwent pneumatic (group A) or laser lithotripsy (group B). Inclusion criteria were a single distal ureteric stone measuring 7-20 mm in largest diameter, no anatomical abnormality, age >18 years, and an unsuccessful attempt of medical expulsion therapy. Patients with signs of urinary infection and pregnant women were excluded. All patients were operated upon under spinal anesthesia. Data recorded included operation time, stone size, type of scope and lithotripter, complications, hospital stay, and stone-free rate. Results: Both groups did not show statistically significant differences in patient demography, stone size, operation time, complications, and stone-free rates (p > 0.05). Conclusion: Both pneumatic and Ho:YAG laser lithotripsy are equally effective and safe in treating distal ureteric stones in our setting. If the cost and availability of laser treatment is an issue, pneumatic lithotripsy is a viable and more cost-effective option.

[Retracted] Surgery and Postoperative Care of Patients Undergoing Percutaneous Nephrolithotomy under the Guidance of B‐Ultrasound Based on Smart Internet of Things

“…Generally, ordinary images have a relatively large dynamic range, and the gray values of pixels are evenly distributed in the entire gray range. Therefore, intuitively, the entire image will have a relatively high contrast, and the details can be seen very clearly [ 17 , 18 ]. The image demanipulation process is shown in Figure 3 .…”

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

“…In our study, while 59.8% of the patients were applied JJ stents and 16.2% were applied external ureteral catheters, 24% did not have any stent. While the use of JJ stent was 86.2% in the study of Khoder et al [9], JJ stenting was routinely applied to all patients (100%) in a prospective study of 50 patients published in 2020 [35]. In our study, when the use of stent was compared between the two groups, it was seen that statistically fewer postoperative catheters were applied in patients who underwent LL than those who underwent PL (70.2% and 82.4%).…”

Comparing Holmium (Ho): YAG Laser with Pneumatic Lithoclast for Treatment Efficacy of Ureteric Stones

“…Rigid stones revise their position during the pneumatic lithoclast, the location changes during the procedure make it difficult for the urologist to emphasize on stone and break it. At the same time as affirmed in several pieces of research Ho: YAG Laser carries superior usefulness weigh against pneumatic modality with improved stone-free rates and decreased operative duration 14,20 . This study results indicated 86.7% versus 63.3% stone clearance on follow-up radiological investigations such as ultrasound KUB and X-rays KUB, in pneumatic and laser groups respectively.…”

“…This study results indicated 86.7% versus 63.3% stone clearance on follow-up radiological investigations such as ultrasound KUB and X-rays KUB, in pneumatic and laser groups respectively. Retropulsion had only been reported in proximal ureter calculi 20 .…”