Pneumatic vs laser lithotripsy for mid-ureteric stones: Clinical and cost effectiveness results of a prospective trial in a developing country

Nour, Hani H.; Kamel, Ahmed I; Elmansy, Hazem; Badawy, Mohamad H; Shabana, Waleed; Abdelwahab, Ayman; Elbaz, Ahmed G; Eleithy, Tarek; Rushdy, Mamdouh

doi:10.1080/2090598x.2020.1749800

Cited by 7 publications

(9 citation statements)

References 23 publications

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“…11,12 Nour et al study has reported significantly longer time in pneumatic lithotripsy that was due to the need for retrieval of relatively larger stone fragments in comparison to laser where this time is reduced due to combined fragmentationdusting technique. 6 The mean hospital stay was also similar in the pneumatic and laser lithotripsy group which was similar to other studies. 13 Post-operative stenting after surgery is recommended to reduce postoperative complications.…”

Section: Discussionsupporting

confidence: 90%

“…Similar results of putting stents in both the groups were also found in other studies. 6 Many researcher have already shown earlier in their studies that post-operative obstruction and other complications can be minimized by using these stents, that was the reason of putting these stents in most the patients in our study and has also been used in other studies. [14][15][16] Stone migration rate in present study was found significantly more in pneumatic group.…”

Section: Discussionmentioning

confidence: 72%

“…Similar results were also seen in other studies. 6,7,21 This shows that pneumatic or laser energy has no significant role in the occurrence of complications.…”

Section: Discussionmentioning

confidence: 97%

“…Many other studies have also reported similar SFR in both groups. 6,18 Studies done Bapat et al and Maghsoudi et al have reported Ho:YAG lithotripsy as superior to pneumatic lithotripsy when comparing stonefree rate (95-98.6% versus 80-86%). 19,20 In our present study, mucosal damage was found 6% in laser group as compared to 2% in pneumatic group.…”

Section: Discussionmentioning

confidence: 99%

“…3,4 Recently use of holmium:yttriumaluminium-garnet (Ho: YAG) laser is increased due to its fewer complication and lower incidence of upward stone migration but it is more expensive and not available in most of the urologic centers. 5,6 There are some studies that have compared the efficacy of these two technique but found different results regarding operative time, stone free rate, migration rate, cost-benefit ratio and complications. 7-On the basis of these finding this retrospective study was conducted with the aim to compare the efficacy and safety of pneumatic versus laser lithotripsy technique for treatment of ureteral stone in Indian population.…”

Section: Introductionmentioning

confidence: 99%

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Comparative evaluation of intracorporeal lithotripsy techniques during ureteroscopy: a clinical experience

Trivedi

2020

Int Surg J

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Background: The objective of the study was to compare pneumatic lithotripsy and laser lithotripsy techniques for safety, efficacy, and complications in the management of ureteric stone.Methods: Patients underwent ureteroscopy for ureteral stones in a tertiary care teaching hospital were divided into 2 groups of 50 each. Group 1 patients underwent pneumatic lithotripsy and group 2 underwent holmium:yttrium-aluminium-garnet (Ho: YAG) laser lithotripsy. Both the groups were compared regarding demographic characteristics, stone dimensions, number of stones, operative time, stone migration rate, application of post-operative double J (DJ) stent, complications, and stone free rate.Results: Mean age of the patients in the group 1, and group 2 were 45.74±18.49, and 44.5±14.33 years, respectively (p=0.709). There was no significant difference in male to female ratio in both groups. Total operative times were found 29.12±10.83 min, and 28.44±7.49 min in the group 1 and group 2, respectively which was statistically non-significant (p=0.716). The stone free rate was 100% and 98% in group 1 and 2 respectively (p=0.130). Stone migration was also found in 5 (10%) patients in the group 1 and 1 (2%) in group 2 which was found statistically significant (p=0.037). Mucosal damage was found 3 (6%) in laser group as compared to 1 (2%) in pneumatic group. No significant difference between complications was seen in both the groups.Conclusions: This study concluded that pneumatic lithotripsy and laser lithotripsy have similar efficacy in terms of operative time, success rate and hospital stay time. However, stone migration rate was significantly more in pneumatic lithotripsy.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 72%

“…Similar results were also seen in other studies. 6,7,21 This shows that pneumatic or laser energy has no significant role in the occurrence of complications.…”

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comparative evaluation of intracorporeal lithotripsy techniques during ureteroscopy: a clinical experience

Trivedi

2020

Int Surg J

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Cost-effectiveness and health economics for ureteral and kidney stone disease: a systematic review of literature

Nedbal,

Tramanzoli,

Castellani

et al. 2024

Current Opinion in Urology

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Purpose of review To systematically review costs associated with endourological procedures (ureteroscopy, URS; shockwave lithotripsy, SWL; and percutaneous nephrolithotomy, PCNL) for kidney stone disease (KSD), providing an overview of cost-effectiveness and health economics strategies. Recent findings A systematic review of the literature was performed, retrieving 83 English-written full-text studies for inclusion. Papers were labelled according to the respective area of interest: ‘costs of different procedures: SWL, URS, PCNL’, ‘costs of endourological devices and new technologies: reusable and disposable scopes, lasers, other devices’, ‘costs of KSD treatment in the emergency setting: emergency stenting versus primary URS’. Forty-three papers reported on associated cost for different procedures, revealing URS to be the most cost-effective. PCNL follows with higher hospitalization costs, while SWL appears to be least cost effective due to high need of additional procedures. The role of disposable and reusable scope is investigated by 15 articles, while other 16 reported on the role of different lasers, devices and techniques. The last nine studies included discussed the best and more cost-effective treatment for acute stone presentation, with promising results for primary URS versus emergency stenting and delayed URS. Summary Cost-effective and cost-conscious intervention is equally imperative to consider whilst weighing in clinical efficacy for endourological procedures. When a decision-making choice of SWL, URS or PCNL is offered to a patient, the outcomes must be balanced with a deeper understanding of additional cost burden of retreatment, reimbursement, repeated interventions, and recurrence. In todays’ practice, investing in endourological devices for KSD management must consider carefully the direct and hidden costs of using reusable and disposable technology. Cost control measures should not in any way compromise the quality of life or safety of the patient.

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Outcome of Uretero Renoscopic Lithotripsy (URSL) with Holmium LASER Vs Pneumatic Lithotripter for Lower Ureteric Stones, Experience from University Hospital of Nepal

Joshi

Singh

Koirala

et al. 2020

Kathmandu Univ. Med. J.

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Background There are various methods of endoluminal ureteral stone fragmentation. Among various modalities Laser lithotripsy and Pneumatic lithotripsy are commonly used and have shown comparable outcomes. Objective To compare the efficacy and outcome of laser and pneumatic lithotripsy in a patient with lower ureteric calculi. The comparison will be done in stone free rate, migration of stone and complication of the procedure. Method This is a prospective comparative study in a cohort of patients at University Hospital with Lower Ureteric stone. Ninety patients were randomized in to two groups (Laser Lithotripsy Vs Pneumatic Lithotripsy) during the study period. The purpose of this study was to measure the immediate stone free rate, intra-operative complications, mean operative time, post-operative complication and if any stone retention after six weeks follow up. Result Both the groups were similar in Age and Gender. Immediate stone free rate was slightly higher in Laser lithotripsy group (97.77%) in comparison to Pneumatic lithotripter group (84.44%) with p=0.507 which is not statistically significant. There was statistical difference in terms of stone migration rate, mean operation time in favor of Laser Lithotripsy group (p<0.01, in both parameters). There were no immediate complications in both the group however there were three cases of short segment ureteric strictures (6.66%) in case of Pneumatic lithotripsy on six weeks follow up which was managed conservatively. Conclusion Both LASER lithotripter and Pneumatic lithotripter are equally efficacious modality of endoluminal URSL in lower ureteric stone with similar Stone Free Rate. Laser lithotripsy showed lower frequency of stone migration and had shorter procedure time.

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Pneumatic vs laser lithotripsy for mid-ureteric stones: Clinical and cost effectiveness results of a prospective trial in a developing country

Cited by 7 publications

References 23 publications

Comparative evaluation of intracorporeal lithotripsy techniques during ureteroscopy: a clinical experience

Comparative evaluation of intracorporeal lithotripsy techniques during ureteroscopy: a clinical experience

Cost-effectiveness and health economics for ureteral and kidney stone disease: a systematic review of literature

Outcome of Uretero Renoscopic Lithotripsy (URSL) with Holmium LASER Vs Pneumatic Lithotripter for Lower Ureteric Stones, Experience from University Hospital of Nepal

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