Requirement of ESWL after ureterorenoscopy and lithotripsy in the management of upper ureteric stone: comparison between Holmium Yag laser and pneumatic lithotripsy in a referral hospital, Bangladesh

Abstract

Various methods have been employed for the removal of ureteric calculi all over the world. Both Ureteroscopic Pneumatic and Laser lithotripsy are popular procedures for this purpose. However proximal migration of stone fragments are not uncommon in these procedures while treating upper ureteric stones. Extra corporeal shock wave lithotripsy (ESWL) may require to fragment those proximally migrated stones after the ureteroscopic Pneumatic or Laser lithotripsy. To compare the requirement of ESWL in the management of ureteric stone between Holmium Yag Laser and Pneumatic Lithotripsy. This study included 100 patients with upper ureteric stones who underwent ureteroscopic lithotripsy at the Department of Urology, CMH, Dhaka, between October 2010 and September 2012. Laser lithotripsy was used in 50 patients (Group A), and pneumatic lithotripsy was used in the remaining 50 patients (Group B). In each case, the same ureteroscope, video monitor, baskets, or irrigation devices were used. A kidney ureter and bladder radiograph and ultrasonograph were performed on patients one month and three months after lithotripsy. Patients with migrated fragments or insufficient clearance underwent a supplementary procedure such as ESWL. Mean age was 41.9}10.9 years and 41.3}12.3 years in Group A and Group B respectively. Males were predominant in both groups. Mean stone size was 1.36 } 0.36 cm in Group A and 1.37} 0.36 cm in Group B. Complete stone clearance was 94.0% in Group A and 76.0% in Group B. EWSL requirement rate was significantly higher in Group B (24.0%) than Group A (6.0%). Peri procedural complications like hemorrhage was significantly higher in Group B and mucosal disruption/perforation was almost same in both the groups. EWSL requirement rate was comparatively higher in pneumatic lithotripsy than laser lithotripsy. BSMMU J 2022; 15(2): 111-114