Treatment of ureteral stones: A prospective randomized controlled trial on comparison of Ho:YAG laser and pneumatic lithotripsy

Abstract

Objectives:To study the treatment of ureteric stones by HO:YAG laser lithotripsy and pneumatic lithotripsy and to evaluate the results of the two treatment modalities to assess effectiveness and complications.Materials and Methods:Over 1-year period, a total of 79 patients with 82 ureteral stones were randomized into two groups. In group 1 (39 cases with 41 ureteral stones) ureteroscopic HO:YAG laser lithotripsy was performed using a rigid 8 Fr-ureteroscope (LL group). In group 2 (40 cases with 41 ureteral stones) pneumatic lithotripsy was performed in like manner. Efficacy safety and complications in both groups were analyzed.Results:A total of 79 patients with 82 calculi were treated. Two cases in LL group and one in PL group had bilateral ureteral stones. Mean stone size was 12.07 mm in LL group and 10.2 mm in PL group. Stones located in lower ureter in 30 cases on LL group and 29 cases in PL group. Proximal migration of stone occurred in 1 case on LL group and in 3 cases on PL group. Successful fragmentation occurred in 37 cases on LL group and in 30 cases on PL group. Stone-free rate after 1 month in the base of Kidney Ureter Bladder (KUB) and sonography was 95% in LL group and 80.5% in PL group. Ureteral perforation, urinoma, and urosepsis were not seen in both groups.Conclusion:HO:YAG laser has advantages over PL in high efficacy of stone fragmentation and a low-retrograde migration of ureteral stone treatment. Other complication of ureteral stone treatment with LL and PL are the same and very rare.

Comparison of Holmium: YAG Laser and Pneumatic Lithotripsy in the Treatment of Ureteral Stones: An Update Meta-Analysis

“…2 ). Early Stone-Free Rate Except Cimino et al [12] , Maghsoudi et al [16] and Manohar et al [7] assessing stone-free rate later than 1 month post operation, all the other trials reported information on early stone-free rate. The results showed LL improved an early stone-free rate than PL (OR 2.69, 95% CI 1.91-3.78, p = 0.00001; fig.…”

“…Mean Operative Time All studies, aside from Maghsoudi et al [16] , unequivocally compared the mean operative time. We excluded studies by the Manohar et al [7] , Garg et al [15] and Razzaghi et al [3] because they only counted the lithotripsy time.…”

“…Figure 1 shows the process of study selection. All included 8 studies were randomized controlled studies published in 2008-2015 [3,7,[11][12][13][14][15][16] ( table 2 ). According to Cochrane handbook, 1 study was graded as A and 7 studies were graded as B ( table 1 ).…”

Laser Application in Iran Urology: A Narrative Review

“…Stone free rate (SFR) was higher in Ho:YAG laser group vs pneumatic lithotripsy (37 cases (90.2%) vs 30 cases (73.20%) (P = 0.46). 32 In another randomized controlled trial, in 2010, Basiri et al studied 100 children with distal ureteral stone, compared transurethral lithotripsy with shock wave lithotripsy (SWL) and holmium laser to evaluate the superior modality. Both were suitable modalities for removal of distal ureteral stone at that age range.…”

Comparison of The Using Pneumatic and Laser Lithotripter in Ureterorenoscopy According to the Modified Clavien Classification

“…Ancak, bu durumun yukarıda Maghsoudi ve ark. (15) yaptığı ileri dönük çalışmada, proksimal üreter taşlarında LL yapılan grupta %2,4, PL yapılan grupta %7,3 oranında taş migrasyonu saptanmış, ancak istatistiksel olarak anlamlı fark bulunmamıştır. Çalışmamızda toplam 9 adet taş migrasyonu gözlendi ve hepsi üreter üst uç taşı idi.…”