Evaluation of Holmium: YAG Laser Versus Pneumatic Lithotripsy for the Intra Corporeal Lithotripsy of the Ureteric Stones

Abstract

ABSTRACT:BACKGROUND :Ureteroscopy (URS) is a precise, minimally invasive surgical intervention that can assess the entire collecting system to treat a stone using intracorporeal lithotripsy.The implication of laser technology in the development of lithotripter fibres has revolutionised intracorporeal lithotripsy. OBJECTIVE:To compare the efficacy and safety of Holmium: YAG laser and pneumatic lithoclast in treating ureteric calculi.METHODS:The study included total of 65 patients divided into two groups of laser lithotripsy (LL) (25 patients) and pneumatic lithoclast (PL)(40 patients). Inclusion criteria were patients with a single ureteric stone of size 0.7cm-2.0 cm. Stone size was determined with pre op CT scan. A 8 French rigid ureteroscope was used for all cases. Holmium: YAG laser with 600 μm wide fiber size was employed in laser group and frequency was set at 8 Hz at a power of 1.2 joule.Pneumotic lithoclast with used in PL group. Postoperatively patients underwent radiography and helical CT as required to asses stone clearance.RESULTS:The mean patient age , the male to female ratio , stone size and site were similar between the two groups. Mean operative time in LL group was 35.5 minutes as compared to 25.7 minutes in PL group, the Stone migration up in pelvicalyceal system occurred in one patients(4%) of LL group while in nine patients(22.5%) of PL group. Double J (DJ) Stent was placed in 9 (36%) patients in LL group where as 17(42%) patients required it in PL group. Stone free rate at 4 weeks was 84% in LL group as compared to 72.5% in PL group. CONCLUSION:Holmium: YAG laser lithotripsy is a superior technology compared to pneumatic lithoclast in terms of rate of stone clearance and complications especially in upper ureteric stones.