Ureteroscopic management of ureteral calculi: electrohydraulic versus holmium:YAG lithotripsy.
OBJECTIVE
This study compared electrohydraulic and holmium:YAG lithotripsy for ureteral calculi.


METHODS
Two cohorts of consecutive patients with ureteral calculi treated with ureteroscopic electrohydraulic or holmium:YAG lithotripsy were retrospectively compared. Electrohydraulic lithotripsy was done using a 1.9F fiber at energy settings between 50 and 100 v. Holmium:YAG lithotripsy was done using a 365 microm. fiber at energy settings of 0.6 to 1.5 J.


RESULTS
A total of 23 and 47 consecutive patients underwent electrohydraulic and holmium:YAG lithotripsy, respectively. For preoperative calculi less than 15 mm. mean stone size plus or minus standard deviation was 9 +/- 3 versus 9 +/- 3 mm. (p = 0.5), mean operative time was 72 +/- 21 versus 102 +/- 38 minutes (p = 0.004), stone-free rate at the end of ureteroscopy was 65 versus 97 (p < 0.01) and 3-month stone-free rate was 94 versus 97% (p = 0.4) for electrohydraulic versus holmium:YAG lithotripsy. For preoperative calculi 15 mm. or greater stone size was 19 +/- 5 versus 19 +/- 4 mm. (p = 0.9), operative time was 159 +/- 61 versus 108 +/- 27 minutes (p = 0.01), stone-free rate at the end of ureteroscopy was 33 versus 87% (p = 0.001) and 3-month stone-free rate was 67 versus 100% (p = 0.02). Complications were not significantly different in either comparison.


CONCLUSIONS
The overall likelihood that a patient would be rendered stone-free at ureteroscopy and 3 months after ureteroscopy favored holmium:YAG over electrohydraulic lithotripsy. For ureteral calculi less than 15 mm. electrohydraulic lithotripsy was more rapid than the holmium:YAG procedure but for ureteral calculi 15 mm. or greater the holmium:YAG technique was more rapid than electrohydraulic lithotripsy. The outcomes differences may have resulted from the different mechanisms of electrohydraulic and holmium:YAG lithotripsy.
Teichman
J M
JM
Division of Urology, University of Texas Health Science Center, San Antonio, USA.
Rao
R D
RD
Rogenes
V J
VJ
Harris
J M
JM
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008096:Lithotripsy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014514:Ureteral Calculi / Q000628:therapy*; D018666:Ureteroscopy