Comparison of holmium laser and pneumatic lithotripsy in managing upper-ureteral stones.
OBJECTIVE
To compare the success rates and complications of Lithoclast and holmium laser-assisted ureterorenoscopy (URS) in managing upper-ureteral stones.


METHODS
We retrospectively analyzed the records of 394 patients with upper-ureteral stone who underwent ureteroscopic lithotripsy at our institution from January 2000 to December 2005. In 193 patients (mean stone size 12.3 mm), pneumatic lithotripsy was used; in 201 patients (mean stone size 11.5 mm), laser lithotripsy was performed. Patients were monitored as outpatients at 2 weeks, at 3 months, and then annually with a kidneys, ureters, and bladder radiograph and ultrasonography. Patients with migrated stones or incomplete clearance underwent an auxiliary procedure such as shockwave lithotripsy (SWL) or repeated URS. Follow-up ranged from 6 to 24 months.


RESULTS
Fragmentation of stones to fine pieces that pass eventually was assessed at 2 weeks. This did not include proximal migration of a stone or fragments that required auxiliary treatment. This occurred in 166/193 (86.01%) patients in the Lithoclast group and in 195/201 (97.01%) in the laser group. Ureteral perforations were nine in the Lithoclast group and six in the laser group. Auxiliary procedures included SWL (27/193 [13.98%] patients in the Lithoclast group and 4/201 [1.99%] patients in the laser group) or repeated URS (two in the Lithoclast group). Urosepsis after URS occurred in 11/193 patients in the Lithoclast group and 5/201 patients in the laser group.


CONCLUSIONS
In our study, the fragmentation rates of holmium laser-assisted ureteroscopy were significantly better in the upper ureter. The complications and the need for auxiliary procedures were significantly less for holmium laser-assisted ureteroscopy when compared with pneumatic lithotripsy.
Bapat
Shivadeo S
SS
Department of Urology, Ratna Memorial Hospital, Pune, India. shivadeo@gateway-ip.com
Pai
Ketan V
KV
Purnapatre
Satyajeet S
SS
Yadav
Pushkaraj B
PB
Padye
Abhijit S
AS
D000293:Adolescent; D000328:Adult; D000368:Aged; D000388:Air; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D017602:Lithotripsy, Laser / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011860:Radiography, Abdominal; D012189:Retrospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography; D014514:Ureteral Calculi / Q000000981:diagnostic imaging / Q000628:therapy*; D018666:Ureteroscopy / Q000379:methods*; D014567:Urography