Comparative evaluation of Swiss LithoClast 2 and holmium:YAG laser lithotripsy for impacted upper-ureteral stones.
OBJECTIVE
We prospectively compared the results of the Swiss LithoClast System with the holmium: yttrium-aluminum-garnet (Ho:YAG) laser for ureteral lithotripsy for management of upper ureteral stones.


METHODS
Fifty patients were randomized to two groups: LithoClast classic 2 (n = 25) and Ho:YAG laser (n = 25) between January 2005 and January 2007. Procedure selection was decided by random chit allotment. All patients who successfully had ureteral dilatation (up to 10F) were included in the study. An 8/9.8F semirigid ureteroscope was used in all procedures with LithoClast 2, and either an 8F or 7F was used in patients who underwent laser lithotripsy. Patients were analyzed for fragmentation time, stone-free rate, stone up-migration, intraoperative complications, and auxiliary procedures.


RESULTS
Average stone size was 9.63 +/- 2.46 mm2 and 10.17 +/- 2.28 mm2 with overall stone-free rates of 84% and 88% (P = 0.41), respectively, for laser and LithoClast 2 groups. Stone up-migration was 24% and 16% (P = 0.82), mean stone fragmentation time was 9.82 +/- 7.58 and 7.86 +/- 3.25 minutes (P = 0.12), and stone fragments requiring ancillary procedures were 16% and 12% (P = 0.99), respectively, in laser and LithoClast 2 groups. Postoperative hematuria (up to 72 hours) was significantly (P = 0.04) prolonged in the laser group (36%) compared with the LithoClast 2 group (8%). Three patients in the LithoClast 2 group had instrument breakage.


CONCLUSIONS
Both Ho:YAG laser and LithoClast 2 were equally efficient in managing ureteral stones with effective stone clearance, minimum morbidity, and reduced stone up-migration.
Manohar
T
T
Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India.
Ganpule
Arvind
A
Desai
Mahesh
M
D000328:Adult; D005260:Female; D006801:Humans; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D017602:Lithotripsy, Laser / Q000009:adverse effects / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors; D014514:Ureteral Calculi / Q000628:therapy*