title: A Prospective Randomized Trial Comparing Pneumatic Lithotripsy and Holmium Laser for Management of Middle and Distal Ureteral Calculi.
abstract: OBJECTIVE
  The aim of this study was to compare the efficacy and safety between pneumatic and holmium:yttrium-aluminum-garnet (Ho:YAG) laser in the treatment of patients with ureteral stones located in the middle and distal ureter.
  
  
  METHODS
  We conducted a prospective study in recruiting 982 eligible patients from 2009 to 2012. Patients were randomly divided into two groups-the pneumatic lithotripsy (PL) group or the Ho:YAG laser lithotripsy (LL) group. Patient demographics, stone characteristics, intraoperative parameters, and postoperative complications were evaluated and analyzed.
  
  
  RESULTS
  The baseline demographics of patients and stone characteristics were similar in the two groups. The LL group showed significant benefits compared with the PL group in terms of mean operative time (28±9.2 vs 41±12.4 min, P=0.001) and early stone-free rate (80.8% vs 91.3%, P=0.04), but there was no statistically significant difference at the third month (92.6% vs 95.5%, P=0.15). In the LL group, 24 postoperative cases of stricture were seen, whereas only 5 cases occurred in the PL group (P=0.02). The other complications, such as perforation, bleeding, and mucosal injury, were comparable in the two groups. The average postoperative stay was also similar (1.7±2.4 days for PL and 1.5±3.1 days for LL (P=0.62).
  
  
  CONCLUSIONS
  Both PL and LL are effective in the management of middle and distal impacted stones. Ho:YAG laser has advantages in better efficacy of stone fragmentation and a higher early stone-free rate but seems to have to face the increased risks of postoperative stricture.
authors.affiliation: 1 Department of Urology, The Third Clinical Institute Affiliated to Wenzhou Medical University, The People's Hospital of Wenzhou , Wenzhou, People's Republic of China .
authors.forename: Linjin
authors.initials: L
authors.lastname: Li
authors.affiliation: 2 Department of Urology, The First Affiliated Hospital of Wenzhou Medical University , Wenzhou, People's Republic of China .
authors.forename: Yue
authors.initials: Y
authors.lastname: Pan
authors.affiliation: 2 Department of Urology, The First Affiliated Hospital of Wenzhou Medical University , Wenzhou, People's Republic of China .
authors.forename: Zhiliang
authors.initials: Z
authors.lastname: Weng
authors.affiliation: 1 Department of Urology, The Third Clinical Institute Affiliated to Wenzhou Medical University, The People's Hospital of Wenzhou , Wenzhou, People's Republic of China .
authors.forename: Wenshuo
authors.initials: W
authors.lastname: Bao
authors.affiliation: 2 Department of Urology, The First Affiliated Hospital of Wenzhou Medical University , Wenzhou, People's Republic of China .
authors.forename: Zhixian
authors.initials: Z
authors.lastname: Yu
authors.affiliation: 2 Department of Urology, The First Affiliated Hospital of Wenzhou Medical University , Wenzhou, People's Republic of China .
authors.forename: Feng
authors.initials: F
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D003251:Constriction, Pathologic / Q000601:surgery; D005260:Female; D006695:Holmium / Q000627:therapeutic use; D006801:Humans; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D017602:Lithotripsy, Laser / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology; D011184:Postoperative Period; D011446:Prospective Studies; D014514:Ureteral Calculi / Q000601:surgery*
chemical_list: D006695:Holmium