A Comparative Study Between Pneumatic and Laser Lithotripsy for Proximal Ureteric Calculus

Abstract

Introduction: There are various modalities of breaking urinary tract calculus. The aim of this study was to compare outcome between laser and pneumatic lithotripsy in patients with upper ureteric calculus in terms of stone free rate, proximal migration and complication. Methods: This was a prospective comparative study done in 210 patients with upper ureteric calculus. The patients were randomized into two groups (Laser Lithotripsy and Pneumatic Lithotripsy) from April 2018 to June 2019. The main objective of both the procedures was to break stone into particles less than 3 mm which was confirmed by X-ray KUB and ultrasonography of abdomen and pelvis after six weeks and to compare effectiveness in terms of immediate stone free rate, proximal migration, operative duration and post-operative complication. Results: There was no difference in age, gender and stone size in both groups. Immediate stone free rate was 99.05% in Laser Lithotripsy and 76.19% in Pneumatic Lithotripsy (p value<0.001). Proximal migration in Laser Lithotripsy was 0.95% and 23.81% in Pneumatic Lithotripsy (p<0.001). There was significantly prolonged operative duration in Pneumatic Lithotripsy (14.7±4.77 min vs 13.31±3.24 in Laser Lithotripsy, p=0.014). Complications were more in Pneumatic Lithotripsy group, which was statistically significant (p=0.017). Conclusion: Both pneumatic and laser lithotripsy are effective and safe modalities for treating upper ureteric calculus, however laser has less chances of proximal migration and higher immediate stone free rate with less complication