Abstract
Objective:To compare the mean operative time (MOT) in patients undergoing Ho: YAG laser lithotripsy (LL) and pneumatic lithotripsy (PL) for ureteric stones.Methods:This randomized study was conducted at Armed Forces Institute of Urology (AFIU) Rawalpindi, Pakistan from July 2016 to November 2018. Non probability consecutive sampling technique utilized to enroll 60 patients of both gender aged 18-60 years, having ureteric calculus ≤1.5cm. Randomization was done into group I (LL) and II (PL) via computer generated number tables. Six Consultant Urologists performed surgeries under spinal anesthesia utilizing Swiss Lithoclast® Master (EMS+ S.A. Switzerland) in group II and holmium laser fiber (365μm, 8-10Hz, 9.6-16W, 2100nm wavelength) in group I respectively. MOT was noted from insertion of cystoscope till removal out of meatus. Data obtained was analyzed through IBM SPSS 24.0.Results:Analysis involved 60 patients (30 each group) having similar baseline characteristics (age, gender, laterality, location). There was statistically significant different MOT between LL & PL (25.48±6.99 vs 34.83± 7.47 minutes, p < 0.001). Data stratification with respect to age, gender, laterality and stone location revealed similar trend. Lithotripsy technique significantly affected MOT (p < 0.001) on Multiple Linear Regression Analysis.Conclusions:Ho: YAG LL is an efficient technique when compared with PL in terms of MOT for ureteric stones.
Highlights
Urolithiasis, a highly recurrent disease, is affecting 15% of world population having serious implications as rapidly increasing obesity; diabetes and western lifestyle are exponentially compounding the issue which has no cure.[1]
Most common lithotripter currently in use are pneumatic (PL) and holmium: yttriumaluminum-garnet (Ho: YAG) laser (LL), the latter recommended by European association of urology (EAU) as gold standard.[6]
Table-IV: Multiple Linear Regression analyses of factors associated with the mean operative time taken for the intra-ureteral lithotripsy procedure (n=60)
Summary
Urolithiasis, a highly recurrent disease, is affecting 15% of world population having serious implications as rapidly increasing obesity; diabetes and western lifestyle are exponentially compounding the issue which has no cure.[1]. Optimal treatment and prevention depends upon clinical, anatomical, technical and stone factors.[4] Past couple of decades has witnessed paradigm shift from open surgery to extracorporeal shock wave lithotripsy (ESWL), ureterorenoscopy (URS), laparoscopic ureterolithotomy and percutaneous nephrolithotomy (PCNL).[5] Endoscopy is the treatment of choice worldwide due to miniaturization of equipment and availability of wide array of intracorporeal lithotripters (electrohydraulic, ultrasonic, pneumatic and laser). We aimed to determine MOT of both in our setting anticipating time slots available and manage operation list in a better way
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