HO:YAG LASER VS PNEUMATIC LITHOTRIPSY WITH SEMI RIGID URETEROSCOPE FOR PROXIMAL URETERAL CALCULI : OUR INSTITUTIONAL EXPERIENCE

Abstract

Introduction & objectives: Different modalities are available for proximal ureteric stone fragmentation. From them pneumatic and holmium: yttrium-aluminum-garnet lithotripsy has favorable outcomes. In our randomized study, we included 100 patients who underwent semi rigid ureteroscopic pneumatic lithotripsy or laser lithotripsy. This study aims to compare the outcome of PL and LL in the management of upper ureteric calculi. 100 patients were a Materials & methods: dmitted in Govt Kilpauk medical college and hospital between January 2021 to June 2022 & randomized 50 cases of URS with pneumatic lithotripter and 50 cases of URS with laser lithotripter were enrolled. Patients with urinary tract infection, radiolucent stones, loss of follow-up, concurrent middle or lower third ureteral stones or acute renal failure were excluded. All patients underwent semi-rigid URS with Ho:YAG laser or pneumatic lithotripsy followed by DJ stenting. The aim of this study to compare the stone-free rate, assess the complications, duration of surgery and assess the need for second procedure , if retropulsion of calculus occurred following PL and LL. Demographically, no s Results: tatistical different in both groups in view of age, gender, mean size of stones (P> 0.05). Retropulsion occurred in 16% of the PL group (P< 0.05) and required auxillary procedure. There was a statistical difference in terms of stone free rate of stone in favor of LL group (p≤0.05) and mean operative time in favor of the PL group (p≤ 0.05). Conclusions: In both techniques, acceptable results were achieved. We found that both the PL and LL approaches were effective and safe for proximal ureteric calculi. LL method had advantages in more stone free rate, lower retropulsion rate but longer procedure duration compare to the PL method