Intracorporeal Pneumatic Lithotripsy Research Articles

Frequency of complications of transurethral pneumatic lithotripsy in pediatric bladder stone disease.

Background: Despite advancements, underdeveloped countries continue to face the burden of widespread illness causing pain, often attributed to factors like low nutrition and recurring infections, particularly vitamin A deficiency.
 Methodology: This descriptive study employed a non probability convenient sampling technique and was conducted at the Urology Department of Lady Reading Hospital, Peshawar. The investigation spanned six months from January 25, 2019, to June 25, 2019. The study encompas sed a cohort of 369 patients, each subjected to comprehensive urine tests and detailed history and physical examinations. Procedures were performed under general anesthesia, utilizing Pediatric URS and pneumatic intracorporeal lithotripsy with Swiss lithoc last for bladder stone treatment. A 48 hour post treatment observation period assessed common intraoperative and postoperative consequences of transurethral pneumatic lithotripsy, including hematuria, bladder perforation, acute urine retention, and fever.
 Results: Among the participants, 32% were female, and 68% were male. Notably, 5% experienced bladder perforation, 7% had hematuria, 4% exhibited acute urinary retention, and 7% presented with fever.
 Conclusion: This study highlights complications of transurethral pneumatic lithotripsy in pediatric bladder stone disease, including bladder perforation, hematuria, acute urinary retention, and fever, providing crucial insights for clinical decisions.

Outcome of Upper Ureteric Stone Management by in Situ Extracorporeal Shock Wave Lithotripsy and Intracorporeal Pneumatic Lithotripsy

Background: Ureteric stone disease is a common urological problem throughout the world. Treatment of ureteral stones depends on stone size, composition and degree of obstruction, pain, presence of infection, single kidney and abnormal ureteral anatomy. The aim of the present study is to evaluate and compare in situ ESWL and URS with pneumatic lithotripsy in terms of Stone clearance, duration of procedural time, duration of hospital stay and complications (fever, haematuria, ureteral injury, stone migration, stone clearance, steinstrasse, UTI, ureteral perforation). Methods: A total of 80 patients were included in the study. 42 of them enrolled in ESWL group and 38 in pneumatic lithotripsy group. This is a Prospective Observational study. ICPL were done as day case surgery and ESWL were done as outpatient basis. Results: Intracorporeal pneumatic lithotripsy is better than in situ ESWL for the treatment of small non-impacted upper ureteric stone because it has more stone clearance rate and less complication like fever, haematuria, steinstrasse, UTI, ureteral injury and ureteral perforation. Conclusion: At the end of the study, it can be concluded that for the management of upper ureteric stones ICPL is a better option than in situ ESWL considering its greater stone clearance and less complications.

Comparison between Intracorporeal Pneumatic Lithotripsy and Extracorporeal Shock Wave Lithotripsy (ESWL) in terms of efficacy and Safety for Management of Proximal Ureteric Stones

Objective: To compare efficacy and safety of intracorporeal pneumatic lithotripsy versus extracorporeal shock wave lithotripsy (ESWL) in patients of upper ureteric stones having stone size from 10 to 15 mm. Study Design: Randomized control trial Setting: Study was done at department of Urology, Nishtar Hospital Multan. The duration of the study was from January 2021 to January 2022. Methodology: 140 patients were divided into two groups randomly. In group A ureterorenoscopy (URS) with Pneumatic Lithotripsy was used for proximal ureteric stones management. URS was performed under general anesthesia. In group B, ESWL was done for the management of proximal ureteric stones identified by ultrasound and fluoroscopy. SPSS version 23 was used for data analysis. Results: In this study In Intracorporeal Pneumatic Lithotripsy group the stone cleared in 90% patients and in ESWL group the stone cleared in 78.6% patients (p-value=0.595). In Intracorporeal Pneumatic Lithotripsy group the pain was present in 14.3% patients and in ESWL group the pain was present in 18.6% patients (p-value=0.494). In Intracorporeal Pneumatic Lithotripsy group the bleeding was noted in 25.7% patients and in ESWL group the bleeding was noted in 40.0% patients (p-value=0.072). Conclusion: This study concluded that intracorporeal pneumatic lithotripsy is a good alternate of ESWL for the management of upper ureteric stones (having size from 10 to 15mm). Keywords: Urolithiasis, Intracorporeal Pneumatic Lithotripsy, Extracorporeal Shock Wave Lithotripsy, Ureteric Stone

Effect of Time Duration on Bacterial Colonization in Double ‘J’ Stent after Ureteroscopy and Intracorporeal Pneumatic Lithotripsy in Adult

Introduction: Ureteric stone disease is common all over the world. Because of advancements in endourology and instruments- urologists manage ureteral stone effectively by ureteroscopy and lithotripsy using various energy sources. Commonly, lower ureteric stones are managed by ureteroscopy and intracorporeal pneumatic lithotripsy (URS and ICPL). After completing the procedure surgeons prefer to install double J (DJ) stent for a variable period within the ureter to overcome ureteral edema. There is no guideline for the optimal duration of keeping DJ stent in ureteral lumen. Urologists decide the duration of DJ stent according to their clinical experience & judgment- that makes a wide variation of stent period. Keeping the double J (DJ) stent for a longer duration may produce harmful effects, those even may be life-threatening. Objective: To observe the effect of time duration on bacterial colonization in DJ stent after URS and ICPL. Material and method: This experimental study was conducted in the Department of Urology, Bangabandhu Sheikh Mujib Medical University (BSMMU), for 1-year duration. The total sample size was 82. Samples were allocated into two groups. In group A: Double J stent was kept in situ for d” 4 weeks, whereas in Group B: stent duration was > 4 (up to 8) weeks. In this study, purposive sampling technique was implemented. Unilateral ureteral stone managed by URS, ICPL were included in the study. Patients having bilateral stones, co-morbidities like diabetes mellitus (DM), malignancy, immunosuppression, chronic kidney disease (CKD), and who had per operative ureteral injury were excluded. After removal of the DJ stent, 2-3 cm bladder-end tip was sent for culture and sensitivity. Reports were collected and documented. Result: Out of 82 cases, 40 were in group A and 42 in group B. 62 patients were male, 20 were female. DJ stent culture was positive in 14 cases (17%), whereas urine culture was positive in 7cases (8.5%). Among those- both stent and urine were positive in 4 cases (4.8%). Stent positive but urine negative in 10 cases (71%). In positive cases, stent and urine were colonized by a similar organism. E. coli was the commonest causative organism. Stent culture was positive in 4 cases (28.6%) in group A, 10 cases (71.4%) in group B but it was statically insignificant (p-value 0.09). Conclusion: Bacterial colonization in DJ stent increases with longer indwelling time. Individually stent or urine culture can not detect all pathogens in the urinary tract. So urine culture, as well as stent culture, is required to detect the uropathogen. The final recommendation is that-removal of DJ stent as early as possible is the key to prevent bacterial colonization. Bangladesh J. Urol. 2021; 24(2): 188-192

Comparison of the Safety and Efficacy of Laser Versus Pneumatic Intracorporeal Lithotripsy for Treatment of Bladder Stones in Children.

This study aimed to compare the safety and efficacy of laser lithotripsy and pneumatic lithotripsy, the two most commonly used transurethral lithotripsy methods for treating bladder stones in children in Iraq. Between January 2013 and December 2016, 64 children with bladder stones were included in this prospective randomized study, after ethical committee approval and written consent from the children’s parents or caregivers were obtained. Patients were assigned randomly by computer software to two groups treated with either pneumatic cystolithotripsy or laser lithotripsy. A 9 Fr. semirigid ureteroscope was used to pass the lithotripter through and fragment the stone. A catheter of 8–12 Fr. was then introduced and kept in place for 24 h. All children were hospitalized for 24 h, and the catheter was removed the next morning. Outpatient follow-up was maintained for 6–12 months. In terms of operation outcomes and complications, the laser lithotripsy group had a significantly longer duration of operation (74.5 ± 26.6 min vs. 51.5 ± 17.2 min, p = 0.001), whereas the number of patients requiring an extended hospital stay was significantly higher in the pneumatic lithotripsy group (48.5% vs. 16.1%, p = 0.006). Moreover, pneumatic lithotripsy was associated with a significantly greater risk of having at least one adverse effect (64% greater than that in the laser group). Stone clearance rates did not significantly differ between treatment groups. In conclusion, both pneumatic and laser lithotripters can be used to treat children with bladder stones with high efficacy and safety.

Comparison of the Intracorporeal Ultrasonic Lithotripsy and Intracorporeal Pneumatic Lithotripsy in Terms of Stone Removal and Postoperative Complications

Background: Urolithiasis is the most common and painful urological disease. Intracorporeal lithotripsy has high success rate in management of ureteric stone. Objective: To do comparison of the intracorporeal ultrasonic lithotripsy and intracorporeal pneumatic lithotripsy in terms of rate of stone removal and post-operative complications. Study Design: Randomized Control Trial. Settings: Department of Urology, Lahore General Hospital, Lahore Pakistan. Duration: Six months from September 01, 2015 to February 29, 2016. Methodology: Total sixty patients were selected fulfilling the inclusion criteria into 2 groups. In group A, 30 patients were selected for intracorporeal ultrasonic lithotripsy and in group B, 30 patients were selected for intracorporeal pneumatic lithotripsy. In both groups all patients were compared in terms of rate of stone removal and postoperative complications then results were analyzed by SPSS 21. Results: Mean stone size in group A (Ultrasonic lithotripsy) was 1.13 ± 0.17 cm and in group B (Pneumatic lithotripsy) was 1.14 ± 0.18 cm. At first week after procedure, in group A 25(83.33%) and in group B 21(70%) of the cases had stone clearance, at 2nd week after procedure a total of 26(86.66%) in group A and 24(80%) cases in group B had stone clearance. At 3rd week after procedure there were 28(93.33%) cases in group A and 27(90%) cases in group B had stone clearance. The stone clearance in both groups at each follow up was statistically insignificant, p-value > 0.05. At 1st week, in group A 3(10%) cases and in group B 6(20%) cases had pain, at 2nd week after procedure there were 1(3.33%) cases in group A and 3(10%) in group B who reported pain and at 3rd week after procedure there were 1(3.3%) case in each group had pain. The pain at each follow up was statistically same in both groups, p-value > 0.05. According to complications, in group A and group B, 2(6.66%) and 3(10%) cases had fever, 3(10%) and 4(13.33%) had infection respectively. Only one case (3.3%) had retention of urine. All complications were statistically same in both groups, p-value > 0.05. Conclusion: Through the findings of this study we conclude that both intracorporeal pneumatic lithotripsy and intracorporeal ultrasonic lithotripsy are equally effective and had fewer complications. However, the ultrasonic procedure had higher rate of stone removal at each follow up (but difference was insignificant with similar morbidity compared to pneumatic devices.

Outcome of Upper Ureteric Stone Management by Semirigid Ureterorenoscope and Intracorporeal Pneumatic Lithotripsy

Objective: To evaluate the outcome of upper ureteric stone management using semirigid URS + ICPL.
 Materials and Methods: Patients undergoing URS + ICPL in patient department were included in the study. Total 38 patient were included in the study from March 2009 to June 2010 in National Institute of Kidney diseases & Urology, Dhaka. Stone size was 8 mm to 1.5 cm, patients were with good renal function, well excreation on both side, without any distal obstruction, infection or multiple ureteric calculi. The procedure was done under SAB.Cystoscopy was done for identification of ureteric orifice and guide wire was passed within ureteric orifice under visual monitoring.46 cm 10 Fr Storz Uretroscope was advanced next to the guide wire.At time a tortuous portion of the ureter was encountered a second guide wire was helpful. As soon as the stone was seen the pneymatic probe was pushed toward the stone.After fixing to the stone, pneumatic source was on and stone fragmentation was started. Care was taken to avoid injury of the ureter and keeping eye one stone fragment migration within the ureter was achieved. Placement of D-J stent was done at the conclusion of the procedure in most of the cases
 Result: The patients were followed upto 3 months post-operatively. Within immediate complications fever occured in 10 (26.3%) patients, severe haematurea occured in 8 (21.3%) patients, ureteral injury in 8 (21.3%) & ureteric perforation in 2 (4.8%) patients underwent URS+ ICPL. Stone clearance rate after 01 month of intervention was 30 (78.9%). Almost half of the patients developed UTI after 01 month of intervention. Pyelonephritis occured in 2 ( 4.8%) patient in this group. After 03 months of intervention 84.2% patients exibited complete clearance of stone. Only 02 (4.8%) patients developed ureteric stricture.
 Conclusion: For management of selective sized upper ureteric stone ureterorenoscopy with semirigid one using pneumatic source of energy is a good option for it’s high stone clearance & resonably low complications.
 Bangladesh Journal of Urology, Vol. 16, No. 2, July 2013 p.47-50

Endoscopic Management of Ureteric Stones: Our Initial Experience.

Aims:The aim of this study is to present our initial experience with intracorporeal pneumatic ureterolithotripsy highlighting the pattern of patients’ clinical presentation, techniques, and limitation of the procedure.Materials and Methods:This is a retrospective study of cases of ureteric stones managed over a period of 18 months in a private hospital. Data obtained include patients’ sociodemography, clinical presentation, stone burden, procedural technique, complication, and need for a secondary procedure. Data were analyzed using the Statistical Package for the Social Sciences version 21.Results:The total number of patients managed was 20 with an age range of 28–75 years and a mean of 48.2 ± 12.4 years. Majority of them, i.e., 11 (55%) were middle aged. Female gender was more predominant, 11 (55%). Flank pain was the most common mode of presentation. Right-sided stone occurred in 9 (45%), left sided in 7 (35%), and bilateral in 4 (20%). Stone location was in the upper ureter in 4 (16.7%), mid-ureter in 7 (29.2%), and lower ureter in 13 (54.2%). The stone size ranged from 6 to 18 mm with a mean of 9.7 ± 2.5 mm. Four patients (20%) required initial bilateral ureteric stenting before definitive procedure to allow for recovery from sepsis and/or nephropathy. All patients had double-J stenting and were discharged 2 days after the procedure. The procedure was successful in 19 (95%) with 100% stone clearance rate and complete resolution of symptom without any complication. One patient (5%) had a very hard upper ureteric stone which retropulsed into the renal pelvis requiring open nephrolithotomy.Conclusion:Endoscopic treatment of ureteric stone with intracorporeal pneumatic lithotripsy is a safe and effective treatment modality. It is, however, limited in the management of hard upper ureteric stone, especially those that are close to the pelviureteric junction due to the risk of retropulsion of the stone into the kidney.

Outcomes of mini-percutaneous nephrolithotomy in children: a single centre experience

IntroductionThe aim of this study was to present to present our experiences with pediatric mini-percutaneous nephrolithotomies (MPNL) in our center.Material and methodsA total of 85 MPNLs performed on 79 pediatric patients being treated for upper urinary tract stones from 2007 to 2017 were analyzed retrospectively in order to determine their safety, efficacy, and relevant outcomes.Results85 MPNLs performed on 79 patients with a mean age of 6.58 (1–14) years were included in this study. The mean size of the stones was 1.99 (1–6.4) mm. A 17 Fr rigid pediatric nephroscope with a pneumatic intracorporeal lithotripsy was used through a 20 Fr access sheath. The stone-free rate was 87.1% at 1 month postoperatively. Mean operative time was 56.4 (20–120) min. Mean fluoroscopy screening time was 183.2 (40–510) sec. Average hospitalization duration was 4.78 (2–13) days. Auxiliary procedures were performed on 7 (8.2%) patients (5 extracorporeal shock wave lithotripsy, 2 re- percutaneous nephrolithotomy). The complication rate of these cases was 6.3% according to the modified Clavien Classification System. However, no major complications classified as Clavien IV–V were observed in the study group.ConclusionsThe outcomes of the contemporary analysis confirm that MNPL is a safe and efficient method of intervention resulting in a stone-free state in pediatric cases.

Role of Semi-Rigid Ureteroscopy and Pneumatic Lithotripsy in the Treatment of Ureteral Stones in Pregnant Women

Background: To present our experience with semi-rigid ureteroscopy (URS) and pneumatic lithotripsy in the treatment of ureteral stones in symptomatic pregnant women. Methods: This study was performed on 55 pregnant women with symptomatic obstructing unilateral ureteral calculi requiring surgical intervention. The patients were treated by URS stone extraction with pneumatic lithotripsy, and Double J (DJ) stent placement were routinely done in all patients. The incidence of premature uterine contractions (PUC) due to URS was recorded. In addition to the details of the procedures, serum magnesium, calcium and glucose levels were also measured. Results: All the patients underwent a successful URS with intracorporeal pneumatic lithotripsy. No perioperative fetal complications were detected, and all patients completed the full term of pregnancy. Seven patients had a postoperative PUC. An increased risk of PUC was found in patients with fever and renal colic at the initial presentation. PUC was more frequent in patients with lower serum magnesium levels. Univariate analysis showed that fever at initial presentation, high serum glucose and lower serum magnesium levels were indicative for PUC. Also, the combination of preoperative complicated renal colic with fever is also a prognostic indicator for development of PUC. Multivariate analysis showed that fever at initial presentation and lower serum magnesium levels are an independent prognostic marker for PUC. Conclusions: URS with pneumatic lithotripsy is an effective and safe treatment for pregnant women with obstructing unilateral ureteric calculi. Patients with fever at initial presentation and lower serum magnesium level are the most important factors affecting the preterm complications. World J Nephrol Urol. 2018;7(3-4):67-72 doi: https://doi.org/10.14740/wjnu373

Outcomes of miniaturized percutaneous nephrolitotomy in infants: single centre experience

ABSTRACTObjectives:The present study was aim to evaluate the safety and efficacy of Mini-PNL to treat kidney stones in patients aged <3 years. This is the one of the largest series in the literature in this age group of patients.Material and methods:From May 2012 to April 2016, the medical records of 74 infant patients who underwent mini-PNL for renal stones were reviewed retrospectively. All infants were evaluated with the plain abdominal radiograph, urinary ultrasound, non-contrast computerized tomography and/or intravenous urogram. Pre-operative, intraoperative and post-operative data were analyzed.Results:A total of 74 infant (42 male, 32 female) with a mean age 21.5±8.2 (10-36) months were included in this study. The mean size of the stones was 22.0±5.9 (14-45) mm. A 17 Fr rigid pediatric nephroscope with a pneumatic intracorporeal lithotripsy were used through 20-22 Fr access sheath. The stone-free rate was 84.7% at 1 month after the operation. Mean operative time was 74.0 (40-140) min. Mean fluoroscopy screening time was as 4.3(3.1-8.6) min. Average hospitalization time was 3.8 (2-9) day. Auxiliary procedures were performed to 11(15.3%) patients (7 extracorporeal shock wave lithotripsy, 3 re- percutaneous nephrolitotomy, 1 retrograde intrarenal surgery). No major complication classified as Clavien IV-V observed in study group.Conclusions:Mini-PNL with pneumatic intracorporeal lithotripsy can be performed safely and effectively to manage kidney stones in infants with high stone free rate and low complications.

Salivary lithotripsy in the era of sialendoscopy.

SUMMARYThe traditional management of obstructive salivary disorders has been replaced by minimally-invasive gland-preserving techniques including shock-wave lithotripsy, sialendoscopy, interventional radiology and endoscopically video-assisted trans-oral and cervical stone retrieval, of which sialendoscopy is considered to be the method of first choice. Primary endoscopically controlled stone extraction without prior fragmentation is only possible in 15-20% of cases; in more than 80%, fragmentation is necessary because of the size, impactation and location of the stone, or an alternative treatment such as transoral duct surgery or combined approaches are required. Moreover, about 10-20% of all stones cannot be adequately accessed by means of a sialendoscope or any alternative surgical method and, in such cases, extra-corporeal shock wave lithotripsy (ESWL) is the treatment of choice. However, in endoscopically accessible stones, ESWL is being gradually replaced by endoscopically assisted intra-corporeal techniques, including endoscopically guided laser and pneumatic intracorporeal lithotripsy. We describe the currently most widely used techniques for salivary lithotripsy, including ESWL, and endoscopically guided laser, electrohydraulic, electrokinetic and pneumatic intra-corporeal lithotripsy, and discuss their indications given the widespread use of advanced rehabilitative sialendoscopy and combined therapeutic approaches.

Sialendoscope-assisted transoral removal of hilo-parenchymal sub-mandibular stones: surgical results and subjective scores.

SUMMARYIt has been suggested that a conservative trans-oral approach to proximal and hilo-parenchymal submandibular stones (HPSMS) is a valid alternative to the more frequently used sialadenectomy. The aim of this study was to evaluate the surgical, ultrasonographic and patients' subjective outcomes of results of the trans-oral removal of HPSMS. Between January 2003 and September 2015, sialendoscope-assisted trans-oral surgery was used to remove symptomatic, large (> 7 mm), fixed and palpable HPSMS from 479 patients under general anaesthesia. All patients were followed clinically and ultrasonographically to investigate symptom relief and recurrence of stones, and were telephonically interviewed to assess saliva-related subjective outcomes with a questionnaire. Stones were successfully removed from 472 patients (98.5%); the seven failures (1.5%) concerned pure parenchymal stones. One year after the procedure, 408 patients (85.1%) were symptom free, 59 (12.3%) had recurrent obstructive symptoms and 12 (2.6%) had recurrent infections. Of the 54 patients who developed a recurrent stone (11.2%), 52 underwent a second procedure: 29 interventional sialendoscopies, two sialendoscope-assisted intra-corporeal pneumatic lithotripsy, eight secondary transoral surgery to remove residual stones, six a cycle of extra-corporeal lithotripsy and seven submandibular sialadenectomy. Most patients (75.2%) reported mild surgery-related pain. The symptoms of 454 patients (94.8%) improved after adjunctive treatment and, at the end of follow-up, the affected gland was preserved in 98.5% of patients. A sialendoscope-assisted trans-oral removal of large HPSMS is a safe, effective, conservative surgical procedure, and functional preservation of the main duct and parenchyma of the obstructed gland allows sialendoscopic access through the natural ostium in case of recurrence. Combining a trans-oral approach with other minimally invasive, conservative procedures ensures symptomatic relief and salivary duct system clearance in the majority of patients.

Salivary Stone Pneumatic Lithotripsy in a Live Porcine Model.

The purpose of this study is to evaluate the efficacy of endoscopic fragmentation and removal of artificial calculi in a live porcine model employing intracorporeal pneumatic lithotripsy. In this experimental study, 7 submandibular ducts were accessed and artificial calculi placed. A salivary pneumatic lithotripter probe was inserted through an interventional sialendoscope to fragment the calculi. A salivary duct catheter was then used to flush stone fragments, followed by endoscopy to assess complete fragmentation and ductal trauma. Ultimately, 7 artificial stones (3-10 mm, 4F/5F) were successfully fragmented without causing significant endoluminal trauma. Number of pulses for adequate stone fragmentation averaged 20 (range, 5-31). In all cases, stone fragments were successfully flushed out with the salivary duct catheter. Postprocedure endoscopy confirmed ductal integrity in all 7 ducts. While more studies are needed, this preliminary animal model demonstrates efficacy of endoscopic pneumatic lithotripsy for the management of sialolithiasis.

Endoscopic Salivary Stone Fragmentation with Pneumatic Lithotripsy in a Simulation Model.

To evaluate the endoscopic fragmentation and removal of human salivary stones by employing intracorporeal pneumatic lithotripsy in a clinical simulation model of the submandibular gland. Simulation model evaluating endoscopic management of human salivary stones. Laboratory. A flexible nitinol contact probe adapted to a CO2-driven handheld salivary pneumatic lithotripter was deployed through a sialendoscope to disrupt parotid (n = 1) and submandibular (n = 8) stones embedded in separate 3-dimensionally printed plastic models of the mouth and submandibular glands. Simulation included endoscopic removal of small stone fragments by standard basket retrieval supplement by irrigation and suction through a salivary duct introducer system. Correlations were made between stone volume and density with the duration of the procedures and number of pneumatic pulses required to disrupt and remove stone fragments. Among the 8 stones fragmented sufficiently to permit either full endoscopic removal (n = 7) or removal of the central portion leaving an adherent rind to the duct (n = 1), the average procedure time (32 minutes) and the average number of pneumatic pulses (98) correlated with stone density (range, 0.4-1.5 g/mL) and stone volume (range, 0.05-0.4 mL). One stone was sufficiently resistant to fragmentation as to prevent successful removal. Modification to the evolving technology of intracorporeal pneumatic management of nephrolithiasis was successfully applied in an ex vivo model to simulate management of sialolithiasis.

Definitive ureteroscopy and intracorporeal lithotripsy in treatment of ureteral calculi during pregnancy

ObjectiveTo evaluate the outcome of using semi-rigid ureteroscopy with or without intracorporeal pneumatic lithotripsy vs. temporary ureteric JJ stenting in the management of obstructing ureteric calculi in pregnant women. Patients and methodsThis prospective comparative study comprised 43 pregnant women with obstructing ureteric calculi. The diagnosis was based on the acute flank pain as the main symptom, microscopic haematuria, and unilateral hydronephrosis on abdominal ultrasonography (US). The patients were randomly divided into two groups; those in group 1 (22 patients) were treated by temporary ureteric JJ stenting until after delivery, and those in group 2 (21) were treated definitively by ureteroscopic stone extraction with intracorporeal pneumatic lithotripsy. Postoperative complications and the degree of patient satisfaction were reported. ResultsAn obstructing ureteric stone was identified by US in 68% and 76% of groups 1 and 2, respectively. In group 1, nine patients had mid-ureteric stones and 13 had stones in the lower ureter. In group 2, seven patients had mid-ureteric stones, whilst the stones were in the distal ureter in 14. No perioperative foetal complications were detected in any group and all patients completed the full term of pregnancy. In group 1, four patients had a postoperative urinary tract infection (UTI), and the JJ stent was exchanged in seven. Two patients in group 2 had a postoperative UTI. ConclusionsDefinitive ureteroscopy, even with intracorporeal pneumatic lithotripsy, is an effective and safe treatment for pregnant women with obstructing ureteric calculi. It has a better outcome and is more satisfactory for the patients than a temporary JJ stent.

Re: Re: The efficacy and safety of ureteroscopy for ureteral calculi in pregnancy: our experience in 32 patients

The aim of this study was to investigate the efficacy and safety of ureteroscopy (URS) in pregnant women. A retrospective analysis was performed on 32 pregnant patients referred to our center between April 2005 and November 2010 with hydronephrosis requiring surgical intervention. A semirigid URS of 9.5 F was used in all patients. The mean age of patients was 27.8 years (range 20–39), and the mean gestation duration was 24 weeks (15–34). The ultrasound findings were diagnostic of obstructive ureteral calculi in 16 (50%) patients and the mean stone diameter was 8 mm. Spinal anaesthesia was performed in 22 (68.8%) patients, while general anaesthesia was performed in 7 (21.8%) patients. Ureteric stones were found in 27 (84.3%) patients during endoscopy, 10 being distal, 9 middle and 8 proximal. There were no stones in five patients. The stones were fragmented with pneumatic lithotripsy in 8 patients and with holmium laser in 17 patients and the fragments were retracted with forceps. Of the 32 patients, 19 (59.4%) required JJ stent insertion peroperatively. There was no serious complication intraoperatively, while urinary tract infection developed in four and renal colic in two patients postoperatively. In one patient, sepsis developed postoperatively, and improved with appropriate treatment. All babies were born normally. Semirigid ureteroscopy for diagnosing and treating ureteral calculi by intracorporeal pneumatic or holmium laser lithotripsy is a safe and reasonable treatment option for pregnant patients.

Minimally invasive percutaneous nephrolithotomy in preschool age children with kidney calculi (including stones induced by melamine-contaminated milk powder)

This study was undertaken to assess the safety and efficacy of minimally invasive percutaneous nephrolithotomy (mini-PCNL) using ureteroscope and pneumatic intracorporeal lithotripsy in preschool age children with kidney calculi. We studied 27 renal units in 20 patients of preschool age (≤ 6 years) who underwent mini-PCNL at our institute. The mean age was 42.6 months (range 14-68 months). The average stone burden was 1.85 cm (range 0.9-2.8 cm). Eight patients aged 14 to 58 months had been exposed to melamine-tainted powdered formula. The mini-PCNL was performed with an X-ray-guided peripheral puncture. Minimal tract dilatation was undertaken to fit a 14-16 Fr peel-away sheath. Ureteroscope and pneumatic intracorporeal lithotripsy were used to fragment the stones. Complete clearance was achieved in 23 renal units (85.2 %) with mini-PCNL monotherapy. This has increased to 92.6 % after adjunctive ESWL. The average fall in hemoglobin was 1.28 g/dL. None of the patients required blood transfusion. The median length of hospital stay was 8.2 days. Patients were followed up every 6 months for 2 years. There has been only one recurrence of stone and no long-term complications. Mini-PCNL is a effective treatment for pediatric kidney stones refractory to extracorporeal shock wave lithotripsy, including stones induced by melamine-contaminated milk powder. The "mini-PCNL" technique, which uses ureteroscope and pneumatic intracorporeal lithotripsy, is a safe and feasible modality for treating renal calculi in preschool age children.

Laser and Pneumatic Lithotripsy in the Endoscopic Management of Large Ureteric Stones: A Comparative Study

Objective: We compared the results of holmium laser and pneumatic intracorporeal lithotripsy for large ureteric calculi in terms of efficacy, safety and complications. Methods: The study was conducted between April 2009 and October 2010. 80 patients divided into two equally matched groups were included in a prospective randomized trial including patients with a ureteric stone size of 0.5–2 cm. A holmium laser with a 550-µm fiber was employed in the laser lithotripsy (LL) group. The Swiss Lithoclast was used in the pneumatic lithotripsy (PL) group. Results: Mean stone size was comparable in both groups, namely 13.1 mm in the PL group and 12.9 mm in the LL group. The early stone-free rate was equal in both groups, while the delayed stone-free rate was 95% in LL and 85% in PL. Stone migration occurred in 12 PL cases and in 5 LL cases. Ureteric perforation occurred in 3 LL cases and in 2 PL cases. Ureteric stricture occurred in 1 case following LL. Conclusion: Both PL and LL are effective and safe modalities in treating large ureteric stones with minor insignificant differences. A pneumatic system may be more efficient with regard to the cost-benefit ratio, which was not studied in the present work; further studies should address this issue.

S113 THE EFFICACY AND SAFETY OF RIGID URETEROSCOPY FOR URETERAL CALCULI IN PREGNANCY: OUR EXPERIENCE IN 32 PATIENTS

The aim of this study was to investigate the efficacy and safety of ureteroscopy (URS) in pregnant women. A retrospective analysis was performed on 32 pregnant patients referred to our center between April 2005 and November 2010 with hydronephrosis requiring surgical intervention. A semirigid URS of 9.5 F was used in all patients. The mean age of patients was 27.8 years (range 20–39), and the mean gestation duration was 24 weeks (15–34). The ultrasound findings were diagnostic of obstructive ureteral calculi in 16 (50%) patients and the mean stone diameter was 8 mm. Spinal anaesthesia was performed in 22 (68.8%) patients, while general anaesthesia was performed in 7 (21.8%) patients. Ureteric stones were found in 27 (84.3%) patients during endoscopy, 10 being distal, 9 middle and 8 proximal. There were no stones in five patients. The stones were fragmented with pneumatic lithotripsy in 8 patients and with holmium laser in 17 patients and the fragments were retracted with forceps. Of the 32 patients, 19 (59.4%) required JJ stent insertion peroperatively. There was no serious complication intraoperatively, while urinary tract infection developed in four and renal colic in two patients postoperatively. In one patient, sepsis developed postoperatively, and improved with appropriate treatment. All babies were born normally. Semirigid ureteroscopy for diagnosing and treating ureteral calculi by intracorporeal pneumatic or holmium laser lithotripsy is a safe and reasonable treatment option for pregnant patients.