Pneumatic Lithotripter Research Articles

Ultra-mini Percutaneous Nephrolithotomy (UM-PCNL) with a Semi-rigid Ureteroscope in Preschool Children: An Innovative Experience in Southern Iran.

Percutaneous nephrolithotomy (PCNL) has undergone extensive modification to reduce complications. One of the recent advances in minimally invasive procedures is the advent of ultra-mini PCNL (UM-PCNL), which provides miniaturized access to the kidney. However, the specific instruments applied in UM-PCNL may not be found in centers with limited resources. This study evaluated the safety, feasibility, results, and short-term complication rates of performing UM-PCNL using a semi-rigid ureteroscope in preschool children. Between September 2013 and September 2021, a total of 68 patients, including 42 boys and 26 girls with a mean age of 3.2 ± 2.4 years, underwent UM-PCNL with a 4.5French tip ureteroscope instead of an ultra-mini nephroscope in children aged less than 7 years old. The procedure was done under general anesthesia in the prone position. The nephrostomy tract was dilated to 12F. Stones were fragmented using a pneumatic lithotripter. Irrigation was done with normal saline. The early stone-free rate (SFR) was 91%, and the short-term total SFR was 97%. No statistically significant difference was found in pre-operative and post-operative Hb, BUN, Cr, Na+, and K+. Fever (11 patients) and ileus (5 patients) constituted the majority of complications, and only one patient required a blood transfusion. None of the cases undergoing UM-PCNL with this method required a re-do PCNL. Our experience shows that with sufficient experience in handling semi-rigid ureteroscopes, urologists practicing in centers with limited resources could perform UM-PCNL with relatively favorable outcomes.

Mini percutaneous nephrolithotomy treat the large upper ureteric stones

Background. The incidence of kidney stones has been raised all over the world. Nephrolithiasis is the most common cause of illnesses in western countries and has been rising in its incidence in developing countries. PCNL describe the management of large renal calculi when measuring >20 mm and even for smaller ones of lower pole with excellent stone-free rate reach to 98%. Aim. To evaluate the mini-percutaneous nephrolithotomy (mini-PCNL) safety used to cure upper ureteral and renal stones with assessing the complication and procedure outcome in Iraqi patients. Method. This is a prospective study done between October 2022 and September 2023 in Ghazi Al-Hariri for Surgical Specialties Hospital, Medical city, with 100 patients enrolled who underwent mini-PCNL. All patients had upper ureteral and renal stones (size ≥20 mm). The nephroscope tube was utilized. The stones were destroyed by pneumatic lithotripter. Complications and outcomes were determined immediately postoperative via X-ray of the ureters, kidneys and bladder. Ultra-sonography also used to determined safety and efficacy of procedure. Results. The cases mean age was 55.8 ± 12.3 years, and their BMI was 29.5 ± 5.9 kg/m2. The size of mean stone was 22.5 ± 17.9 mm. The stone-free rate (SFR) was 94.7%. The post-operative hospital stay mean was 3.6 ± 2.7 days. The Hb drop mean was 0.6 ± 0.3 g/dL. There were none of our cases had organ trauma or any complications. Thirty cases required additional subsequent extra-corporeal shock wave lithotripsy. Conclusion. The mini-PCNL is effective and safe in cases of upper ureteral and renal stones ≥20 mm. Researches with a larger multi-center cohorts may be needed to validate these techniques.

Comparison of Outcomes of Pneumatic Ballistic Lithotripsy, Holmium Laser Lithotripsy, and Combined Electromagnetic with Ultrasonic Lithotripsy during Percutaneous Nephrolithotomy

Objective: To compare outcomes of combined electromagnetic with ultrasonic lithotripter, pneumatic ballistic lithotripter, and holmium laser lithotripter among patients at a Tertiary Care Hospital. Study Design: Prospective comparartieve study. Place and Duration of Study: Department of Urology at Tabba Kidney Institute, Karachi Pakistan, from May 2020 to Jun 2021. Methodology: Ninety patients were divided into three groups of lithotripsy energies. Group-A (n=30) patients got pneumatic lithotripsy, Group-B (n=30) patients got laser lithotripsy, while Group-C (n=30) patients got trilogy lithotripsy technique. Outcomes such as post-operative pain, post-operative complications, and stone clearance were evaluated in all groups. Results: The overall mean age of the patients was 50.23±9.24 years, ranging from 33-74 years. The majority of the participants were males (n=52,57.8%), and 38(35.6%) of the participants were females. The intra-operative time, severity of post-operative pain, fever and UTI were the same between the three groups. However, the proportion of hematuria (p=0.001) and stone clearance (p=0.025) significantly differed between the three groups. Conclusion: Laser and pneumatic lithotripter were more effective in complete stone clearance than trilogy lithotripter. While laser lithotripter significantly decreases the occurrence of hematuria.

URERTEROSCOPIC LASER LITHOTRIPSY IS BETTER THAN PNEUMATIC LITHOTRIPSY FOR URETRIC STONES

Background: Among various intra-corporeal lithotripters, pneumatic lithotripter has become the widely used tool for the treatment of urinary stones. Recently the holmium: YAG laser has been used with a wide range of potential urological applications, including intra-corporeal lithotripsy of urinary calculi. Aims and objective: Compare the effectiveness and complications of treatment for ureteric stones between holmium laser lithotripsy and pneumatic lithotripsy. Material and Methods: Comparison of 100 patients presented with ureteric stones, group one (50) of whom were treated with pneumatic lithotripsy and group two (50) with holmium laser was done and the effectiveness and complications of both were analyzed. Results: There was no difference in patient age, sex, stone size and location of stones between the two groups. The immediate stone free rates were 86% in the holmium: YAG group and 64% in the pneumatic lithotripsy group (p = 0.011).. The mean operative time in the holmium: YAG group (35.7±3.2) was shorter than those with pneumatic lithotripsy group (50.2±5.3). Postoperative stay in hospital was less than 24 hours in holmium: YAG group (74%) and shorter than those for pneumatic group (36%) (p < 0.002). Post treatment complications such as ureteral perforation were encountered in only three patients who underwent pneumatic lithotripsy. Other complications, such as mucosal injury, ureteral perforation and postoperative fever; there was no statistically signicant difference between the two groups. While light hematuria was found more frequently in the pneumatic group (10%) in comparison to laser group (4%) (p = 0.045). On the other hand, the overall complication rates between the two groups was statistically signicant (10%) laser group vs. (36%) pneumatic group (p = 0.002). Conclusions: Holmium: YAG laser lithotripsy was associated with shorter operation time and postoperative hospitalization period. We believe that Holmium: YAG laser lithotripsy is an excellent treatment modality for managing ureteral calculi in central Rajasthan where stone formation rate is quite high. Drawback of holmium laser lithotripsy is its cost and maintainance

EXPERIENCE OF BILATERAL SYNCHRONOUS PERCUTANEOUS NEPHROLITHOLAPAXY (PCNL)

Objective: This case report will present bilateral synchronous percutaneous nephrolitholapaxy (PCNL) that was performed in Saiful Anwar General Hospital Malang for the first time. Case(s) Presentation: 49 years old male with flank pain on both sides continuously. Non contrast abdominal Computed Tomography (CT) scan showed bilateral pyelum stone and bilateral hydronephrosis. From blood analysis, the creatinine serum was 1.5 mg/dL and ureum serum was level 69.8 mg/dL. Discussion: Bilateral synchronous PCNL was performed in prone position, and stone fragmentation was done with pneumatic lithotripter, the operation last for about 2 hours with minimal amount of bleeding. After 3 months of follow-up, urology ultrasound and abdominal X-ray shows no residual stone, and normal ureum-creatinine level (0.77mg/dL; 43.7mg/dL). Conclusion: Bilateral synchronous PCNL is a safe choice to be done in order to treat bilateral pyelum stone, it can decrease length of stay , total cost therapy, and morbidity of the patient.

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

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

Endoscopic Management of Upper and Lower Ureteric Stones Using Pneumatic Lithotripter: A Retrospective Medical Records Review.

In this study we aimed to assess and compare the rate of sem-irigid ureterorenoscope in the treatment of upper and lower ureter stones through pneumatic lithotripsy (PL). Ninety-two patients with a mean age±SD of 45±15years who had had a surgical procedure performed by the same experienced surgeon between January 2013 and July 2015 were included in the study. The mean±SD stone size was 8.8±2.6 mm. Forty-two of the patients (45.7%) had upper ureter stones and 50 (54.3%) had lower ureter stones in order to increase the success rate and avoid stone migration. The medical files of the patients were reviewed regarding age, sex, stone size, stone location, success rate, complications, and presence of hydronephrosis. Success was operationally defined as the complete fragmentation of stone to very small parts that could pass or complete extraction of the stone. Eighty-four of the patients were stone free (91%). The success rates for patients with upper or lower ureteric stones were 93% and 90%, respectively (P=0.63). There were no complications during the operation. However, 4 patients (4.4%) had postoperative complications in terms of urinary tract infection or urosepsis. Those were accurately managed by the suitable medical treatment. Semi-rigid ureterorenoscopy by using PL was a safe and practical treatment option for managing the upper and lower ureter stones. Performing the tips and tricks of ureterorenoscopy by an experienced surgeon seems to enhance the success rate, especially in upper ureter stones.

Assessment of single-probe dual-energy lithotripters in percutaneous nephrolithotomy: a systematic review and meta-analysis of preclinical and clinical studies.

To evaluate the safety and efficacy of single-probe dual-energy (SPDE) lithotripters in patients undergoing percutaneous nephrolithotripsy (PCNL) through a systematic review and meta-analysis. We searched PubMed, Cochrane Library, Scopus and Embase databases until July 2022 for any preclinical or clinical studies, exploring the safety and efficacy of different SPDE lithotripters in patients undergoing PCNL. We performed a meta-analysis to compare stone-free rate, bleeding, or other complications and mean operative time between SPDE lithotripters and other lithotripters (PROSPERO: CRD42021285631). We included 16 studies (six preclinical, seven observational and three randomized with 625 participants) in the systematic review and four in the meta-analysis. Preclinical studies suggest that SPDE lithotripters are safe and effective for the management of renal stones. Among clinical studies, four studies assessed Trilogy with no comparative arm, two compared Trilogy or ShockPulse with a dual-probe dual-energy lithotripter, two compared Trilogy with a laser, one compared ShockPulse with a pneumatic lithotripter, and one directly compared Trilogy with ShockPulse. Comparing SPDE lithotripters to other lithotripters, no significant differences were demonstrated in stone free rate (OR 1.13, 95% CI 0.53-2.38, I2 = 0%), postoperative blood transfusion (OR 1.33, 95% CI 0.34-5.19, I2 = 0%), embolization (OR 0.45, 95% CI 0.02-12.06), operative time (WMD: 2.82min, 95% CI -7.31-12.95, I2 = 78%) and postoperative complications based on the Clavien-Dindo classification. SPDE lithotripters represent a promising treatment modality for patients requiring PCNL. Despite the initial encouraging findings of preclinical and isolated clinical studies, it seems that Trilogy or ShockPulse provide similar efficiency compared to older generation devices.

Contact ureterolithotripsy of a giant ureteral stone in a 3-year-old child

Giant ureteral stones in young children are extremely rare and their surgical treatment tactics are variable. The present case describes a case of effective and safe endoscopic treatment of giant ureteral stones in a young child. The patient is a 3-year-old male child. Examination findings of abdominal pain and fever verified a left distal ureteric stone up to 30 mm complicated by ureterohydronephrosis. The first treatment stage was ureteral stenting, in which the stone migrated to the middle ureteral third. The second treatment stage was contact ureterolithotripsy with a 9 Ch semi-rigid ureteroscope («Richard Wolf» GmbH, Knittlingen, Germany) and Swiss LithoClast® 2 pneumatic lithotripter («E.M.S. Electro Medical Systems» S.A., Nyon, Suisse), ureteral stenting (2-way PigTail, 4.5 Ch). The third treatment stage in the delayed period was extracorporeal shockwave lithotripsy of the steinstrasse using the Dornier Compact Sigma («Dornier MedTech» GmbH, Weßling, Germany) and stent removal. Residual stones were not revealed according to the follow-up examination. No treatment complications were registered. The multimodal staged treatment of a giant ureteral stone resulted in its complete elimination. Next-step ureteral endoscopy made it possible to identify concomitant pathology of the proximal ureter, which required its evaluation in the delayed period. Ureteral stenting contributed to the restoration of renal function. The result achieved reflects the maximum efficiency and high safety of the surgical technique applied.

Efficacy of Laser Vs Pneumatic Lithotripsy for Mid and Distal Ureteric Stone: A Comparative Study

Introduction: Urolithiasis refers to a condition characterized by the formation or occurrence of calculi in the urinary tract. In Asia, about 1%-19.1% of the population suffers from urolithiasis. Pneumatic and laser intra corporeal lithotripsy are mostly preferred and frequently used during endoscopic management for ureteral stone.
 Aims: This study was done to compare the efficacy of the laser versus pneumatic lithotripsy.
 Methods: This was a prospective comparative study conducted from May 2019 to April 2020 in Nobel Medical College and Teaching Hospital, Biratnagar. Patients with mid- or distal ureteric calculi of size 5mm and more or failed medical management were included in the study. The patients were equally divided into two groups: laser & pneumatic. The efficacy of the procedure was measured in terms of stone clearance. Stone size less than 5mm, nephrolithiasis on same side of ureteric stone, pregnancy, bleeding disorder and patient not giving consent were excluded from the study.
 Results: Total 130 patients were enrolled in this study. The stone clearance was observed in 86.15% in pneumatic group and 96.92% in laser group at the end of 6 weeks. In pneumatic group 13.85% did not achieve stone clearance where as in laser group it was 3.08%. In patients with mid ureteric stone the clearance rate was significantly higher in laser group (93.33%) than in pneumatic group.(p=0.041) When the clearance rate of two techniques were compared for distal ureteric stone the results were similar. The mean operation time was 28.89 ± 8.26 min in pneumatic group and 22.93 ± 6.05 min in laser group(p<0.05).
 Conclusion: Holmium: YAG laser lithotripsy is superior to pneumatic lithotripter in terms of stone clearance rate for the mid ureteric calculus and also less time consuming.

A retrospective observational study compared the efficacy of pneumatic and holmium laser ureteroscopic lithotripsy for treatment of ureteral stones

Purpose: To compare the efficacy and complications of holmium laser lithotripters and pneumatic lithotripters, the two most commonly used lithotripters in the endoscopic treatment of ureteral stones, at all ureteral levels. Material and method: Retrospective data on 510 patients who had ureterorenoscopic lithotripsy performed by a single surgeon between January 2018 and 2021 were studied. Patients were divided into two groups: those who received a holmium laser lithotripter and those who received a pneumatic lithotripter. Demographic information, stone-free rates, double-j (JJ) stent usage, JJ stent removal time, type of anesthesia, operation time, hospital stay, and complication rates were all examined. Results: The patient numbers in the holmium laser and pneumatic groups were 265 and 245, respectively. The overall success rate in group 1 was found to be significantly higher than in group 2 (98.5 percent vs 93.9 percent; p=0.006). Group 1 had a significantly higher success rate in proximal ureteral stones (94.4 percent vs 68.9 percent; p=0.001). Patients in group 1 had a significantly higher rate of not using any ureteral stent (29.8 percent vs 17.6 percent; p<0.001). There was no difference between the two groups in terms of mid-ureter and distal ureter stones, anesthesia type, operation time, hospital stay, JJ stent removal time, and complications. Conclusion: For ureteral stones, ureterorenoscopic lithotripsy is the chosen therapeutic approach. The location of the stone in the ureter as well as the type of lithotripters used can have an impact on the outcome. Because of its great efficiency and lack of need for ureteral stents, holmium laser lithotripsy may be preferred for the treatment of proximal ureteral stones.

Totally ultrasound-guided minimally invasive percutaneous nephrolithotomy in children: Is it safe?

Objective:The objective of the study was to assess the outcome and feasibility of ultrasonography (US)-guided minimally invasive percutaneous nephrolithotomy (mini-PCNL) in children.Materials and Methods:Twenty-five children with upper urinary tract stones who had undergone US-guided mini-PCNL from June 2017 to June 2020 were enrolled in this study. Patients’ demographic information and post-treatment results were retrospectively gathered and analysed. Pyelocaliceal system was punctured in prone position using US guidance, and the tract was dilated using single-shot dilation technique. All steps of renal access were done using only US. Mini-PCNL in all cases was done by using 15 Fr rigid nephroscope. Stones were fragmented with a pneumatic lithotripter and evacuated.Results:The patients’ mean age was 6.30 ± 3.25 years (range: 1.5–15). The mean stone size was 16.04 ± 3.93 mm (range: 10–30). The mean access time to the stone was 1.50 ± 0.62 min (range: 1–4). The mean operation time was 94.66 ± 3.05 min (range: 90–100 min). The final stone-free rate was 96%. Post-operation fever occurred in 4 (16%) patients who were treated successfully with an antibiotic. No major complications occurred.Conclusions:We recommend US-guided mini-PCNL as a harmless alternative treatment option, in children with renal calculi due to its excellent outcomes and little complications.

Laparoscopic Management of Common Bile Duct Stones using Semi-rigid Ureteroscope- a Single Centre Prospective Observational Study

Background: Minimally invasive and endoscopic techniques are increasingly being used by surgeons nowadays in the management of patients with cholelithiasis and choledocholithiasis. However, there is a high failure rate in the extraction of large impacted stones using the conventional flexible choledochoscope by the laparoscopic approach. Improvisation of this technique will reduce the failure rate. The present study explored the safety, feasibility, and efficacy of a semirigid ureteroscope (SRUS) in the laparoscopic management of common bile duct (CBD) stones. Methods: A prospective observational clinical study was carried out in an experienced GI surgical unit from January 2020 to December 2021. It included 36 patients diagnosed with radiologically proven gallstone disease with bile duct calculi who underwent Laparoscopic CBD exploration (LCBDE) and stone extraction using SRUS with lap cholecystectomy (LC) as a single-stage procedure. The success rate in terms of complete CBD clearance is the primary outcome measure. Post-procedure complications, 24 hr pain score, in-hospital stay, and patient satisfaction score are the secondary outcome measures. Results: Mean age of the study subjects was 50.45±9.12 years. The most common clinical symptom was biliary colic followed by jaundice. The primary outcome measure of complete CBD clearance was achieved in 94%. A complication following surgery was bile leak in one patient (3%). There were no surgical site infections or T-tube related complications. The average WHO 24-hour pain score was 4.9±1.9. The mean in-hospital stay was 3.3±1.4 and the mean patient satisfaction score was 2.42±0.3. Conclusion: Laparoscopic approach avoids the complications of endoscopic retrograde cholangiopancreatography (ERCP) sphincterotomy/sphinteroplasty and keeps the sphincter of Oddi (SOD) intact. LCBDE with SRUS is a safe and effective single-stage approach without any radiation hazards. The pneumatic lithotripter with its pneumatic ballistic effect is more efficacious, cost-effective, and safe as compared to other lithotripsy techniques. This lithotripter is capable of dealing with different varieties of stones regardless of their composition, size and degree of impaction. However, future comparative studies are needed to prove the superiority of this technique.

Definition of clinically insignificant residual fragments after percutaneous nephrolithotomy among urologists: a world-wide survey by EAU-YAU Endourology and Urolithiasis Working Group.

The aim of this article was to evaluate the current perception of urologists as to what size is considered as a clinically insignificant residual fragment (CIRF). A survey was globally distributed to the members of the Endourological Society via SurveyMonkey. A total of 385 participants responded to the survey on CIRF. Most participants considered 2 mm (29%) as CIRF threshold, followed by 3 mm (24%), 4 mm (22%), 0 mm (14%), 5 mm (8%) and 1 mm (3%). North American urologists considered CIRF to be smaller than urologists from Asia, Eurasia and South America, (p-values ≤0.001, 0.037 and 0.015 respectively). European urologists identified smaller CIRF in comparison to Asian urologists (p-value = 0.001). Urologists mainly using a pneumatic lithotripter accepted larger fragments as CIRF, compared to urologists mainly using ultrasonic devices or a combination of ultrasonic and pneumatic devices (p-value = 0.026 and 0.005 respectively). Similarly, urologists mainly performing X-Ray and ultrasound as post-operative imaging accepted larger fragments as CIRF in comparison to urologists mainly performing non-contrast computed tomography (p-value = 0.001). What is considered as CIRF varies between urologist from different continents and seems to be associated with the lithotripter used and the post-operative imaging modality of preference to assess treatment success.

Feasibility of Percutaneous Nephrolithotomy After Urology Residency Training in the 2nd Stage State Hospital

Purpose: It was aimed to evaluate the results and complications of percutaneous nephrolithotomy (PCNL) in a second stage state hospital by a surgeon after Urology residency. Materials and methods: Between January 2019 and January 2020, PCNL was applied to 102 renal units in 97 patients with kidney stones in a second stage state hospital. Standard PCNL was performed in all patients in the prone position with a 26 Fr rigid nephroscope and pneumatic lithotripter. The data of the patients were collected retrospectively. Success rates, length of stay, and complications were evaluated in the light of the literature. Results: The average age of 97 patients who underwent PCNL was 41.7±10.5 (8-71) and 54 (55.7%) of these patients were male and 43 (44.3%) were female. Access was provided to 102 renal units. 42 (41.2%) of them were left and 60 (58.8%) were right. The mean stone surface area was 8.3±5.5 (2-34) cm2 and the number of stones per patient was 2.4. Operation time was measured as 85>32 (40-170) minutes. The duration of fluoroscopy was observed as 1.2±0.2 (0.5-9) minutes. The stone free rate was achieved in 86 (84.3%) of 102 cases. Including clinically insignificant residual fragments (>4 mm), the overall success rate was 93.1%. The hospital stay of the patients was 2.7 (1-11) days. The number of patients with major and minor complications was 21 (20.6%). Conclusion: We thought that PCNL can be applied safely and effectively in 2nd stage state hospitals with acceptable complications and success rates in line by the literature.

Intraductal Fragmentation in Sialolithiasis Using Pneumatic Lithotripsy: Initial Experience and Results.

ObjectiveTo report initial experience in using a pneumatic lithotripter to treat salivary stones.Study DesignLevel IV retrospective study.SettingUniversity hospital and tertiary referral center.MethodsA pneumatic lithotripter was used to treat salivary stones after these were diagnosed. Probes with diameters of 0.7 mm were used. Total fragmentation was intended in all stones. Stone fragments were removed using several instruments in serial sialendoscopies to achieve complete stone clearance.ResultsA total of 62 patients with 77 stones were treated. Forty-three submandibular stones were treated in 34 patients, and 34 parotid stones were treated in 28 patients. An operating pressure of 2.5 bar and a single frequency mode were used. Complete fragmentation was achieved in all but one of the treated stones in both glands (98.7%). Among the patients, 90.32% became stone free and 100% symptom free. Multiple stones were treated in 24.19% of the patients, and multimodal therapy was also carried out in 24.19%. All of the glands were preserved.ConclusionsThe pneumatic lithotripter proved to be effective in the treatment of sialolithiasis. Stone size, location, and the gland involved were important clinical factors. The device was sufficient to achieve success without any increased risk for complications in the patients or damage to the sialendoscopes.

1341 Outcomes of Sialendoscopic Stone Retrieval Under Local Anaesthesia in The Outpatient Setting- A Single Surgeon’s Experience

Abstract Aim The aim of this retrospective case series was to investigate the success rate of sialendoscopic stone retrieval under local anaesthetic. Method The records of 52 patients who underwent salivary endoscopy between September 2018 and February 2020 were reviewed. Included cases presented with at least one symptomatic major salivary gland, and sonographic or radiographic evidence of stone disease. Results A total of 25 patients (48%) and 27 stones were identified. Most cases (19/25) involved the submandibular gland, with a virtually even division between left and right sides. 19/25 patients underwent stone retrieval under local anaesthetic (LA) in the first instance (two of these patients had two stones). 6/25 patients underwent stone retrieval under general anaesthetic (GA) in the first instance, and this was successful in 5/6 cases. The overall success rate of LA sialendoscopic stone retrieval was 18/21 (86%), with 14/21 stones (66%) being successfully removed at the first treatment session and a further four at the subsequent treatment session. Under LA, 13/18 stones were removed intact, while the remaining 5 underwent fragmentation with an intraoral salivary pneumatic lithotripter (Cook Medical). Conclusions Sialendoscopic stone retrieval is a minimally invasive and effective treatment for both submandibular and parotid duct stones. It is possible to remove most stones under local anaesthetic at the first treatment session, using intraoral lithotripsy as an adjunct when indicated. This treatment modality provides therapeutic benefit with 86% success of stone retrieval under local anaesthetic with gland preservation in the vast majority of patients.

1196 Sonographic Assessment Versus Direct Clinical Measurement of Sialolith Size and Its Influence on Modality of Endoscopic Removal

Abstract Aim The aim of this retrospective case series was to investigate the influence of sialolith size on the potential for endoscopic stone removal. Method The records of 52 patients who underwent salivary endoscopy between September 2018 and February 2020 were reviewed. Included cases presented with at least one symptomatic major salivary gland, and sonographic or radiographic evidence of stone disease. Results A total of 25 patients (48%) and 27 stones were identified. These patients had a mean age of 45.2 years (range 16–72); 52% were female. Most cases (19/25) involved the submandibular gland, with a virtually even division between left and right sides. The overall success rate of sialendoscopic retrieval was 23/27 (85%), with 17/27 stones removed intact and 6/27 undergoing fragmentation with an intraoral salivary pneumatic lithotripter (Cook Medical). Median (sonographic) stone size in the largest dimension for those stones removed intact was 4mm (range 3-12mm), while for those undergoing fragmentation it was 7mm (range 3-11mm). Ultrasound provided an accurate assessment of stone size in most cases, but underestimated diameter by an average of 1mm in 6/27 cases, and overestimated size by 1mm in a single case. Conclusions Sialendoscopic stone retrieval is a minimally invasive and effective treatment for sialolithiasis. It is possible to remove most stones using a basket, with intraoral lithotripsy employed for larger stones. Ultrasound is a reliable diagnostic tool for predicting stone size but may underestimate size in a small proportion of cases.

Comparative Study between Pneumatic and Holmium Laser Lithotripsy in Treatment of Ureteric Stones

Abstract Objective The aim of this study was to compare the efficacy &amp; safety of holmium laser and pneumatic lithotripsy used in the ureteroscopic treatment of ureteral stones. Materials and Methods A prospective randomized clinical study was done using the data of patients to whom ureteroscopic lithotripsy (URL) was applied for ureter stones in our clinic. Then these patients were separated into 2 groups according to the type of lithotriptor used in stone fragmentation as laser lithotripsy (Group 1) and pneumatic lithotripsy (Group 2). Results Statistically, the two groups were similar in respect of the number of stones, stone burden and the number of double J stents applied intra-operatively. Mean operating time was calculated as 62.9 (±7.69) minutes in Group 1 and 50.98 (±6.63) minutes in Group 2. The mean operating time was found to be higher in group 1 than group 2 (P = 0.000). On postoperative day 1 after the URL, the SFR of Group 1 79.0% found to be significantly high compared to the SFR of Group 2 (64.0%) (P = 0.019), while at postoperative month 1, the SFR of both groups (Group 1 84%, Group 2 80%) was found to be similar (P = 0.462). Conclusions Compared to the pneumatic lithotripter, the Ho: YAG laser seems to have a statistically significant higher SFR in the early postoperative period (1 day), even though there are statistically insignificant success rate (after 1 month) and complications (hematuria, mucosa injury, stone migration, stricture and perforation avulsion).

Comparison of pneumatic lithotripsy versus laser lithotripsy for upper ureteral calculi

Background: Several modalities are available for upper ureteric stone fragmentation. From them pneumatic and holmium: yttrium-aluminum-garnet lithotripsy has favourable outcomes. In this study we studied 50 patients who underwent ureteroscopic pneumatic lithotripsy or laser lithotripsy. This study aims to to compare the outcome of PL and LL in the management of upper ureteric calculi.Methods: This is a prospective, randomized study of 50 cases; 25 cases of TUL with pneumatic lithotripter and 25 cases of TUL with laser lithotripter over two years. The purpose of this study was to analyze the factors predicting the stone-free rate, assess the complications following PL and LL, and assess the need for a second procedure if retropulsion of calculi occurs.Results: Two groups were similar in age, gender, mean size of stones, retropulsion and complications. There was a statistical difference in terms of stone free rate in favour of LL group (p≤0.05) and mean operative time in favor of the PL group (p≤ 0.05). Conclusions: In conclusion, we found that both the PL and LL approaches were effective and safe for upper ureteric calculi, but the LL method had advantages, especially in stone free rate, over the PL treatment. Another advantage of the LL method was safe stone fragmentation in upper ureteral calculi due to lower retropulsion rate in contrast with the PL method.