Ureteroscopic Pneumatic Lithotripsy Research Articles

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

Operation and Nursing of Ureteroscopic Pneumatic Lithotripsy for Urethral Calculi

Operation and Nursing of Ureteroscopic Pneumatic Lithotripsy for Urethral Calculi

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.

English

BACKGROUND This study was conducted to check whether computer tomography (CT) parameter Hounsfield Unit has any bearing on outcome of ureteroscopic pneumatic lithotripsy and as to whether it can predict success rate of ureteroscopic lithotripsy in the management of ureteric calculus. CT Hounsfield Unit tells us about hardness of stone, and it is primarily important in non-invasive management of ureteric and renal calculus such as extracorporeal shock wave lithotripsy (ESWL). METHODS We retrospectively reviewed records of 420 patients who underwent URSL from January 2016 to January 2020. A total of 186 patients of ureteric calculus did undergo CT in pre-operative evaluation for stone. Data of those patients was taken for study. Intra op clearance of calculus was decided by ureteroscopy finding on the table. All complications and difficulties of the procedure were documented. RESULTS We analysed the correlation between the outcome of the URSL and Hounsfield unit in finding the position of the stone and size of the stone. Out of 186 study participants, 111 (59.6 %) patients needed a single procedure for stone clearance whereas 75 (40.4 %) needed multiple procedures for clearance. Out of 186, 22 had HU < 500, 112 had HU 501 - 1000, 52 had HU > 1000. The majority of patients had HU between 501 - 1000HU. Complete clearance was seen in 63.6 % of < 500 HU patients, 62.5 % of 501 - 1000 HU patients and 55.7 % of > 1000 HU patients. This difference in clearance was statistically not significant. Similarly, the rate of complication when compared among the three groups doesn’t show a statistically significant difference (P value 0.293). The requirement of repeat procedure was maximum in > 1000 HU patients but the difference between the three groups was not statistically significant. Stone migration rate was found to be more in > 1000 HU stones (80.76 %) and this was statistically significant. CONCLUSIONS To conclude CT Hounsfield Unit’s utility in predicting the stone-free rate and complication rate doesn’t show significant bearing in patient undergoing URSL procedure. KEYWORDS CT, Hounsfield Unit, URSL, Stone Free Rate, Stone Density, Complication

English

BACKGROUND Urinary stone disease is major health problem affecting 2 – 3 % population worldwide, and is more commonly seen in the working age group (30 - 60 years) of society. X-ray, USG, CT, and IVU are diagnostic modalities available to us. IVU is still being requested by clinicians as diagnostic tool for urolithiasis but we need to reassess the importance of this modality as it seldom makes a difference in the management decision and outcome. METHODS Medical records of 184 patients who underwent ureteroscopic pneumatic lithotripsy from 2016 to 2019 for lower ureteric calculus were reviewed retrospectively. All patients of lower ureteric calculus (n = 184) were included in study; of which 130 patients had undergone USG and x-ray as pre-operative imaging; 54 underwent CT / IVU in pre-operative imaging along with USG and Xray. Stone free rate, complication, requirement of repeat procedure, and post op fever were compared and analysed. RESULTS Results were analysed in view of the need of second look surgery, post op fever, complication, and Stone Free Rate (SFR). The majority of patients who underwent URSL were with lower ureteric calculus 184 (43.8 %), upper ureteric 145 (34.5 %), middle ureteric 70 (16.7 %) and multiple 21 (5 %). The mean stone size of lower ureteric calculus was 10.4 ± 3.8 mm. Stone free rate for with URSL for lower ureteric calculus was 88 %, upper ureteric calculus 60 %, middle ureteric calculus 68 %. Overall SFR was 69.5 %. SFR in patients with imaging group was 61 % whereas in patients who didn’t undergo imaging was 77.83 %; this difference is statistically significant with a p-value 0.0003 (< 0.05). The complication rates were group I 106 (50 %) and group II 95 (45.6 %) and the difference is not statistically significant. In patients with imaging study (CT and IVU) done in the pre-op period the average hospital stay is 3.89 ± 1.23 days. CONCLUSIONS IVU has a limited clinical role, and its use should be strictly limited to highly select cases and can be avoided in straight forward cases. Similarly, CT can also be avoided in straight forward cases of lower ureteric calculus as it doesn’t provide any added advantage in terms of decreasing intra-op complication and SFR. KEYWORDS Computed Tomography, Intravenous Urography, Stone Free Rate, Stone Migration, Re Procedure

Prevention of stone retropulsion during ureteroscopy: Limitations in resources invites revival of old techniques

ABSTRACT Objective To compare a modified technique using the Dormia basket vs Stone Cone for stone entrapment to avoid proximal stone migration during ureteroscopic pneumatic lithotripsy of ureteric stones. Patients and methods Our study included all patients with ureteric stones of <15 mm who underwent ureteroscopic pneumatic lithotripsy from January 2015 to September 2018. The study had two arms that were conducted over two consecutive periods; the first included 72 patients in whom we used the Stone Cone (Group 1) and the second included 86 patients in whom we started to use a Dormia basket with a modification (Group 2) to guard against proximal stone migration. Results Both groups were comparable for gender, age, and stone characteristics. Lower ureteric stones were the most prevalent as they represented 62.5% and 60.5% in groups 1 and 2, respectively; while upper ureteric stones were respectively found in 16.7% and 17.4%. Chemical stone analysis revealed that calcium oxalate stones were most predominant accounting for 51.3% and 51.1% in groups 1 and 2, respectively. Most of the stones were radio-opaque stones representing 57% and 58.1% in groups 1 and 2, respectively. There was a significant difference in operative time, with a mean (SD) operative time was 50.9 (11.2) in Group 1 vs 58.3 (12.4) min in Group 2 (P < 0.001). The success rate, defined as no retropulsion of stone fragments, was 97.7% in Group 2 vs 91.7% in Group 1 (P < 0.01). Complications were minor and comparable between the groups. There was no difference in hospital stay between the groups, but the cost assessment favoured Group 2. Conclusion We found that our modified-basket stone entrapment technique compared favourably with the Stone Cone to guard against stone retropulsion during ureteroscopic pneumatic lithotripsy. Our modification to the basket was found to be feasible, efficient, safe, reproducible and cost-effective in preventing proximal stone migration. This procedure is particularly suitable in cost-limited environments.

Comparison of Ureteroscopic Pneumatic Lithotripsy and Extracorporeal Shock Wave Lithotripsy for Proximal Ureteral Calculi.

ObjectiveThe goal of this study was to compare the effectiveness and complications of ureteroscopic pneumatic lithotripsy (URS) and extracorporeal shock wave lithotripsy (SWL) in the management of patients with proximal ureteral stones.MethodsIn this trial, 150 patients presenting with proximal ureteral stones at the Department of Urology of Nishter Hospital Multan from November 2018 to November 2019 were allocated 1:1 to undergo URS or SWL. The presence of stone fragments <4 mm on follow-up was regarded as being stone free. The study outcomes included stone-free rates after first, second, and third treatment sessions and stone retropulsion into the kidneys.ResultsA total of 75 patients each underwent URS and SWL. The mean procedure times for SWL and URS were 61.61± 3.21 and 85.01±6.75 minutes, respectively (P=0.000), and the mean numbers of procedures were 1.51±0.49 and 1.01±0.42, respectively (P=0.000). Stone-free rates after the first, second, and third sessions of SWL were 64%, 77.3%, and 94.7%, respectively, whereas stone-free rates after the first, second, and third sessions of URS were 86.7%, 92%, and 100%, respectively. Rates of stone retropulsion into the kidneys in the SWL and URS groups were 0% and 6.7%, respectively (P=0.000).ConclusionCompared with SWL, URS had significantly higher stone-free rates in patients with proximal ureteral stones. Treatment costs and hospital stay were lower in the SWL group, whereas complication rates were comparable.

Incidence of Stone Retropulsion in Ureteroscopic Pneumatic Lithotripsy for lower ureteric stones by using stone cone.

Objectives: To measure the incidence of stone Retropulsion and its complication in ureteroscopic pneumatic lithotripsy for lower ureteric stones by using stone cone. Study Design: Observational cross sectional study. Setting: Gujranwala Medical College, Gujranwala. Period: January 2017 to December 2018. Material &amp; Methods: Consecutive simple random sampling technique was used. Total 120 patients were treated with URS pneumatic lithotripsy for single ureteric stone were enrolled in study. The diagnosis was established by plain spiral CT scan in all patients. The incidence of stone Retropulsion and complications of procedure were noted. Data was analyzed using SPSS 22.0, chi square test was used to check stratification of data, p value less than 0.05 was taken significant. Results: The stone was in lower ureter in all patients who were included in study regardless of side. The mean age of patients was 46±2.6 years and 65% (78) patients were male while 35% (42) patients were females. Success rate of 97.5% (116) achieved in patients in which stone cone was used. Conclusion: Use of stone cone gives high success rate in preventing stone Retropulsion by using pneumatic lithotripsy.

Efficacy and safety of ureteroscopic holmium laser lithotripsy and pneumatic lithotripsy for complex ureteral calculi

Objective To compare the effect of ureteroscopic holmium laser lithotripsy and pneumatic lithotripsy on the curative effect and safety of complicated ureteral calculi, so as to provide evidence for surgical treatment of complex ureteral calculi. Methods A total of 104 patients with complicated ureteral calculi admitted in our hospital from May 2015 to May 2017 were enrolled in this study. The patients were divided into two groups according to the random number table method each 52 cases. The control group was treated by ureteroscopy combined with pneumatic lithotripsy. The observation group was treated by ureteroscope combined with holmium laser lithotripsy. Statistical analysis was carried out with SPSS 18.0. The operative time, intraoperative blood loss, postoperative hospital stay and complete discharge time of the two groups were analyzed. Results The success rate of operation in the observation group was higher than that in the control group, the difference was statistically significant (P<0.05), the clinical indicators in the observation group were better than those in the control group, and the incidence of postoperative complications in the observation group was lower than that in the control group, with a statistically significant difference (P<0.05). Conclusions Compared with ureteroscopy combined with pneumatic lithotripsy, ureteroscopy combined with holmium laser lithotripsy for complex ureteral calculi curative effect is better, can shorten the complete discharge time of stone and hospital stay, reduce intraoperative bleeding, reduce the incidence of complications, More safe and reliable, it is worth clinical promotion. Key words: Ureteral Calculi; Ureteroscopy; Lasers, Solid-State; Holmium; Lithotripsy, Laser

Evaluation of Outcome of Ureteroscopic Pneumatic Lithotripsy in Single Lower Ureteric Calculus and Its Association with CT Parameters

Objective: To evaluate the outcome of ureteroscopic pneumatic lithotripsy in single lower ureteric calculus and correlate its success with different CT parameters like HU, size of calculus and hydrnephrosis, if present. Patients and Methods: This study was conducted from October 2017 to March 2019 in Department of General Surgery, Maulana Azad Medical College, New Delhi. 30 patients (out of which 6 were excluded due to spontaneous passage of calculus), with single lower ureteric calculus were chosen and the outcome of URSL was compared with respect to CT parameters of Size, HU and Hydronephrosis and intra-operative clearance of calculus. Results: Success rate of URSL in single lower ureteric calculus was found to be 75%. Lower HU (774.12 ± 212.85) was associated with higher success rate. Similarly smaller size of calculus (9 ± 2.1) mm was associated with success group. Patients with gross hydronephrosis had a poor outcome of URSL. Lower urinary tract infection (8.33%) was the most common complication. Conclusion: Patients with small size calculus, low HU and absence of hydronephrosis have a better outcome of URSL.

Preoperative Th1/Th2 and related cytokines: Prediction value in postoperative febrile UTI after ureteroscopy in patients with ureteral calculi.

The topic of whether preoperative Th1/Th2 cells and their related factors have a predictive value for postoperative febrile urinary tract infection (UTI) in patients with ureteral calculi has not been explored. The objective of this study was to investigate the role of preoperative Th1/Th2 cells and related cytokines in the prediction of postoperative febrile UTI after ureteroscopy in patients with ureteral calculi. One hundred sixty patients who underwent ureteroscopic pneumatic lithotripsy in the Affiliated Hospital of Hangzhou Normal University (China) were recruited and divided into febrile UTI group (n = 78) and non-UTI group (n = 82). Flow cytometry was used to detect the proportions of Th1 and Th2 cells (Th1% and Th2%). Detection of Th1/Th2 cell-related cytokines was conducted using enzyme-linked immunosorbent assay (ELISA). Quantitative real-time polymerase chain reaction (qRT-PCR) was applied to measure the expression of T-bet and GATA3. Compared with patients in non-UTI group, those in febrile UTI group had significantly increased proportions of Th2 cells, levels of Th2 cytokines (interleukin (IL)-4, IL-10 and IL-5), and mRNA expression of Th2-associated transcription factor GATA3 (all p < 0.05). In addition, the Th1/Th2 ratio of febrile UTI group was significantly lower than that of non-UTI group (p < 0.001). Receiver operating characteristic (ROC) curve analysis showed that the accuracy rate of Th2%, Th1/Th2 ratio, and IL-4, IL-10 and IL-5 levels for the diagnosis of postoperative febrile UTI in patients with ureteral calculi was 90.63%, 85.00%, 72.50%, 87.50%, and 91.88%, respectively, and their combined diagnostic sensitivity was 97.4% with specificity as high as 100%. Perioperative Th2 dominance was correlated with the risk of postoperative febrile UTI after ureterscopy in patients with ureteral calculi, which can provide clinical guidance for the development of individualized treatment.

Outcome, Efficacy and Safety of Ureteroscopic Pneumatic Lithotripsy In Management of Lower and Mid Ureteric Calculi

OBJECTIVE: To determine the efficacy and safety of pneumatic lithotripsy in the treatment of mid and lower ureteric calculi.DESIGN: prospective study.DURATION: From 2014 to 2015SETTING: Department of Urology, AL-Diwaniya teaching Hospital.PATIENTS &amp; METHODS:Over a period of one year,one hundred (100) patients of ureteric stones were treated with pneumatic lithoclast. Twenty five (25) Stones were located in mid ureter, Seventy five (75) stones were located in lower ureter . Success rate was defined as symptom free, no residual stones larger than 2mm. General anesthesia was given to all patients.RESULTS:Over all success rate was 90%. Success rate in middle and lower ureteric stones were 82%, 92% respectively. Completely fragmented stones cleared spontaneously within two weeks in 95% of cases and all patients were free of stones one month after the procedure. In six (6) patients stone was migrated, later on submitted for ESWL and successful. Complications were encountered in 11% of cases and were managed conservatively.Hospital stay was 24 to 48 hours.CONCLUSION:Pneumatic lithotripsy is reliable, highly effective rapid, safe and cost effective treatment modality for ureteric stones with negligible incidence of complications.

Pneumatic Lithotripsy Versus Laser Lithotripsy for Ureteral Stones.

Introduction: Several different modalities are available for ureteral stone fragmentation. From them pneumatic and holmium: yttrium-aluminum-garnet (Ho: YAG) lithotripsy have supportive outcomes. In this study we studied 250 subjects who had ureteroscopic pneumatic lithotripsy (PL) or laser lithotripsy (LL). Methods: Two-hundred fifty patients with ureteral stones underwent ureteroscopic lithotripsy (115 subjects in the PL group, 135 subjects in the LL group) from August 2010 to April 2016. The purpose of this investigation was to evaluate stone-free rate (SFR), mean operation time (MOT), mean hospital stay (MHS), stone migration and complications. Results: Two groups were similar in age, gender, mean size of stones, side of stone, and complications. There was a statistical difference in terms of SFR, stone migration and MHS in favor of the LL group (P ≤ 0.05, P ≤ 0.05 respectively), and MOT in favor of the PL group (P ≤ 0.05). Conclusion: Both the PL and LL techniques were effective and safe for ureteral stones, however a slightly higher SFR was found in the LL group.

Analysis of the influence of ureteroscopic pneumatic lithotripsy on the serum levels of CRP, IL-1 and TNF-αin patients with upper ureteral calculi

Objective To investigate the therapeutic effect of ureteroscopic pneumatic lithotripsy (URSL) on ureteral calculi and the effect on serum CRP, IL-1, TNF-αlevels. Methods Retrospective analysis of clinical data of patients with upper ureteral calculi from February 2015 to October 2016 in our hospital was performed. All patients were divided into ureteroscopy lithotripsy group (URSL group) and percutaneous nephrolithotomy group.The general situation of the two groups were observed. The levels of serum inflammatory factors, urinary function and quality of life were compared between the two groups before and after operation. Results The operation time and hematuria time of URSL group were shorter than those of percutaneous nephrolithotomy (t=27.415, 12.018, P<0.001). The stone free rate was higher than that in the percutaneous nephrolithotomy group.The level of inflammatory factors in the two groups had no difference before treatment, after treatment, the level of CRP, TNF-α, NF-κB alpha and IL-1 of the URSL group were lower than those of percutaneous nephrolithotomy group. The IPSS score of patients in URSL group was lower than that of percutaneous nephrolithotomy group at 1 month and 3 months after operation, and Qmax was higher than that of percutaneous nephrolithotomy group.There was no difference in quality of life between the two groups before operation. After operation, the quality of life score of URSL group was higher than that of percutaneous nephrolithotomy group in the 3 months after operation. Conclusions URSL has a good effect on the treatment of upper ureteral calculi, it can reduce postoperative serum CRP, IL-1, TNF-αlevel, im- prove the quality of life. Key words: Ureteral Calculi; Nephrostomy, Percutaneous; Ureteroscopy; Calcitonin Gene-Related Peptide; Interleukin-1; Tumor Necrosis Factor-alpha

Comparison of ureteroscopic pneumatic lithotripsy and extracorporeal shock wave lithotripsy for the management of proximal ureteral stones: A single center experience.

To evaluate and compare the effectiveness of ureteroscopic (URS) pneumatic lithotripsy versus extracorporeal shock wave lithotripsy (ESWL) in the management of the proximal ureteral stones in terms of stone- free rates, complications and costs involved. We included 200 patients in Group 1 who underwent ESWL and 200 patients in Group 2 who underwent URS intervention. We used Modulith SL X lithotripter 3rd generation Storz medical for ESWL group while Swiss pneumatic lithoclast was used to break the stone in the URS group. Stone-free status was defined as stone fragment of less than 4 mm on follow- up kidney ureter and bladder X-ray after 3 months of procedure. SPSS version 16 was used for statistical analysis. The mean age in ESWL and URS groups were 39.21±13.36, and 43.13±13.65 years respectively. Mean stone size was 10.47±3.7 mm (ESWL) and 13.6±6.6 mm (URS). Stone- free rate after single procedure was (125/200 patients) 62.5% for ESWL and (168/200 patients) 84% for URS group (p=0.001). Complications included post procedure sepsis in 3 (1.5%) patient of ESWL, while 7 (3.5%) patients of URS groups. Steinstrasse was seen in 4 (2%) patients of ESWL group. No mortality was seen in both groups. Mean costs for ESWL were US $320±50 while US $1100±150 for URS group (p=0.001). The stone-free rates after single procedure were significantly higher for the URS group while the complication rates were comparable in both groups. Treatment costs were significantly lower for the ESWL group.

Subcapsular renal hematoma after ureteroscopic pneumatic lithotripsy for lower ureter stone

Subcapsular renal hematoma after ureteroscopic pneumatic lithotripsy for lower ureter stone

The clinical efficacy of retroperitoneal laparoscopic ureterolithotomy versus that of ureteroscopic pneumatic lithotripsy for upper ureteral calculi

Objective To compare the efficacy of retroperitoneal laparoscopic ureterolithotomy with that of ureteroscopic pneumatic lithotripsy for upper ureteral calculi,and provide clinical guidance for choices of treatment.Methods 112 patients who received treatment for upper ureteral calculi during the period of December 2009 to December 2010 in our hospital were randomly divided into two groups.Group A underwent retroperitoneal laparoscopic ureterolithotomy,while group B group received ureterescopic pneumatic lithotripsy.The efficacy of the two procedures and the related complications were compared between the two groups.Results The success rate of the procedure was significantly higher in group A ( 92.86％ ) than in group B ( 62.5％ ),with a statistical significance ( P＜ 0.05 ).The rate of intraoperative or postoperative complications did not differ statistically between the two groups ( P ＞ 0.05 ).Conclusions Retroperitoneal laparoscopic ureterolithotomy,as compared with ureteroscopic pneumatic lithotripsy,has a higher success rate,less surgical damage,rapid postoperative recovery,and no serious complications.It is worth popularizing clinically. Key words: Retroperitoneal laparoscopic ureterolithotomy; Ureteroscopic pneumatic lithotripsy; Upper ureteral calculi

Comparison of the effect of ureteroscopic lithotripsy and extracorporeal shock wave lithotripsy for ureteral stones

Objective To compare the effect of ureteroscopic pneumatic lithotripsy(URL) and extracorporeal shock wave lithotripsy(ESWL) for ureteral stones.Methods 90 patients with ureteral stones were randomly divided into group A( URL group),group B( ESWL group),each group 45 cases.The effect of surgical treatment was compared between the two groups.Results The one-time success rate of gravel,stone free after 4 weeks of A group was significantly higher than that of group B( x2 =9.680,5.414,all P ＜0.05),but there was no significant difference in the surgical time and hospital stay of the two groups( t =1.010,0.909,all P ＞ 0.05 ).The postoperative renal colic,fever and other complications of group A were significantly lower than that of group B ( x2 =6.049,5.075,all P ＜0.05),but the gross heraturia and ureteral injury of group A was higher than that of group B(x2 =5.874,3.873,all P ＜ 0.05 ).Conclusion The ureteroscopic pneumatic lithotripsy and extracorporeal shock wave lithotripsy in the treatment of ureteral stones all have good effect,but ureteroscopic pneumatic lithotripsy and stone rubble drain success rate are significantly higher than extracorporeal shock wave lithotripsy,and postoperative complications are relatively less than extracorporeal shock wave lithotripsy. Key words: Ureteral stones; Ureteroscopic; Extracorporeal; Lithotripsy

Ureteroscopic pneumatic versus extracorporeal shock wave lithotripsy for lower ureteral stones.

To compare the efficacy of ureteroscopic pneumatic lithotripsy (URS) and extracorporeal shock wave lithotripsy (ESWL) in the treatment of lower ureteric stones in terms of stone-free rates. Randomized trial. Department of Urology, Government Institute of Kidney Diseases and Transplant, Hayatabad, Peshawar, from September 2010 to March 2011. Patients (n=136) presented with lower ureteric stones and fulfilling the inclusion criteria for the study were included. They were divided equally into two groups. Division of patients was done by lottery method. Patients in group A were treated with ureteroscopic pneumatic lithotripsy (URS) as compared to those in group B, who were dealt with extracorporeal shock wave lithotripsy (ESWL). There were 46 males (67.6%) and 22 females (32.3%) with a ratio of 2.1:1 in group A as compared to 50 males (72%) and 18 females (26.4%) with a ratio of 2.8:1 in group B. Mean age was 35.2 ± 9.5 years in group A and 35.4 ± 9.2 years in group B. The mean stone size in group A was 12.8 ± 3.7 (range 5 - 25 mm) and 12.82 ± 3.5 (range 5 - 25 mm) in group B. Mean hospital stay in group A was 2.07 ± 0.6, while patients in group B were all day-cases. The statistical difference was significant in terms of repeat procedure, auxiliary procedure postoperative analgesia and stone free status at 3 months (p=0.043, 0.020, 0.000, 0.001) respectively, while it was not significant in respect of complications of procedure (p=0.753). URS proved more effective than ESWL for the treatment of ureteric calculi. However, ESWL performed as an outpatient procedure showed fewer complications.

Pneumatic Ureteroscopic Lithotripsy: Is It Still a Reasonable Treatment Option for Multiple Ureteric Stones?

Objectives: To assess the efficacy and safety of ureteroscopic pneumatic lithotripsy for multiple ureteric stones. Materials and Methods: 36 patients with multiple ureteric stones were treated with ureteroscopic lithotripsy (URSL). A 8/9.8-Fr Wolf semirigid ureteroscope and pneumatic lithotripter were used for stone fragmentation. Results: 87 stones were treated with URSL. Successful fragmentation was achieved in 77 (88.5%) of the stones. The retreatment rate was 11.5%. The stone-free rate (SFR) of lower ureteric stones (93.3%) and middle ureteric stones (87.5%) was significantly higher compared with upper (73.3%) ureteric stones (p < 0.05). For patients with stones less than 1 cm and greater than 1 cm, the SFR was 91.5 and 75.0%, respectively (p < 0.05). Perforation occurred in 1 patient, mucosal injury occurred in 5 and stone migration in 5. No long-term complication was observed in any patient. Conclusions: Ureteroscopic pneumatic lithotripsy is still a reasonable treatment option for multiple ureteric stones. The procedure has high success rates with minimal morbidity. However, success rate can be affected by stone size and ureteric location.