Comparison of efficacy of ureteroscopic lithotripsy between pneumatic lithoclast and Holmium laser in management of upper ureteral stone
Li-Chen Chen, Marcelo Chen, Wun-Rong Lin, Wen-Chou Lin, Huang-Kuang Chang, Stone Yang, Jong-Ming Hsu , Wei-Kung Tsai, Pai-Kai Chiang, Yung-Chiong Chow
Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan
Purpose: To evaluate the efficacy of ureteroscopic lithotripsy with pneumatic lithoclast and laser in management of upper ureteral stones.
Materials and methods: We retrospectively review the medical record. Patients who underwent ureteroscopic lithotripsy by pneumatic lithoclast and laser between January 2012 to January 2013 for upper ureteral stone in Mackay Memorial Hospital were included. Cases with concurrent UTI and acute renal failure were excluded. Invisible stones, loss follow-up or concurrent middle or lower ureteral stones were also excluded. Patient age, method of lithotripsy, stone size and burden (based on KUB or CT), ureteral catheter insertion and further ESWL or URSL for residual stone were recorded.
Results: There were 216 patients identified. A total of 158 patients met criteria (118 patients in pneumatic lithoclast group and 40 patients in laser group). One hundred and seventy-eight ureteral stones (135 in pneumatic lithoclast group and 43 in laser group respectively) were treated. The mean age of pneumatic lithoclast and laser group was 53.5years (22-92 years) and 52.9 years (21-69 years) respectively. The stone size and burden in both groups were similar (p=0.44 and 0.45 respectively). There was a mild trend of better stone free rate and lower secondary intervention rate in laser group (p=0.07 and p=0.09 respectively). No severe complication (>Grade III Clavien classification) were observed.
Use of laser lithotripsy in management of upper ureteral stone was associated with lower rate of ureteral catheter insertion. We also observed a weak association of better stone free rate and lower secondary intervention rate in laser lithotripsy group. They were both safe procedures without major complications.