Ureteroscopic Laser Lithotripsy versus Ballistic Lithotripsy for Treatment of Ureteric Stones: A Prospective Comparative Study

Abstract

Objectives: This study was undertaken to compare the results of laser (Ho:YAG) and pneumatic (ballistic) intracorporeal lithotripsy for ureteric calculi in terms of efficacy, safety and complications. Methods: 55 patients having ureteric calculus were randomly allocated into pneumatic lithotripsy (PL) and laser lithotripsy (LL) groups. Swiss lithoclast was used for PL (3 atm pressure and 12 Hz frequency) and the VersaPulse PowerSuite was used for LL. Appropriate statistical tests were applied. Results: 30 patients (34 stones) were treated with LL and 25 patients (25 stones) with PL. Both groups were comparable in profile. Mean lithotripsy time was 24.03 ± 9.51 min in the LL group and 19.80 ± 4.44 min in the PL group (p = 0.027). The immediate stone clearance rate was higher in the LL group (p = 0.001), but it was comparable at 4 weeks (p = 0.097). Stone migration occurred in 16% of cases in the PL group. No major complication was observed in either group. Conclusions: We conclude that both laser and pneumatic energies are effective and safe for intracorporeal lithotripsy. Laser lithotripsy takes more time but provides earlier stone-free status.

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

“…Additionally, stone migration is more common with PL than LL, which may be explained by the mechanism of action of both types of lithotripsy (photothermal in LL versus the jackhammer effect in PL). This explanation is consistent with other studies where stone migration occurred in the PL group in 19.2, 16 and 16% compared to the LL group in 4, 4 and 0% respectively [12,13,14]. Intraoperative submucus dissection by the guidewire occurred in 8 cases in our study (4 cases in each group), which was managed by external ureteric stent with no long-term sequelae.…”

“…Mean stone size in LL and PL in our study was 12.8 ± 4 and 13.1 ± 3.7 mm respectively (range 5–20 mm); the two groups were comparable with a statistically non-significant difference in stone size unlike other studies which show a wider difference in size between the two groups (table 1) [11,12,13,14]. The stones were located in the lower ureter in 50 patients (62.5%), which was comparable in both groups (26 LL and 24 PL).…”

Prevention of Stone Migration with the Accordion During Endoscopic Ureteral Lithotripsy

“…During endoscopic lithotripsy, there is often proximal migration of the calculus. [4][5][6] During the initial experience with ultrasonic lithotripsy, it was necessary to secure the stone with a basket. 1 Other lithotripsy devices, including impact and lasers, have also caused proximal migration of the calculus.…”

Instrumentation in endourology

“…It is considered safer than electrohydraulic lithotripsy (which has the narrowest margin of safety), with a depth of penetration of less than 0.5 mm and provides higher stone-free rates. The Holmium:YAG causes less stone retropulsion compared with pneumatic lithotripsy [Garg et al 2009]. …”