COMPARISON OF HO:YAG LASER AND PNEUMATIC LITHOTRIPSY IN THE TREATMENT OF PROXIMAL URETERAL STONES

Ho: YAG Laser And Pneumatic Lithotripsy of Ureteral Stones

Abstract

Objective: To evaluate the effectiveness and safety of treatment for proximal ureteral stones with pneumatic lithotripsy compared to holmium: yttrium-aluminum-garnet (HO: YAG) laser therapy.
Study Design: Randomized control study.
Place and Duration of Study: Armed Forces Institute of Urology, Rawalpindi from Sep 2014 to Mar 2015
Material and Methods: This randomized control trial was conducted at Armed Forces institute of Urology Rawalpindi. A total of 73 patients who underwent treatment between Sep 2014 and Mar 2015 were included in the study. Of the patients, 37 had pneumatic lithotripsy (PL group) and 36 had ureteroscopic HO: YAG laser lithotripsy (LL group) using rigid 8 Fr-ureteroscope for the fragmentation of the ureteric stones. Patients were evaluated for stone clearance after 3 weeks, with X-ray KUB, ultrasound and plan CT KUB (where indicated). All the data were recorded in a proforma and analyzed in SPSS version 11.
Results: There was a difference between the two groups according to overall stone clearance rate 83.8% for PL group vs. 86.5% for LL group. Proximal stone migration was seen in 16.2% of cases in PL group while in only 5.5% of cases in LL group. The overall complication rate was 35.1% in PL group while 30.5% in LL group. The mean procedure time was 28.8 ± 4.5 minutes for PL group while it was 35.5 ± 8.6 minutes for LL group.
Conclusion: The pneumatic and holmium: yttrium-aluminum-garnet laser lithotripsy both are established choices for treatment of ureteral stone but in terms of stone clearance rate and decrease incidence of proximal stone migration HO: YAG lithotripsy is better than pneumatic lithotripsy.