Comparison of Outcomes of Pneumatic Ballistic Lithotripsy, Holmium Laser Lithotripsy, and Combined Electromagnetic with Ultrasonic Lithotripsy during Percutaneous Nephrolithotomy
DOI:
https://doi.org/10.51253/pafmj.v73i6.8856Keywords:
Complications, Hematuria, Laser lithotripsy, Pneumatic lithotripsy, Stone clearance, Trilogy lithotripsy, urolithiasisAbstract
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.
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Bouatia M, Benramdane L, Idrissi MOB. An epidemiological
study on the composition of urinary stones in Morocco in
relation to age and sex. Afr J Urol 2015; 21(3): 194-197.https://doi.org/10.1016/j.afju.2015.02.006.
Daudon M, Traxer O, Lechevallier E. Épidémiologie des lithiases
urinaires. Prog Urol 2008; 18(12): 802-814.https://doi.org/10.1016/j.purol.2008.09.029.
Fernström I, Johansson B. Percutaneous pyelolithotomy. A new
extraction technique. Scand J Urol Nephrol 1976; 10(3): 257-259.
https://doi.org/10.1080/21681805.1976.11882084.
Rajeev T, Pratihar SK, Sarma D. A Comparative Study between
Holmium Laser, Pneumatic Lithotripsy and Shock Pulse in
Terms of Efficacy and Safety in Percutaneous Nephrolithotomy
(PCNL): A Prospective Randomised Study. J Endolumin
Endourol 2020; 3(1): e1-e8.https://doi.org/10.22374/jeleu.v3i1.75.
Karakan T, Diri A, Hascicek AM. Comparison of ultrasonic and
pneumatic intracorporeal lithotripsy techniques duringpercutaneous nephrolithotomy. Sci World J 2013; 2013: 604361.https://doi.org/10.1155%2F2013%2F604361.
Cho CO, Yu JH, Sung LH. Comparison of percutaneous
nephrolithotomy using pneumatic lithotripsy (lithoclast®) alone
or in combination with ultrasonic lithotripsy. Korean J Urol 2010;
(11): 783-787. https://doi.org/10.4111/kju.2010.51.11.783.
Lin L, Zhou L, Xiao K. Does combined lithotripter show superior
stone-success rate than ultrasonic or pneumatic device alone
during percutaneous nephrolithotrotomy? A meta-analysis. Int J
Surg 2022; 98: 106223.https://doi.org/10.1016/j.ijsu.2021.106223.
Large T, Nottingham C, Brinkman E. Multi-Institutional
Prospective Randomized Control Trial of Novel Intracorporeal
Lithotripters: ShockPulse-SE vs Trilogy Trial. J Endourol 2021;
(9): 1326-1332. https://doi.org/10.1089/end.2020.1097.
Proietti S. Instruments. In: Hubosky, S.G., Grasso III, M., Traxer,
O., Bagley, D.H. (eds) Advanced Ureteroscopy. Springer, Cham,
https://doi.org/10.1007/978-3-030-82351-1_3.
Abd ZH, Muter SA. Comparison of the Safety and Efficacy of
Laser Versus Pneumatic Intracorporeal Lithotripsy for Treatment
of Bladder Stones in Children. J Clin Med 2022; 11(3): 513.https://doi.org/10.3390/jcm11030513.
Axelsson TA, Cracco C, Desai M. Consultation on kidney stones,
Copenhagen 2019: lithotripsy in percutaneous nephrolithotomy.
World J Urol 2021; 39(6): 1663-1670.https://doi.org/10.1007/s00345-020-03383-w.
Castellani D, Corrales M, Lim EJ. The Impact of Lasers inPercutaneous Nephrolithotomy Outcomes: Results from a
Systematic Review and Meta-Analysis of RandomizedComparative Trials. J Endourol 2022; 36(2): 151-157.
https://doi.org/10.1089/end.2021.0507.
Auge BK, Lallas CD, Pietrow PK. In vitro comparison ofstandard ultrasound and pneumatic lithotrites with a new
combination intracorporeal lithotripsy device. Urology 2002;60(1): 28-32. https://doi.org/10.1016/s0090-4295(02)01624-2.
Teichman JM, Vassar GJ, Bishoff JT, Bellman GC. Holmium:YAGlithotripsy yields smaller fragments than lithoclast, pulsed dyelaser or electrohydraulic lithotripsy. J Urol 1998; 159(1): 17-23.https://doi.org/10.1016/s0022-5347(01)63998-3.
Razvi HA, Song TY, Denstedt JD. Management of vesical calculi:comparison of lithotripsy devices. J Endourol 1996; 10(6): 559-563. https://doi.org/10.1089/end.1996.10.559.
Rabani SM, Rabani S, Rashidi N. Laser Versus PneumaticLithotripsy With Semi-Rigid Ureteroscope; A Comparative
Randomized Study. J Lasers Med Sci 2019; 10(3): 185-188.https://doi.org/10.15171/jlms.2019.29.
Maghsoudi R, Amjadi M, Norizadeh D. Treatment of ureteral
stones: A prospective randomized controlled trial on comparison
of Ho:YAG laser and pneumatic lithotripsy. Indian J Urol 2008;
(3): 352-354. https://doi.org/10.4103/0970-1591.39549.
Pietrow PK, Auge BK, Zhong P. Clinical efficacy of a
combination pneumatic and ultrasonic lithotrite. J Urol 2003;
(4): 1247-1249.https://doi.org/10.1097/01.ju.0000049643.18775.65.
Timm B, Farag M, Davis NF. Stone clearance times with minipercutaneous nephrolithotomy: Comparison of a 1.5 mm
ballistic/ultrasonic mini-probe vs. laser. Can Urol Assoc J 2021;
(1): E17-e21. https://doi.org/10.5489/cuaj.6513
Abedi AR, Razzaghi MR, Allameh F. Pneumatic Lithotripsy
Versus Laser Lithotripsy for Ureteral Stones. J Lasers Med Sci
; 9(4): 233-236. https://doi.org/10.15171/jlms.2018.42.
Joshi HN, Singh AK, Koirala NP. Outcome of Uretero
Renoscopic Lithotripsy (URSL) with Holmium LASER Vs
Pneumatic Lithotripter for Lower Ureteric Stones, Experience
from University Hospital of Nepal. Kathmandu Univ Med J 2020;
(69): 49-53
Jhanwar A, Bansal A, Sankhwar S, et al. Outcome analysis of
holmium laser and pneumatic lithotripsy in the endoscopic
management of lower ureteric calculus in pediatric patients: a
prospective study. Int Braz J Urol 2016; 42(6): 1178-1182.
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