Pneumatic ureteroscopic lithotripsy: is it still a reasonable treatment option for multiple ureteric stones?

Direct Comparison of Pneumatic and Ho:YAG Laser Lithotripsy in the Management of Lower Ureteric Stones

INTRODUCTION

Besides extracorporeal shockwave lithotripsy, semi-rigid ureteroscopy (URS) has become an equal therapy of choice for the treatment of most distal ureteric stones. Before the wide availability of laser lithotripsy as a tool for stone fragmentation, pneumatic lithotripsy was, and still is, widely used. In a country like Iraq, availability and affordability are the huge questions asked. Besides the capital investment for a laser machine, the pneumatic device is reusable, whereas the laser fibers are limited in their reusability. This makes pneumatic lithotripsy a more cost-effective option, at least in our setting. The question remains whether both options, compared in our setting with our limited resources, are equally effective and beneficial to our patients.

PATIENTS AND METHODS

Fifty patients were included in our prospective study who underwent URS for the treatment of a distal ureteric stone. Half each (n = 25) underwent pneumatic (group A) or laser lithotripsy (group B). Inclusion criteria were a single distal ureteric stone measuring 7-20 mm in largest diameter, no anatomical abnormality, age >18 years, and an unsuccessful attempt of medical expulsion therapy. Patients with signs of urinary infection and pregnant women were excluded. All patients were operated upon under spinal anesthesia. Data recorded included operation time, stone size, type of scope and lithotripter, complications, hospital stay, and stone-free rate.

RESULTS

Both groups did not show statistically significant differences in patient demography, stone size, operation time, complications, and stone-free rates (p > 0.05).

CONCLUSION

Both pneumatic and Ho:YAG laser lithotripsy are equally effective and safe in treating distal ureteric stones in our setting. If the cost and availability of laser treatment is an issue, pneumatic lithotripsy is a viable and more cost-effective option.

Pneumatic versus laser ureteroscopic lithotripsy: a comparison of initial outcomes and cost

PURPOSE

To audit the cost of laser versus pneumatic semirigid ureteroscopic lithotripsy and to analyze their relative initial outcomes and cost.

METHODS

Hundred and eighty-seven patients who underwent semirigid ureteroscopic lithotripsy were analyzed retrospectively in terms of age and sex of the patients; location and size of the stones; the type of probe and ancillary equipment such as guide wire, basket catheter, JJ stent requirements; irrigation amount; operation time; the cost of the anesthesia and further treatments such as a JJ stent removal operation and shock wave lithotripsy requirements and their costs. Two groups were formed based on this type of lithotripters, pneumatic and laser lithotripsy.

RESULTS

Operation times (min.) in terms of the stone size, for stones <100 and >100 mm(2) were 20.75 ± 10.78 and 25.82 ± 14.23, respectively (p = 0.007). Operation times for the pneumatic and laser groups were 33.05 ± 11.36 and 15.25 ± 6.14, respectively (p < 0.05).The stone-free rates for pneumatic and laser groups were 89.6 % (n = 69) and 98.2 % (n = 108), respectively (p = 0.01). The mean cost of the operations for each of the study groups was 261.5 ± 66.13 and 311.7 ± 51.97 US$, respectively (p = 0.001). The mean cost in terms of the stone size, for stones <100 and >100 mm(2), was 272.86 ± 53.05 and 323.71 ± 66.88 US$, respectively (p = 0.01).

CONCLUSIONS

It seems that usage of laser lithotripsy (LL) in patients with ureteral stones is more effective than pneumatic lithotripsy (PL) in terms of operation time and SF rate. On the other hand, the mean cost of LL seems to be more expensive than PL. Urologists should think these parameters before the choice of these two treatment modalities. The higher the effectiveness, the greater the cost.

Experience of mini-percutaneous nephrolithotomy in the treatment of large impacted proximal ureteral stones

OBJECTIVES

To evaluate the efficacy and safety of mini- percutaneous nephrolithotomy (PCNL) in the treatment of large impacted proximal ureteral stones.

METHODS

We retrospectively reviewed the outcomes of 163 patients who underwent mini-PCNL between January 2006 and August 2010. Mean age was 48.6 years and mean stone size was 18.4 mm. Hydronephrosis and/or hydroureterosis appeared in all patients. In the prone position, percutaneous access (16-Fr sheath) was established by placement of an access needle into the intended calyx under fluoroscopic guidance or combined with ultrasound guidance for complete obstruction by stones while the contrast agent cannot transit. Pneumatic or ultrasonic probes were used throughout ureterorenoscopy for lithotripsy. The ureteral stents and nephrostomy tube were placed at the end of the procedure. Mean drop in hemoglobin, operative time, success rate, hospital stay, and complications were assessed.

RESULTS

Mini-PCNL operations were performed successfully in all patients. Mean operation time was 37 min. Mean postoperative hospital stay was 3.6 days. All cases were followed up for 6-20 months. No major complications like hemorrhage, perforation or organic injury were noted during the operation or postoperatively. The stone-free rate in all patients was 95.7%. Calculus had no recurrence during the follow-up period. Hydronephrosis and hydroureterosis disappeared or were relieved.

CONCLUSIONS

Mini-PCNL is a safe and effective therapy for large impacted proximal ureteral stones.