MANAGEMENT OF URETERIC CALCULI WITH PNEUMATIC LITHOTRIPSY AND INTRACORPOREAL HOLMIUM: YAG LASER: A COMPARATIVE STUDY.

  • Consultant, Department of surgery and H.O.D., Department of urology.
  • Specialist, Department of surgery.
  • Resident, Department of surgery and urology 1.,2 & 3. Dr. B.S.A. Medical College and Hospital, Rohini, New Delhi -110085.
  • Abstract
  • Keywords
  • References
  • Cite This Article as
  • Corresponding Author

Background: Among many lithotripters available for fragmentation of ureteric stones, pneumatic and Holmium: YAG laser lithotripsy have reported favorable outcomes. Aim of this study is to compare the intracorporeal Holmium: YAG laser with pneumatic lithotripsy in ureteral calculi fragmentation in terms of fragmentation time, stone migration, intra-operative and post-operative complications, stone free rate and need for auxiliary procedures. Material & Methods: Fifty patients selected with diagnosis of calculus in ureter suitable for endoscopic treatment. They were subsequently randomized in to two groups by sealed envelope method. Group 1 was treated with Holmium: YAG laser lithotripsy and group 2 with pneumatic lithotripsy. All patients with ureteral calculi of size 6-20 mm were included while stone size >20mm, patients with sign of sepsis, pregnancy, renal insufficiency or urinary tract abnormalities were excluded from the study. Results: Maximum number of cases (64%) were from 21-40 years age group in both the groups, while least number of cases (8% of all) were from age group <20 years in pneumatic (4%) and Holmium group (12%) respectively. At six weeks, only 22 patients were stone free in pneumatic group (88%) while all patients in holmium group (100%) were free of stones. However, difference was not statistically significant (p=0.074). Conclusion: Both Holmium: YAG laser lithotripsy and Pneumatic lithotripsy are very safe methods of ureteroscopic stone fragmentation in experienced hands. However, Holmium: YAG laser is more successful in treatment of upper ureteric stones.


  1. Denstedt JD et al. The swiss Lithoclast: A new device for intracorporeal lithotripsy. J Urol. 1992; 148(pt2): 1088-1090.
  2. Menez P et al. A randomized trial comparing lithoclast with an electro kinetic liyhotripter in the management of ureteric stones. BJU Int. 2000; 85:22-25.
  3. Knispel HH et al. Pneumatic lithotripsy applied through deflected working channel of miniureteroscope: Results in 143vpatients. J. Endourol. 1998; 12: 513-515.
  4. Vassar GJ et al. Holmium: YAG Lithotripsy: photothermal mechanism. J Endourol. 1999; 13: 181-190.
  5. Sofer M, Denstedt J. Flexible ureteroscopy and lithotripsy with the holmium: YAG laser. Can J urol 2000; 7: 952-956.
  6. Binbay M et al. Evaluation of pneumatic versus holmium: YAG laser lithotripsy for impacted ureteral stones. Int. Urol. Nephrol. 2011; 43(4): 989-95.
  7. Manohar et al. Journal of Endourology. 2008; 22(3): 443-446.
  8. Garg S et al. Ureteroscopic laser lithotripsy versus ballistic lithotripsy for treatment of ureteric stones: a prospective comparative study. Urol. Int. 2009; 82(3): 341-5.
  9. Tipu SA et al. Treatment of ureteric calculi by use of Holmium: YAG laser lithotripsy versus pneumatic lithoclast. J Pak Med Assoc. 2007; 57(9): 440-3.
  10. Jeon SS et al. A comparison of Holmium: YAG laser with Lithoclast lithotripsy in ureteral calculi fragmentation. Int. J. of Urol. 2005; 12: 544-547.
  11. Bapat et al. Comparison of Holmium Laser and Pneumatic Lithotripsy in managing upper ureteral stones. Journal of Endourology. 2007; 1425-1428.
  12. Yapanoglu T et al. Ureteroscopic management of distal ureter stones in children: Holmium: YAG laser Vs Pneumatic lithotripsy. Turk. J. Med. Sci 2009; 39(4): 623-628.
  13. Koura AC et al. Ureteroscopic stone management in prepubertal children. Paediatr. Surg. Int. 2007; 23: 1123-1126.
  14. Dogan HS et al. Use of the Holmium: YAG laser for ureterolithotripsy in children. BJU Int. 2004; 94: 131-133.

[P. S. Khatana, Jitendra Kumar and Preeti Juneja. (2018); MANAGEMENT OF URETERIC CALCULI WITH PNEUMATIC LITHOTRIPSY AND INTRACORPOREAL HOLMIUM: YAG LASER: A COMPARATIVE STUDY. Int. J. of Adv. Res. 6 (Apr). 408-412] (ISSN 2320-5407). www.journalijar.com


Dr Jitendra Kumar
Dr B.S.A. Medical college & Hospatal

DOI:


Article DOI: 10.21474/IJAR01/6874      
DOI URL: https://dx.doi.org/10.21474/IJAR01/6874