URERTEROSCOPIC LASER LITHOTRIPSY IS BETTER THAN PNEUMATIC LITHOTRIPSY FOR URETRIC STONES

Background: Among various intra-corporeal lithotripters, pneumatic lithotripter has become the widely used tool for the treatment of urinary stones. Recently the holmium: YAG laser has been used with a wide range of potential urological applications, including intra-corporeal lithotripsy of urinary calculi. Aims and objective: Compare the effectiveness and complications of treatment for ureteric stones between holmium laser lithotripsy and pneumatic lithotripsy. Material and Methods: Comparison of 100 patients presented with ureteric stones, group one (50) of whom were treated with pneumatic lithotripsy and group two (50) with holmium laser was done and the effectiveness and complications of both were analyzed. Results: There was no difference in patient age, sex, stone size and location of stones between the two groups. The immediate stone free rates were 86% in the holmium: YAG group and 64% in the pneumatic lithotripsy group (p = 0.011).. The mean operative time in the holmium: YAG group (35.7±3.2) was shorter than those with pneumatic lithotripsy group (50.2±5.3). Postoperative stay in hospital was less than 24 hours in holmium: YAG group (74%) and shorter than those for pneumatic group (36%) (p < 0.002). Post treatment complications such as ureteral perforation were encountered in only three patients who underwent pneumatic lithotripsy. Other complications, such as mucosal injury, ureteral perforation and postoperative fever; there was no statistically signicant difference between the two groups. While light hematuria was found more frequently in the pneumatic group (10%) in comparison to laser group (4%) (p = 0.045). On the other hand, the overall complication rates between the two groups was statistically signicant (10%) laser group vs. (36%) pneumatic group (p = 0.002). Conclusions: Holmium: YAG laser lithotripsy was associated with shorter operation time and postoperative hospitalization period. We believe that Holmium: YAG laser lithotripsy is an excellent treatment modality for managing ureteral calculi in central Rajasthan where stone formation rate is quite high. Drawback of holmium laser lithotripsy is its cost and maintainance