Efficacy of Laser Vs Pneumatic Lithotripsy for Mid and Distal Ureteric Stone: A Comparative Study

Ram Sagar Shah, Nischal Shrestha
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Abstract

Introduction: Urolithiasis refers to a condition characterized by the formation or occurrence of calculi in the urinary tract. In Asia, about 1%-19.1% of the population suffers from urolithiasis. Pneumatic and laser intra corporeal lithotripsy are mostly preferred and frequently used during endoscopic management for ureteral stone. Aims: This study was done to compare the efficacy of the laser versus pneumatic lithotripsy. Methods: This was a prospective comparative study conducted from May 2019 to April 2020 in Nobel Medical College and Teaching Hospital, Biratnagar. Patients with mid- or distal ureteric calculi of size 5mm and more or failed medical management were included in the study. The patients were equally divided into two groups: laser & pneumatic. The efficacy of the procedure was measured in terms of stone clearance. Stone size less than 5mm, nephrolithiasis on same side of ureteric stone, pregnancy, bleeding disorder and patient not giving consent were excluded from the study. Results: Total 130 patients were enrolled in this study. The stone clearance was observed in 86.15% in pneumatic group and 96.92% in laser group at the end of 6 weeks. In pneumatic group 13.85% did not achieve stone clearance where as in laser group it was 3.08%. In patients with mid ureteric stone the clearance rate was significantly higher in laser group (93.33%) than in pneumatic group.(p=0.041) When the clearance rate of two techniques were compared  for  distal ureteric stone the results were similar. The mean operation time was 28.89 ± 8.26 min in pneumatic group and 22.93 ± 6.05 min in laser group(p<0.05). Conclusion: Holmium: YAG laser lithotripsy is superior to pneumatic lithotripter in terms of stone clearance rate for the mid ureteric calculus and also less time consuming.
激光与气压碎石术治疗输尿管中远端结石的疗效比较
导言:尿石症是指以尿路结石形成或发生为特征的一种疾病。在亚洲,约1%-19.1%的人口患有尿石症。在输尿管结石的内镜治疗中,气压和激光体外碎石是首选和常用的方法。目的:本研究比较激光碎石与气压碎石的疗效。方法:前瞻性比较研究于2019年5月至2020年4月在比拉特纳格尔诺贝尔医学院和教学医院进行。输尿管中端或远端结石直径大于5mm或治疗失败的患者纳入研究。患者平均分为两组:激光组和气动组。该程序的有效性是根据结石清除来衡量的。排除结石小于5mm、输尿管结石同侧肾结石、妊娠、出血性疾病及不同意患者。结果:本研究共纳入130例患者。6周后,气动组结石清除率86.15%,激光组结石清除率96.92%。气动组达13.85%,激光组达3.08%。输尿管中段结石,激光组的清除率(93.33%)明显高于气动组(p=0.041),输尿管远端结石的清除率比较两种方法的结果相似。气动组平均手术时间28.89±8.26 min,激光组平均手术时间22.93±6.05 min (p<0.05)。结论:钬激光碎石术治疗输尿管中段结石清除率优于气动碎石术,且耗时短。
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