Outcome analysis of holmium laser and pneumatic lithotripsy in the endoscopic management of lower ureteric calculus in pediatric patients: a prospective study

Analysis of the efficacy of holmium laser and pneumatic ballistic in the treatment of impacted ureteral calculi

To explore the safety and effectiveness of ureteroscopic holmium laser lithotripsy (UHLL) and ureteroscopic pneumatic lithotripsy (UPL) in the treatment of impacted ureteral calculi (IUC).Clinical data of 280 patients in our hospital from April 2016 to May 2019 were retrospectively collected and analyzed, including 136 cases of UHLL group and 144 cases of UPL group. The general clinical data, operation time, intraoperative bleeding volume, hospital stay, stone-free rate (SFR), and surgical complications were collected and analyzed in 2 group.Compared with UPL group, the operation time of UHLL group was significantly reduced (27.25 ± 8.39 vs 34.32 ± 10.57, P < .05), but the hospitalization cost was significantly increased (9.25 ± 0.75 vs 8.24 ± 0.51, P < .05). In terms of total SFR, the UHLL group was significantly higher than the UPL group (93.38% vs 83.33%, P = .011). For proximal IUC, compared with the UPL group, the SFR of the UHLL group was significantly increased (88.33% vs 70.31%, P = 0.005). For distal IUC, there was no significant difference in SFR (97.37% vs 93.75%, P = .638) between the UHLL group and UPL group. There were no significant differences in the complications of local mucosal injury, hematuria, febrile urinary tract infection, ureteral perforation, and urinary sepsis in the 2 groups (P > .05). However, the UHLL group was significantly lower in stone residual rate than the UPL group (6.61% vs 16.67%, P = .001).This study found that UHLL and UPL are safe and effective in the treatment of IUC, but UHLL has the advantages of shorter operation time and high SFR in the treatment of IUC.

Ho:YAG laser versus pneumatic lithotripsy for management of pediatric ureteral stones: a prospective-comparative analysis with adults

BACKGROUND

There are limited number of studies comparing the results of Holmium:YAG laser lithotripsy (LL) and pneumatic lithotripsy (PL) for pediatric ureteral stones.

OBJECTIVES

To perform a comparative analysis of LL and PL in the management of ureteral stones in children and adults.

STUDY DESIGN

Ninety-eight children (56 boys and 42 girls) and 623 adults (360 men and 263 women), who were treated for ureteral stones at our clinic between 2017 and 2019, were the subjects of this study. Patients were grouped according to their age as group 1 (n:98, pediatric [<18 age]) and group 2 (n:623, adult [≥18 age]). The patients were then grouped according to lithotripter type as laser (n:580) and pneumatic (n:141). The effects of lithotripter type, stone size and location, and operative times on success and complication rates were investigated.

RESULTS

In both groups, mean operation time was in favor of PL (14.6 vs 22.8 min, p = 0.042 and 26.4 vs 36.3 min, p = 0.013, respectively). In both groups, overall stone-free rates (SFR) were in favor of LL (86.8% vs 66.7%, p < 0.001, and 83% vs 73.9%, p = 0.005, respectively), but there was no significant difference in overall SFRs between adults and children (78.4% vs 76.7, p = 0.390). Retreatment rates were higher in the pneumatic group in both children and adults (p = 0.026 and p = 0.041, respectively). While there was no significant difference in the overall complication rates between adults and children (53.5% vs 40.6%, p = 0.816), the rate of complications with LL was lower in adults (37.7% vs 69.4%, p < 0.001) (TABLE).

DISCUSSION

This paper is the first to report a comparative analysis of factors affecting URS success in adults and children. SFRs were higher in all ureteral locations for LL. LL, lower ureteral location, and <6 mm ureteral stone were determined as the predictors of success for both pediatric and adult patients. The presence of multiple surgeons with different levels of experience is the main limitation of this study.

CONCLUSION

Both LL and PL are safe in children and adults with similar clinically insignificant complication rates. However, in the short term, LL provides better SFRs in both children and adults, especially in the upper ureteral stones. Surgeons should decide the energy technique to be used in URS according to the characteristics of the stone rather than the patient's age group.

Laser Versus Pneumatic Lithotripsy With Semi-Rigid Ureteroscope; A Comparative Randomized Study

Introduction: Ureteral stones are among the most common disorders in the urologic field. Miniaturization of endoscopic devices in urology and extracorporeal shock wave lithotripsy (ESWL) has revolutionized the management of ureteral stones. The aim of this study was to compare the efficacy and results of laser versus pneumatic lithotripsy (PL) with semi-rigid ureteroscope in a randomized prospective clinical trial in removing stones. Methods: 117 adult patients underwent transurethral lithotripsy (TUL) in a single academic center and by a single surgeon. The patients were randomized in 2 groups: In group 1, 58 patients with ureteral stones underwent ureteroscopy and stone fragmentation was done by Ho: YAG laser lithotripsy (LL) and in group 2, 59 patients underwent PL (Swiss LithoClast) by using the same ureteroscope. Results: Mean age was 41.77 years and 41.1years in group one and 2 respectively (P=0.79), there was no significant difference in male to female ratio and mean stone in both groups. The success rate for stone clearance was 79.31% and 77.96% in group 1 and 2 respectively (P=0.52). No difference between complications was seen in both groups, but the duration of operations was different (significantly lower in group 2). Conclusion: In both techniques, acceptable results were achieved. We have found a significant statistical difference in duration of operation between our results (P=0.001) and similar studies, while this was shorter in the pneumatic group in our study, it was longer in other similar ones. This might be a result of more experience in working with PL in our center.

Risk factors for ureteroscopic lithotripsy: a case-control study and analysis of 385 cases of holmium laser ureterolithotripsy

Introduction

Ureteroscopic lithotripsy has become the first choice for the treatment of middle and lower ureteral stones, but it still has a certain rate of surgical failure. Here we aimed to determine the factors that may affect the success rate of holmium laser ureterolithotripsy (HLU) and provide the basis and guidance for its future use.

Aim

To evaluate the risk factors for HLU failure.

Material and methods

The clinical data of 385 patients undergoing holmium laser ureterolithotripsy from 2009 to 2012 were retrospectively reviewed to analyze the impact of gender, age, stone side, stone size, stone location, stone number, degree of hydronephrosis, stone impaction, previous extracorporeal shock lithotripsy (ESWL), and associated urinary tract infection (UTI) on the success or failure of surgery.

Results

Surgical success was achieved in 338 (87.8%) patients versus surgical failure in 47 (12.2%) patients. Univariate analysis revealed that the degree of hydronephrosis (p = 0.024), stone impaction (p = 0.003), stone location (p = 0.012), and previous ESWL (p = 0.037) were risk factors for surgical failure. Multivariate logistic regression revealed that stone impaction (odds ratio (OR) = 2.66; p = 0.018) and stone location (OR = 2.11; p = 0.013) were significantly associated with surgical failure. Since some cases of ureterostenosis developed postoperatively, we continued follow-up. The patients had the stent for a year and underwent regular follow-up checks until 5 years. No cases of ureterostenosis recurred.

Conclusions

Ureteroscopic lithotripsy is a safe procedure with few complications. Stone impaction and proximal location are the risk factors for its failure.