Background: Renal stone has worldwide prevalence of between 2 and 20%. Pakistan is
part of the Afro-Asian stone forming belt, where the prevalence of renal stone
is very high. An impacted stone that has not changed its radiological position
for more than two months has virtually no chances of spontaneous passage.With
the introduction of different type of ureteroscopes and lithotripters the
management of distal and mid ureteric stones has changed dramatically.
Currently the two most effective lithotripters used are pneumatic and holmium
laser. Holmium laser is considered superior to all other forms of lithotripsy.
Aim: To compare the effectiveness of holmium laser and pneumatic lithotripsy
in terms of complete ureteric stone clearance.
Methodology: Randomized controlled trial study was done in Institute of Kidney
Disease (Team-C) Peshawar from 01-03-2015 to 01-08-2015 which includes 264 (132
in each group). After the approval of Hospital Ethical Committee, informed
consent taken from every patient. All the patient with ureteric stone from 18-60
years of age and mean 40.58+11.4 and 40.39+11.9 years. The stone
size was 9-20mm. The patients were diagnosed on contrast radiography with
failure of medical treatment.
Results: A total of 264 patients (female, n=80 and male, n=184; Group PL
(Pneumatic lithotripsy), n=132; Group LL (Laser lithotripsy), (n=132) were
included. Mean ages of patients in PL and LL groups were 40.58+11.4 and
40.39+11.9 years respectively. Stone surface areas were 13.04+1.53mm2,
13.90+0.92mm2 in PL and LL groups respectively. Besides, in the LL
group, we detected proximal (29%), midureteral (23.3%) and distal (47.7%)
ureter stones. Stone-free rates of 77% and 78% were achieved in the management
of proximal ureter stones in the PL and LL groups respectively. Overall success
rate was 72.5%.
Conclusion: It is concluded that the treatment of Laser lithotripsy patients with
proximal ureteric stones has yielded superior results as compared to the Pneumatic
lithotripsy, Pneumatic lithotripsiy, Ureteroscopy