Rafiullah, Naeem Ahmed Butt, Muhammad Bilal Khan, Zakir Khan, Liaqat Ali




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 group.

Keywords: Laser lithotripsy, Pneumatic lithotripsiy, Ureteroscopy

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