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Comparison of holmium laser and pneumatic lithotripsy in managing upper-ureteral stones

Comparison of holmium laser and pneumatic lithotripsy in managing upper-ureteral stones

Journal of Endourology 21(12): 1425-1427

To compare the success rates and complications of Lithoclast and holmium laser-assisted ureterorenoscopy (URS) in managing upper-ureteral stones. We retrospectively analyzed the records of 394 patients with upper-ureteral stone who underwent ureteroscopic lithotripsy at our institution from January 2000 to December 2005. In 193 patients (mean stone size 12.3 mm), pneumatic lithotripsy was used; in 201 patients (mean stone size 11.5 mm), laser lithotripsy was performed. Patients were monitored as outpatients at 2 weeks, at 3 months, and then annually with a kidneys, ureters, and bladder radiograph and ultrasonography. Patients with migrated stones or incomplete clearance underwent an auxiliary procedure such as shockwave lithotripsy (SWL) or repeated URS. Follow-up ranged from 6 to 24 months. Fragmentation of stones to fine pieces that pass eventually was assessed at 2 weeks. This did not include proximal migration of a stone or fragments that required auxiliary treatment. This occurred in 166/193 (86.01%) patients in the Lithoclast group and in 195/201 (97.01%) in the laser group. Ureteral perforations were nine in the Lithoclast group and six in the laser group. Auxiliary procedures included SWL (27/193 [13.98%] patients in the Lithoclast group and 4/201 [1.99%] patients in the laser group) or repeated URS (two in the Lithoclast group). Urosepsis after URS occurred in 11/193 patients in the Lithoclast group and 5/201 patients in the laser group. In our study, the fragmentation rates of holmium laser-assisted ureteroscopy were significantly better in the upper ureter. The complications and the need for auxiliary procedures were significantly less for holmium laser-assisted ureteroscopy when compared with pneumatic lithotripsy.

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Accession: 020755508

Download citation: RISBibTeXText

PMID: 18186678

DOI: 10.1089/end.2006.0350

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