Comparative outcomes of laser and pneumatic lithotripsy for solitary mid and lower ureteric stones

Abstract

Introduction:

The management of ureteric stones has been revolutionized by minimally invasive techniques, with Holmium:YAG laser lithotripsy (LL) and pneumatic lithotripsy (PL) being two primary modalities. While effective, they differ in mechanism, cost, and potential complications. This study aims to compare the intraoperative and postoperative outcomes of LL versus PL for solitary mid and lower ureteric stones.

Methods:

This retrospective cohort study analyzed 178 patients who underwent ureteroscopic lithotripsy at SCB Medical College, Cuttack. Patients were divided into two groups: Group 1 (LL, n = 97), and Group 2 (PL, n = 81). Demographic data, operative time, hospital stay, and postoperative complications (ureteral perforation, hematuria, stricture, stone migration, UTI, fever) were compared using appropriate statistical tests, with a p < 0.05 considered significant.

Results:

The groups were well-matched at baseline. A significantly higher rate of stone migration was observed in the PL group (19.8%) compared to the LL group (2.1%; p = 0.001). The mean operative time was longer for LL (20.76 ± 2.98 min) than for PL (14.78 ± 3.67 min; p = 0.04). However, the mean hospital stay was significantly shorter for the LL group (26.67 ± 3.28 h) compared to the PL group (32.78 ± 4.18 h; p = 0.02). The incidence of other complications was comparable between the two groups.

Conclusion:

Both modalities are effective for managing ureteric stones. However, LL is superior in preventing stone retropulsion and leading to a shorter hospital stay. The choice of lithotripsy depends on available resources, stone characteristics, and surgical expertise.