"LASER LITHOTRIPSY VS PNEUMATIC LITHOTRIPSY IN URETERIC STONE REMOVAL: A CONTROLLED TRIAL"

Abstract

Ureteric stones represent a significant proportion of urolithiasis cases and are a common cause of emergency department visits worldwide. Minimally invasive endourological techniques have become the mainstay for definitive stone management, with ureteroscopic lithotripsy being widely used due to its safety, efficacy, and rapid recovery. Two major intracorporeal lithotripsy modalities laser lithotripsy, predominantly using Holmium:YAG laser, and pneumatic lithotripsy are frequently employed. Although both are effective, they differ in fragmentation efficiency, stone migration rates, operative time, and complication profiles. Determining the optimal modality is essential for improving patient outcomes, especially in resource-variable settings.

Objective:

To compare the efficacy, safety, and clinical outcomes of laser lithotripsy versus pneumatic lithotripsy in patients undergoing ureteroscopic removal of ureteric stones.

Methodology:

This controlled clinical trial was conducted at Sughra Shafi Medical Complex Narowal in the urology department over a 12-month period from Ist January to 31^st December 2024. A total of n = 60 patients aged 18-70 years presenting with single ureteric stones measuring 5–15 mm were enrolled. Participants were allocated into two groups: Group A (Laser Lithotripsy) and Group B (Pneumatic Lithotripsy). Exclusion criteria included pregnancy, active urinary tract infection, bleeding disorders, solitary kidney, congenital ureteral anomalies, and prior ureteric surgery. All procedures were performed using semi-rigid ureteroscopy under general or regional anesthesia. Primary outcome was stone-free rate at 2 weeks. Secondary outcomes included operative time, stone migration, intra-operative and post-operative complications, need for auxiliary procedures, and hospital stay. Data were analyzed using SPSS v 26 with p < 0.05 considered significant.

Results:

A total of 60 patients were analyzed, with 30 in each group. The stone-free rate was significantly higher in the Laser group (93.3%) compared with the Pneumatic group (73.3%). Stone migration occurred in 6.7% of Laser patients versus 23.3% in the Pneumatic group. Auxiliary procedures were required in 6.7% of Laser cases compared with 26.7% in Pneumatic cases. Operative time was slightly longer in the Laser group (38.5 ± 7.2 min) versus Pneumatic (35.9 ± 6.8 min)

Conclusion:

Laser lithotripsy offers superior stone-free rates, lower stone migration, and fewer intra-operative complications compared with pneumatic lithotripsy, although at the expense of marginally longer operative time. It should be considered the preferred modality for ureteric stone fragmentation, particularly in centers equipped with laser technology.