Introduction and Objectives
We prospectively analyzed and compared effectiveness and complications of pneumatic with the holmium:yttrium-alaminum-garnet (Ho:YAG) laser in the ureterorenoscopic management of impacted ureteral stones.
Material and Methods
From January 2006 to January 2008, we performed retrograde endoscopic treatment in 288 patients with ureteral stones in our clinic. The patients with impacted stones were prospectively randomized into two groups according to the lithotripter used to fragment the stone: pneumatic (n: 40) and laser (n: 40). The preoperative, operative and postoperative follow up findings are analyzed and compared.
The average stone size was similar in both groups (11.3+4 mm versus 11.4+5 mm). The operation time was significantly diminished in laser (p < 0.001). The stone free rates after a single ureteroscopic procedure were 80% and 97.5% in pneumatic and laser, respectively (p < 0.05). Auxiliary treatments were needed in 8 (20%) patients in pneumatic group while it was needed only 1 (2.5%) patient in the laser group (p: 0.02). After the additional procedures 100% success rate was achieved in both groups. The rate of double J stent insertion was significantly higher in pneumatic (p: 0.01). In the pneumatic group, 3 cases of stone up migration and 1 case of post-operative stricture was seen while no such complication was noted in the laser group. The rate of complications was significantly higher in the pneumatic group (p: 0.02).
Ureteroscopic treatment with Holmium-YAG laser is effective first line therapy for chronically impacted ureteral stones with diminished operation time, high stone free, low complication and additional treatment rates.
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.