Laser and Pneumatic Lithotripsy in the Endoscopic Management of Large Ureteric Stones: A Comparative Study

OBJECTIVE: We compared the results of holmium laser and pneumatic intracorporeal lithotripsy for large ureteric calculi in terms of efficacy, safety and complications. METHODS: The study was conducted between April 2009 and October 2010. 80 patients divided into two equally matched groups were included in a prospective randomized trial including patients with a ureteric stone size of 0.5-2 cm. A holmium laser with a 550-μm fiber was employed in the laser lithotripsy (LL) group. The Swiss Lithoclast was used in the pneumatic lithotripsy (PL) group. RESULTS: Mean stone size was comparable in both groups, namely 13.1 mm in the PL group and 12.9 mm in the LL group. The early stone-free rate was equal in both groups, while the delayed stone-free rate was 95% in LL and 85% in PL. Stone migration occurred in 12 PL cases and in 5 LL cases. Ureteric perforation occurred in 3 LL cases and in 2 PL cases. Ureteric stricture occurred in 1 case following LL. CONCLUSION: Both PL and LL are effective and safe modalities in treating large ureteric stones with minor insignificant differences. A pneumatic system may be more efficient with regard to the cost-benefit ratio, which was not studied in the present work; further studies should address this issue.