COMPARISON OF OUTCOMES IN HOLMIUM LASER VERSUS PNEUMATIC LITHOTRIPSY FOLLOWING URETERORENOSCOPY IN THE TREATMENT OF UPPER URETERIC STONE OF SIZE UP TO 1.5 CM

Abstract

OBJECTIVE

To evaluate the efficacy of holmium laser lithotripsy in comparison to pneumatic lithotripsy post-ureterorenoscopy for the management of upper ureteric calculi measuring up to 1.5 cm in diameter.

METHODOLOGY

A randomized controlled trial was executed involving 106 participants (aged 18–65 years, encompassing both sexes) presenting with solitary upper ureteric calculi (≤1.5 cm, ≤2 months’ duration). Participants were allocated into two distinct groups through a lottery mechanism to receive ureterorenoscopy utilizing either Holmium:YAG laser or pneumatic lithotripsy under general anesthesia with the implantation of a double-J stent. The application of SPSS version 26.0 allowed for the data to be analysed, utilizing independent t-tests and chi-square tests for statistical evaluation.

RESULTS

In a sample of 106 participants (mean age: 35.1 ± 13.8 yrs; 82.1% male), patients treated with Holmium:YAG showed significantly shorter operative time (49.2 ± 7.1 vs. 55.5 ± 6.6 mins; p=0.0001), a greater stone clearance rate (88.7% vs. 66.0%; p=0.005). No statistically significant difference was observed in the length of hospital stay (p = 0.345) and complications (p = 0.175).

CONCLUSION

It can be conclusively asserted that Holmium:YAG laser lithotripsy demonstrated markedly superior outcomes in comparison to pneumatic lithotripsy for the treatment of upper ureteric stones measuring ≤1.5 cm, providing advantages such as reduced operative duration, elevated stone-free rates, and a diminished occurrence of complications. These results corroborate existing literature and advocate for its adoption as the optimal approach when resources are available. To evaluate the long-term evaluation of the safety and effectiveness of this methodology, particularly with respect to delayed outcomes such as ureteral strictures, longitudinal studies across various institutions are essential