COMPARATIVE EFFICACY OF PNEUMATIC VERSUS LASER LITHOTRIPSY IN UPPER URETERIC STONES: A PROSPECTIVE STUDY

Abstract

Background: Upper ureteric stones are a common urological condition causing significant morbidity. Minimally invasive techniques such as pneumatic lithotripsy (PL) and laser lithotripsy (LL) are widely used. However, differences in stone clearance, complication rates, and need for postoperative stenting remain clinically relevant, particularly in resource-limited healthcare settings.
Objectives: To compare pneumatic and laser lithotripsy in upper ureteric stones regarding stone clearance rates, operative time, complication profile, and postoperative double-J stent requirement among adult patients.
Methods: This prospective comparative study included 120 patients with upper ureteric stones (6–20 mm), equally divided into PL and LL groups. Procedures were performed using semi-rigid ureteroscopy under anesthesia. Primary outcome was stone clearance at 4 weeks. Secondary outcomes included operative time, DJ stent requirement, and complications. Statistical analysis was performed using chi-square and independent t-tests, with p<0.05 considered significant.
Results: Mean age was 42.3 ± 11.7 years in PL and 43.1 ± 12.3 years in LL. Stone clearance was significantly higher in LL (92%) compared to PL (84%) (p=0.045). DJ stent requirement was lower in LL (38.3%) versus PL (58.3%) (p=0.004). Mean operative time was slightly longer in LL (35.4 ± 9.2 minutes) than PL (31.2 ± 8.7 minutes), though not statistically significant (p=0.089). Minor complications occurred in 6.7% of PL and 3.3% of LL groups, with no major complications reported, indicating comparable safety profiles.

Conclusion: Laser lithotripsy demonstrates superior efficacy in achieving higher stone clearance rates and significantly reduces the need for postoperative DJ stenting compared to pneumatic lithotripsy. Although operative time is slightly longer, the difference is not clinically significant. Both methods are safe; however, LL should be preferred when resources permit, while PL remains a cost-effective alternative in resource-limited healthcare settings.