MANAGEMENT OF URETERIC CALCULI WITH PNEUMATIC LITHOTRIPSY AND INTRACORPOREAL HOLMIUM: YAG LASER: A COMPARATIVE STUDY.

Background: Among many lithotripters available for fragmentation of ureteric stones, pneumatic and Holmium: YAG laser lithotripsy have reported favorable outcomes. Aim of this study is to compare the intracorporeal Holmium: YAG laser with pneumatic lithotripsy in ureteral calculi fragmentation in terms of fragmentation time, stone migration, intra-operative and post-operative complications, stone free rate and need for auxiliary procedures. Material & Methods: Fifty patients selected with diagnosis of calculus in ureter suitable for endoscopic treatment. They were subsequently randomized in to two groups by sealed envelope method. Group 1 was treated with Holmium: YAG laser lithotripsy and group 2 with pneumatic lithotripsy. All patients with ureteral calculi of size 6-20 mm were included while stone size >20mm, patients with sign of sepsis, pregnancy, renal insufficiency or urinary tract abnormalities were excluded from the study. Results: Maximum number of cases (64%) were from 21-40 years age group in both the groups, while least number of cases (8% of all) were from age group <20 years in pneumatic (4%) and Holmium group (12%) respectively. At six weeks, only 22 patients were stone free in pneumatic group (88%) while all patients in holmium group (100%) were free of stones. However, difference was not statistically significant (p=0.074). Conclusion: Both Holmium: YAG laser lithotripsy and Pneumatic lithotripsy are very safe methods of ureteroscopic stone fragmentation in experienced hands. However, Holmium: YAG laser is more successful in treatment of upper ureteric stones.