PNEUMATIC VS LASER LITHOTRIPSY FOR THE MANAGEMENT OF PROXIMAL URETERIC STONE

Abstract

To compare the outcomes of pneumatic and laser lithotripsy among patients with proximal ureteric 
stones. The prospective randomized control trial study was conducted in the Department of Urology, 
Sindh Institute of Urology & Transplantation (SIUT), Karachi. Patients between the age group 18-
70 years old, either gender with a size 8-15 mm proximal ureteric stones were included through 
non-probability consecutive sampling, which were assigned to two equal groups of pneumatic 
lithotripsy and laser lithotripsy. Patients were subjected to a CT KUB scan to confirm the presence 
and size of ureteric stones. The empirical antibiotics were given both just before the procedure 
(preoperative) and at least 5 days post-procedure or more. The follow-up assessment was noted 
after 4 weeks, to assess the outcomes like stone clearance, migration, and need of any secondary 
intervention. The SPSS version 26.0 was used to analyze the collected data with 95% C. I and 5% 
level of significance. The mean ± standard deviation of age in the pneumatic group was 40.83 ± 
14.09 and laser group was 40.40 ± 14.28 years. In the pneumatic group, 48.6% were male and 
62.9% were female while in the laser group, 51.4 were males and 37.1% were females. Stone 
clearance was significantly higher in the laser group (74.3%) compared to the pneumatic group 
(48.6%), stone migration was more common in the pneumatic group (42.9%) compared to the laser 
group (14.3%), and the need for secondary intervention was higher in the pneumatic group (51.4%) 
than in the laser group (28.6%). The results of this study indicate that laser lithotripsy was more 
efficacious in the treatment of proximal ureteric stones compared to pneumatic lithotripsy with 
higher stone clearance, and lower rates of migration. Although more time and expense are required
for laser lithotripsy, its low requirement of secondary interventions makes it the preferable option. 
For these particularly high-risk cases, laser lithotripsy should be selected to minimize stone 
migration and promote clearance. Larger studies are warranted to validate these results and to 
inform treatment algorithms.Laser Lithotripsy, Management, Pneumatic Lithotripsy, Proximal 
Ureteric Stone