METHODS: This has been a clinical randomized trail study in 26 patients with upper ureteral stone more than 1 cm. Patients were divided into 2 randomized groups, each treated with one of the following approaches: pneumatic lithoclast(14 patients), or holmium laser(12 patients). The goal of lithotripsy was to break the stone into particles less than 3 mm. IVP (Intravenous Pyelogram) was performed 4 weeks after.
RESULTS: The immediate stone free rate was 100% in LL group and 42.9% in PL group (P=0.001). Stone pushing back was 0% in LL group and 57.1% in PL group. Complications such as a perforation, or urosepsis, or bleeding were not seen in any of these groups. Fever more than 38º C was observed in 1.8% in LL, and 3.8% in PL group (p=0.56). After 4 weeks no complication was seen in IVP.
CONCLUSION: According to our experience, for upper ureteral stones larger than 1 cm, lithotripsy with holmium laser is preferred approach with high success rate and low complication.
Pearle MS, Lotan Y. Urinary Lithiasis: Etiology, Epidemiology, and Pathogenesis. Wein A.j, Kavousi l.R Novick A.C, partin A.W, peters C.A. Campbell- Walsh urology, 9th edition 2007; chapter 42:1363p.
Denstedt JD, Eberwein PM,Singh RR. The Swiss lithoclast: a new device for intracorporeal lithotripsy. J Urol. 1992;148:1088-90.
Robert M, Bennani A, Guiter J, Averus M, Grasset D. Treatment of 150 ureteric calculi with the lithoclast. Eur Urol 1994;26(3):212-15.
Vorreuther R, Klots T, Heidenreich A, Nayal W, Engelmann U. Pneumatic vs electrokinetic lithotripsy in treatment of ureteral stones. J Endourol 1998;12:233-6.
Lingeman JE, Matlaga BR, Evan AP. Surgical Management of Upper Urinary Tract Calculi. Wein A.j, Kavousi l.R Novick A.C, partin A.W, peters C.A. Campbell- Walsh urology, 9th edition 2007; chapter 44:1460-3p.
Bapat SS, Pai KV, Purnapatre SS, Yadav PB, Padye AS. Comparison of holmium laser and pneumatic lithotripsy in managing upper-ureteral stones. J Endourol 2007; 21(12):1425-7.
Manohar T, Ganpule A, Desai M. Comparative evaluation of Swiss LithoClast 2 and holmium:YAG laser lithotripsy for impacted upper-ureteral stones. J Endourol 2008; 22(3):443-6.
Mugiya S, Nagata M, Un-No T, Takayama T, Suzuki K, Fujita K. Endoscopic management of impacted ureteral stones using a small caliber ureteroscope and a laser lithotriptor. J Urol 2000;164(2):329-31.