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18. Comparative Efficacy and Safety of Hand-Held and Conventional Intra-Corporeal Pneumatic Lithotripsy in the Treatment of Ureteric Stones
Akhtar Nawaz Orakzai1, Bakhtawar Gul Wazir1 and Noor Muhammad2
ABSTRACT
Objective: To evaluate hand-held vs conventional intra-corporeal pneumatic lithotripters for the treatment of ureteric stones in terms of effectiveness and safety.
Study Design: A comparative study
Place and Duration of Study: This study was conducted at the Department of Urology, Institute of Kidney Disease (IKD) Peshawar, from 1st Oct 2010 to 1st Oct 2011.
Methods: This study was carried out from October 1, 2010, to October 1, 2011, at the Urology Department, IKD Peshawar. Examined were 100 adult patients with ureteric calculi measuring at least 0.7 cm. Using two distinct pneumatic lithotripters, ureteroscopy and lithotripsy were performed on each patient. There was follow-up. The following factors were evaluated: stone location, size, laterality, degree of fragmentation, rate of clearance, and complications.
Results: Mean stone size was 16.8±0.62mm in Group A and 18.0±0.69mm in Group B. In Group A stone clearance was 96% (48/50) while it was 92% (46/50) in Group B. Group A lithoclast was able to break 49/50 stones while Group B could break 44/50 stones. Group A lithoclast was able to break 46/50 stones into fragments ≤4mm while Group B could break 40/50 stones into such fragments. Proximal migration occurred in 1 case in Group A while in 6 cases in Group B. 4 and 1 stone in Group A and B, respectively, required ESWL and 2 stones in Group B required open ureterolithotomy as auxiliary procedure. There were 2 perforations in Group “B”. Intra operative bleed, post operative pain and hematuria were more common in Group “B” while fever was more common in Group “A”.
Conclusion: Hand-Held pneumatic lithoclast is more efficient and safe as compared to conventional pneumatic Lithoclast in the treatment of ureteric stones.
Key Words: Ureteric stones, Ureterorenoscopy, Pneumatic Lithoclast.