Skip to main content
SpringerLink
Log in

Evaluation of pneumatic versus holmium:YAG laser lithotripsy for impacted ureteral stones

  • Urology – Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Purpose

We prospectively analyzed and compared the effectiveness and complications of pneumatic lithotripter with a holmium:yttrium–aluminum–garnet (Ho:YAG) laser for the ureterorenoscopic management of impacted ureteral stones.

Materials and methods

From January 2006 to January 2008, we performed retrograde endoscopic treatment in 288 patients with ureteral stones in our clinic. The patients with impacted stones were randomized into two groups according to the lithotripter used to fragment the stone: pneumatic (n = 40) and laser (n = 40). The preoperative, operative, and post-operative follow-up findings were analyzed and compared.

Results

The average stone size was similar in both groups (118.8 ± 58.3 mm2 vs. 110.7 ± 54.4 mm2). The calculi were located in the distal ureter in most of the patients in both groups (65% in pneumatic group and 52.5% in laser group). The operation time was significantly diminished in the laser group (P = 0.001). The stone-free rates after a single ureteroscopic procedure were 80 and 97.5% in the pneumatic and laser groups, respectively (P = 0.03). Auxiliary treatments were needed in seven patients in the pneumatic group, while only one patient in the laser group (P = 0.05) needed this treatment. After the additional procedures, a 100% success rate was achieved in both groups. The rate of double J stent insertion was significantly higher in the pneumatic group (P = 0.01). In the pneumatic group, four cases of stone up-migration and one case of post-operative stricture were seen, whereas only one case of stone up-migration was noted in the laser group.

Conclusion

Our comparative study has shown that the use of Ho:YAG as an intracorporeal lithotripter during ureteroscopic management of impacted ureteral stones is highly efficient with high success rates, regardless of the stone location.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Deliveliotis C, Chrisofos M, Albanis S et al (2003) Management and follow up impacted utereral stones. Urol Int 70:269–272

    Article  PubMed  CAS  Google Scholar 

  2. Morgentaler A, Bridge SS, Dretler SP (1990) Management of the impacted ureteral calculus. J Urol 143:263–266

    PubMed  CAS  Google Scholar 

  3. Dretler SP, Keating MA, Riley J (1986) An algorithm for the management of ureteral calculi. J Urol 136:1190–1193

    PubMed  CAS  Google Scholar 

  4. Lingeman JE, Shirrell WL, Newman DM et al (1987) Management of upper ureteral calculi with extracorporeal shock wave lithotripsy. J Urol 138:720–723

    PubMed  CAS  Google Scholar 

  5. Mueller SC, Wilbert D, Thueroff JW et al (1986) Extracorporeal shock wave lithotripsy of ureteral stones: clinical experience and experimental findings. J Urol 135:831–834

    PubMed  CAS  Google Scholar 

  6. Chaussy CG, Fuchs GJ (1989) Current state and future developments of noninvasive treatment of human urinary stones with extracorporeal shock wave lithotripsy. J Urol 141:782–789

    PubMed  CAS  Google Scholar 

  7. Mugiya S, Nagata M, Un-No T et al (2000) Endoscopic management of impacted ureteral stones using a small caliber ureteroscope and a laser lithotriptor. J Urol 164:329–331

    Article  PubMed  CAS  Google Scholar 

  8. Khairy-Salem H, El Ghoneimy M, El Atrebi M (2011) Semirigid ureteroscopy in management of large proximal ureteral calculi: is there still a role in developing countries? Urology http://hinarigw.who.int/whalecomwww.sciencedirect.com/whalecom0/science?_ob=MImg&_imagekey=B6VJW-521P96T-1-1&_cdi=6105&_user=2778664&_pii=S0090429510019618&_origin=search&_zone=rslt_list_item&_coverDate=01%2F26%2F2011&_sk=999999999&wchp=dGLzVzzzSkzk&md5=98ac193f052aaa576f63703ad5091693&ie=/sdarticle.pdf

  9. Elganainy E, Hameed DA, Elgammal M, Abd-Elsayed AA, Shalaby M (2009) Experience with impacted upper ureteral stones; should we abandon using semirigid ureteroscopes and pneumatic lithoclast? Int Arch Med 2(1):13–17

    Article  PubMed  Google Scholar 

  10. Manohar T, Ganpule A, Desai M (2008) Comparative evaluation of Swiss LithoClast 2 and holmium:YAG laser lithotripsy for impacted upper-ureteral stones. J Endourol 22:443–446

    Article  PubMed  CAS  Google Scholar 

  11. Sun X, Xia S, Lu J et al (2008) Treatment of large impacted proximal ureteral stones: randomized comparison of percutaneous antegrade ureterolithotripsy versus retrograde ureterolithotripsy. J Endourol 22:913–917

    Article  PubMed  Google Scholar 

  12. Hofbauer J, Hobarth K, Marberger M (1992) LithoClast: New and inexpensive mode of intracorporeal lithotripsy. J Endourol 6:429–432

    Article  Google Scholar 

  13. Turk C, Knoll T, Petrik A et al (2010) Guidelines on urolithiasis. Eur Assoc Urol 1–106

  14. Huffman JL, Bagley DH, Lyon ES (1985) Abnormal ureter and intrarenal collecting system. In: Bagley DH, Huffman JL, Lyon ES (eds) Urologic endoscopy: a manual and atlas, Chapter 6. Little, Brown and Co., Boston, pp 59–73

  15. Dretler SP, Young RH (1993) Stone granuloma: a cause of ureteral stricture. J Urol 150:1800–1802

    PubMed  CAS  Google Scholar 

  16. Motola JA, Smith AD (1992) Complications of ureteroscopy: prevention and treatment. AUA update series, volume 11, lesson 21

  17. Cotran RS, Kumar V, Robbins SL (1989) Robbins pathologic basis of disease, chapter 3, 4th edn. W.B.Saunders Co, Philadelphia, pp 39–86

    Google Scholar 

  18. Mitchinson MJ, Bird DR (1971) Urinary leakage and retroperitoneal fibrosis. J Urol 105:56–58

    PubMed  CAS  Google Scholar 

  19. Roberts WW, Cadeddu JA, Micali S et al (1998) Ureteral stricture formation after removal of impacted calculi. J Urol 159:723–726

    Article  PubMed  CAS  Google Scholar 

  20. Brito Artur H, Mitre Anuar I, Miguel Srougi (2006) Ureteroscopic pneumatic lithotripsy of impacted ureteral calculi. Int Braz J Urol 32:295–299

    Article  PubMed  CAS  Google Scholar 

  21. Eisner BH, Dretler SP (2009) Use of the Stone Cone for prevention of calculus retropulsion during holmium:YAG laser lithotripsy: case series and review of the literature. Urol Int 82:356–360

    Article  PubMed  Google Scholar 

  22. Dretler SP (2001) The stone cone: a new generation of basketry. J Urol 165:1593–1596

    Article  PubMed  CAS  Google Scholar 

  23. Desai MR, Patel SB, Desai MM et al (2002) The Dretler stone cone: a device to prevent ureteral stone migration-the initial clinical experience. J Urol 167:1985–1988

    Article  PubMed  Google Scholar 

  24. Seitz C, Tanovic E, Kikic Z et al (2007) Impact of stone size, location, composition, impaction, and hydronephrosis on the efficacy of holmium: YAG laser ureterolithotripsy. Eur Urol 52:1751–1759

    Article  PubMed  Google Scholar 

  25. Dushinski JW, Lingeman JE (1997) Urologic applications of the Holmium laser. Tech Urol 3:60–64

    PubMed  CAS  Google Scholar 

  26. Teichman JM (2002) Laser lithotripsy. Curr Opin Urol 12:305–309

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, Haseki Training and Research Hospital, Istanbul, Turkey

    Murat Binbay, Avinash Singh, Tolga Akman, Erdem Tekinaslan, Omer Sarilar, Murat Baykal & Ahmet Yaser Muslumanoglu

  2. Department of Urology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey

    Abdulkadir Tepeler

Authors
  1. Murat Binbay
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Abdulkadir Tepeler
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Avinash Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tolga Akman
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Erdem Tekinaslan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Omer Sarilar
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Murat Baykal
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ahmet Yaser Muslumanoglu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Murat Binbay.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Binbay, M., Tepeler, A., Singh, A. et al. Evaluation of pneumatic versus holmium:YAG laser lithotripsy for impacted ureteral stones. Int Urol Nephrol 43, 989–995 (2011). https://doi.org/10.1007/s11255-011-9951-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-011-9951-8

Keywords

Search

Navigation