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Ureteroscopic Management of Ureteral Calculi: Pneumatic versus Holmium: YAG Laser Lithotripsy  [PDF]
Sarwar Noori Mahmood, Diar Hameed Bajalan
Open Journal of Urology (OJU) , 2016, DOI: 10.4236/oju.2016.63008
Abstract: Background: Among various intracorporeal lithotripters, pneumatic lithotripter has become the widely used tool for the treatment of urinary stones. Recently the holmium: YAG laser has been used with a wide range of potential urological applications, including intracorporeal lithotripsy of urinary calculi. Purpose: Compare the effectiveness and complications of treatment for ureteric stones between holmium laser lithotripsy and pneumatic lithotripsy. Material and Methods: Comparison of 100 patients presented with ureteric stones, group one (50) of whom were treated with pneumatic lithotripsy and group two (50) with holmium laser was done and the effectiveness and complications of both were analyzed. Results: There was no difference in patient age, sex, stone size and location of stones between the two groups. The immediate stone free rates were 88% in the holmium: YAG group and 66% in the pneumatic lithotripsy group (p < 0.05). The four weeks stone free rates were 98% and 94% respectively (p = 0.07). The mean ± SD operative time in the holmium: YAG group (40 ± 26 min) was shorter than those with pneumatic lithotripsy group (60 ± 40 min). Postoperative stay in hospital was less than 24 hours in holmium: YAG group (70.4%) and shorter than those for pneumatic group (29.6%) (p < 0.002). Post treatment complications such as ureteral perforation were encountered in only two patients who underwent pneumatic lithotripsy. Other complications, such as mucosal injury, ureteral perforation and postoperative fever; there was no statistically significant difference between the two groups. While light hematuria was found more frequently in the pneumatic group (14%) in comparison to laser group (12%) (p = 0.02). On the other hand, the overall complication rates between the two groups was statistically significant (8%) laser group vs. (32%) pneumatic group (p = 0.003). Conclusions: Holmium: YAG laser lithotripsy was associated with shorter operation time and postoperative hospitalization period. These data suggest that holmium: YAG lithotripsy was safe and more effective than Pneumatic lithotripsy in the aspect of immediate stone free rate. We believe that holmium: YAG is an excellent treatment modality for managing ureteral calculi.
Trans-Ureteral Ureterolithotripsy of Ureteral Calculi:Which is the Best; Pneumatic or Holmium Laser Technique?
Mohammad Reza Razzaghi,Abdollah Razi,Mohammad Mohsen Mazloomfard,Hooman Mokhtarpour
Journal of Lasers in Medical Sciences , 2011,
Abstract: INTRODUCTION: Our aim was compare of two types of lithotripter include holmium: YAG laser and pneumatic one in transurethral ureterolithotripsy (TUL) for the management of ureteral calculi ≥1 cm. METHODS: 112 patients with ureteral calculi more than 1 cm were selected in randomized order for pneumatic or holmium: YAG laser transurethral ureterolithotripsy (56 patients in each group). Ultrasonography and intravenous urography were performed for all patients before surgery. Complete clearance and success was defined as the absence of any fragments on post operation KUB and ultrasonography images. RESULTS: Success rate was 85.7% in pneumatic group and 100% in holmium: YAG laser group (p =0.003). Stone migration up in the pelvicalyceal system was observed only in 8 cases of pneumatic group. No statically differences were observed in terms of patient’s age, hospital stay, and complications between two groups. CONCLUSION: According to our experience, for ureteral stone larger than 1 Cm treatment with ureteroscopy and laser lithotripsy is a preferring approach with favorable operation time and hospital admission, and no more significant complication.
Ureteroscopic pneumatic lithotripsy of impacted ureteral calculi
Brito, Artur H.;Mitre, Anuar I.;Srougi, Miguel;
International braz j urol , 2006, DOI: 10.1590/S1677-55382006000300006
Abstract: introduction: this work evaluates the results of ureteroscopic treatment of impacted ureteral stones with a pneumatic lithotripter. materials and methods: from march 1997 to may 2002, 42 patients with impacted ureteral stones were treated by retrograde ureteroscopic pneumatic lithotripsy. twenty-eight patients were female and 14 were male. the stone size ranged from 5 to 20 mm. the ureteral sites of the stones were distal in 21, middle in 12 and proximal in 9. results: considering stones with distal location in the ureter, 1 patient had ureteral perforation and developed a stricture in the follow-up (4.7%). as for stones in the middle ureter, 2 perforations and 1 stricture were observed (8.3%) and regarding stones located in the proximal ureter, 5 perforations and 4 strictures occurred (44%). in the mid ureter, 1 ureteral avulsion was verified. in 34 patients without ureteral perforation, only 1 developed a stricture (2.9%). of 8 patients who had perforation, 6 developed strictures. the overall incidence of stricture following treatment of impacted ureteral calculi was 14.2%. conclusions: ureteroscopy for impacted ureteral calculi is associated with a higher incidence of ureteral perforation and stricture. ureteroscopy of proximal ureteral calculi is associated with a high risk of perforation, when compared to mid or distal ureteral calculi. ureteral perforation at the site of the stone seems to be the primary risk factor for stricture formation in these cases.
Ureteroscopic Holmium Lasertripsy for Treatment of Impacted Ureteral Calculi
A M Latif
African Journal of Urology , 2007,
Abstract: Objective: To evaluate the effi cacy and safety of Holmium: YAG laser lithotripsy for the treatment of impacted ureteral stones. Patients and Methods: From January 2000 to January 2007, 150 patients (105 males and 45 females) with impacted ureteral stones were treated at the Urology Department of the Assiut University Hospital, Assiut, Egypt. Their mean age was 36 years (range 20 to 66 years). The mean duration of stone impaction was 4.6 months. The patients were managed via the retrograde endoscopic approach using small caliber (6.9 F rigid and 7.5 F fl exible) ureteroscopes and the Holmium:YAG laser lithotriptor. Results: Out of 150 ureteral stones, 144 (96%) were completely fragmented with a single endoscopic procedure. Proximal stone migration occurred in two cases, and the stones were treated by extracorporeal shock wave lithotripsy (ESWL). Intra-operative ureteral perforation occurred in 4 cases and was managed by open surgical treatment. Endoscopic observation revealed infl ammatory polyps at the site of impaction in 75 patients and a stricture adjacent to the stone in 20 cases. Conclusion: Holmium: YAG laser lithotripsy may be considered an effective fi rst-line therapy for chronically impacted ureteral stones, which are frequently associated with chronic infl ammation, polyps and strictures. It is quite safe and it avoids the futile repetition of ESWL and problems caused by a prolonged passage of stone fragments.
African Journal of Urology , 2002,
Abstract: Objective To evaluate the clinical outcome of non-stented ureteroscopic Holmium:YAG laser lithotripsy of distal lower ureteral calculi with respect to efficacy, safety, postoperative pain and hospital stay. Patients and Methods Thirty-five patients with distal lower ureteral calculi underwent ureteroscopy without prior ureteral dilatation followed by Holmium:YAG laser lithotripsy. No stenting was carried out at the end of the procedure. A second group of 35 age and sex matched patients who underwent the same procedure with placement of stents served as a control group. The patients were evaluated 24 and 48 hours, as well as 1 and 4 weeks postoperatively to determine postoperative pain and analgesic requirements. Radiological follow-up consisted of renal ultrasound and plain KUB film, while excretory urography was done 3 months postoperatively. Results Five patients (14.2%) of the study group showed a dilatation of the pelvicalyceal system and the upper ureter which improved completely by the seventh postoperative day. Patients with stents had statistically significantly more postoperative pain (P<0.001) and a higher requirement of analgesics (P<0.001) compared to the non-stented study group. Hospitalization was 1.8 ± 1.6 and 5.7 ± 1.7 days, respectively (P<0.001), and the time to return to normal activities was 7.3 ± 1.2 and 9.7 ± 1.3 days, respectively (P<0.001) in the non-stented and the stented group. None of the 27 patients (77.1%) of the non-stented group who had a follow-up excretory urography at 3 months had a newly identified ureteral stricture. Conclusion Non-stented uncomplicated ureteroscopy for distal ureteral calculi without prior ureteral dilatation can be safely performed in selected patients using Holmium:YAG laser lithotripsy. It will minimize the postoperative pain, the requirements of analgesia and the hospital stay and is at the same time cost effective. La Lithotritie Par Laser Holmium-YAG sans Drainage Urétéral dans le Traitement des Calculs du Bas Uretère Objectif Evaluer les résultats cliniques de la lithotritie par Laser Holmium-YAG sans drainage uré-téral, quant à l'efficacité, la sécurité, la douleur post-opératoire et la durée du séjour hospitalier. Patients and Méthodes Trente cinq patients présentant un calcul du bas uretère ont bénéficié d'une urétéroscopie sans dilatation urétérale préalable suivie d'une lithotritie par Laser Holmium-YAG. Au-cun drainage urétéral n'a été posé à la fin de la procédure. Un second groupe de 35 patients appariés par le sexe et l'age qui ont été bénéficié de la même procédure mais avec drainage urétéral a servi de groupe témoin. Les patients ont été évalués à 24 h et 48 h, mais aussi 1 et 4 semaines après l'intervention pour déterminer la douleur opératoire et le besoin en prise d'analgésiques. Le suivi radiologique consistait en une échographie rénale et une radiographie de l'abdomen sans préparation. Une UIV a été réalisée 3 mois après l'opération. Résultats Cinq patients du groupe d'
Transureteral Lithotripsy of Ureteral Calculi in Children with Holmium: Yttrium Aluminium Garnet Laser
Mohsen Amjadi,Fahimeh Kazemi Rashed,Reza Sari Motlagh,Farzin Sheikh Monazzah
Journal of Lasers in Medical Sciences , 2012,
Abstract: INTRODUCTION: Surgical management of pediatric urinary calculi evolved dramatically over the past two decades. However, with the miniaturization of equipment and with improvisation of endourologic techniques, access to the entire pediatric urinary system is possible. Ho: YAG laser provides more maneuverability during transuretereal lithotripsy (TUL) than the pneumatic system which uses a metal probe, especially when used in pediatrics urinary systems. In this study, we report our experience about treatment of pediatric ureteral stone with HO: YAG laser. METHODS: Between 2008 -2011, 41 children ≤ 12 years of age with ureteral stones were included in our study. Using K.U.B, sonography, and intravenous urogram, diagnoses were established for all patients. 6F or 8F wolf semi rigid ureteroscope was used for ureteroscopy under general anesthesia and stone fragmentation was implemented by Ho: YAG laser. For the evaluation of stone free rate, we used the following day & week confirmatory KUB, and sonograms additional to the direct visualization of the ureter during ureteroscopy. The patients were scheduled to be followed by control sonograms 2 weeks and 2 months after the operation to rule out past operational ureteral stenosis. RESULTS: From our 40 patients whose ages were in the range of 8 months and twelve years of old with a mean age 3.5 years, 18 patients (45%) had distal ureteral stones, ten (25%) in mid ureter, and twelve of them (30%) had the stone in their proximal ureter. The mean diameter of stones was 9.3 mm (3.5-11 mm). Three patients had encrusted double j stents (DJS). Our overall stone free rate was 89.35% at the end of 1 week. The complications were fever in 5 patients (12.5%) and ureteral stricture due to ureteral perforation in one patient, while one patient had long hospital stay due to refractory pain and nausea. The mean time of post-surgical hospital stay was 42 hours, while for only 20% of patients (8 patients) and in the rest of patients (30 patients) this period was only 24hours. DISCUSSION: Endoscopic lithotripsy in children has gradually become a major technique for the treatment of ureteral stones. This progression has been on the basis of the development of appropriate endoscopes and effective working instruments. The stone-free rate following urteroscopic lithotripsy for ureteral stones has been reported in as high as 98.5-100%. In this study, overall stone free rate was 89.35%. The complications after ureteroscopic laser lithotripsy are uncommon and usually related to passage of the ureteroscope than from laser action. Fever was
Comparison between the Holmium Laser (Made in Iran) and Pneumatic Lithotripsy in Patients Suffering from Upper Ureteral Stone between 1-2cm
Mohammad Reza Razaghi,Abdollah Razi
Journal of Lasers in Medical Sciences , 2012,
Abstract: INTRODUCTION: The aim of this study is to compare holmium laser (LL) with pneumatic lithoclast (PL) in patients with upper ureteral stones and their ability to destruct the stones and making the patient stone free. We also compare the duration of these procedures and their complications, such as urosepsis, perforation, and pushing the stone backward. 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.
Experience with impacted upper ureteral Stones; should we abandon using semirigid ureteroscopes and pneumatic lithoclast?
Ehab ElGanainy, Diaa A Hameed, MA Elgammal, Alaa A Abd-Elsayed, M Shalaby
International Archives of Medicine , 2009, DOI: 10.1186/1755-7682-2-13
Abstract: Complication rates, most notably ureteral perforation and long-term complications of URS such as stricture formation rates, have been reduced to < 5%. Moreover, impacted ureteral calculi are more difficult to fragment with SWL because of the lack of natural expansion space for stones, this result in a situation that is better managed by ureteroscopy. The aim of this study is to assess the efficacy, safety, and complications of impacted upper ureteral stone disintegration using semirigid ureteroscopes and pneumatic lithotripsy.We retrospectively analyzed the records of 267 consecutive patients with impacted upper ureteral stones (9–20 mm) who were treated by semirigid ureteroscopes and pneumatic disintegration. The efficacy of treatment was estimated using the stone-free rate and all treatment related complications were analyzed.Except for 24 cases where the stone migrated to the kidney, the stone was successfully treated ureteroscopically, with a low rate of minimal complications such as mild hematuria (18.4%), short term low grade fever (13.5%). Only 3 patients (1.1%) had high grade fever and none had post operative stricture.The use of semirigid URS and pneumatic lithotripsy in impacted upper ureteral stones in experienced hands has very satisfactory results with minimal complications. When Holmium laser and flexible URS are not available, semirigid URS and pneumatic lithotripsy is a good alternative that shouldn't, yet, be abandoned.In the early 1980s, the development of shock wave lithotripsy (SWL) changed the therapeutic modalities for urinary stones [1]. The AUA/EAU Ureteral Stones Guideline Panel reported that the stone free rate for both SWL and ureteroscopy (URS) when treating proximal ureteral stones is around 81%. The rate for stones >10 mm decreased to 68% and 79% if they were treated by SWL and URS respectively [2].URS has traditionally constituted the favored approach for the surgical treatment of mid and distal ureteral stones while SWL has been prefe
Treatment of giant ureterocele calculi by Holmium Laser Lithotripsy  [PDF]
Haluk S?ylemez,Bülent Alt?noluk,Murat Y. U?ra?
Dicle Medical Journal , 2009,
Abstract: Aim: Most ureteral stones pass spontaneously. But patients who have a calculi in an ureterocele could not pass their stone, because of narrow ureteral orifice. These stones may remain asymptomatic until hematuria or obstruction occurs.Materials and Methods: Holmium laser has many uses in urology, including soft tissue incision and calculus fragmentation. These properties are ideal for endoscopic management of the ureterocele calculusResults: We present a young patient who has no spesific and severe symptoms with a hypofunctional left kidney because of giant calculi in an ureterocele Conclusion: Its imaging characteristics on intravenous pyelography and endoscopic treatment were emphasized.
Outcomes of flexible ureteroscopic lithotripsy with holmium laser for upper urinary tract calculi
Cocuzza, Marcello;Colombo Jr, Jose R.;Cocuzza, Antonio L.;Mascarenhas, Frederico;Vicentini, Fabio;Mazzucchi, Eduardo;Srougi, Miguel;
International braz j urol , 2008, DOI: 10.1590/S1677-55382008000200003
Abstract: objective: to assess the perioperative and financial outcomes of flexible ureteroscopic lithotripsy with holmium laser for upper tract calculi in 44 patients. materials and methods: between february 2004 and september 2006, 44 patients treated for upper tract stone with flexible ureteroscopic lithotripsy were evaluated. renal stones were associated with collecting system obstruction in 15 (34%) patients, failed extracorporeal shock-wave lithotripsy (swl) occurred in 14 (32%) patients, unilateral multiple stones in 18 (41%) patients, and multiple bilateral stones in 3 (7%). in 29 (66%) patients, the stone was located in the inferior calyx. perioperative and financial outcomes were also evaluated. results: 50 procedures were performed in 44 patients. the mean stone burden on preoperative ct scan was 11.5 ± 5.8 mm. the mean operative time was 61.3 ± 29.4 min. the stone free rate was 93.1% after one procedure and 97.7% after a second procedure, with overall complication rate of 8%. therapeutic success occurred in 92% and 93% of patients with lower pole stones and swl failure, respectively. treatment failure of a single session was associated with presence of a stone size larger than 15 mm (p = 0.007), but not associated with inferior calyx location (p = 0.09). surgical disposables were responsible for 78% of overall costs. conclusion: flexible ureteroscopy using holmium laser is a safe and effective option for the treatment of upper urinary tract calculi. in addition, it can be considered an attractive option as salvage therapy after swl failure or kidney calculi associated with ureteral stones. stone size larger than 15 mm is associated with single session treatment failure.
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