Comparison of the Morbidity of Holmium YAG Laser Lithotripter and Conventional Pneumotic Lithotripter in the Treatment of Ureteral and Kidney Stones
Project no. 112 · Status: Kapanmış · 2017
Summary
Background: There are limited number of studies comparing the results of Holmium:YAG laser (LL) and pneumatic lithotripsy (PL) for pediatric ureteral stones. Objectives: To perform a comparative analysis of LL and PL in the management of ureteral stones in children and adults. Project design: Ninety-eight children (56 boys and 42 girls), and 623 adults (360 men and 263 women), who were treated for ureteral stones at our clinic between 2017 and 2019, were the subjects of this project. Patients were grouped according to their age as group 1 (n:98, pediatric [<18 age]) and group 2 (n:623, adult [?18 age]). The patients were then grouped according to lithotriptor type as laser (n:580) and pneumatic (n:141). The effect of lithotriptor type, stone size and location, and operative times on success and complication rates were investigated. Results: In both groups, mean operation time was in favor of PL (14.6 vs 22.8 min, p = 0.042 and 26.4 vs 36.3 min, p = 0.013, respectively). In both groups, overall stone-free rates (SFR) were in favor of laser lithotripsy (86.8% vs 66.7%, p < 0.001, and 83% vs 73.9%, p = 0.005, respectively), but there was no significant difference in overall SFRs between adults and children (78.4% vs 76.7, p = 0.390). Retreatment rates were higher in the pneumatic group in in both children and adults (p = 0.026 and p = 0.041, respectively). While there was no significant difference in the overall complication rates between adults and children (53.5% vs 40.6%, p=0.816), the rate of complications with LL was lower in adults (37.7% vs 69.4%, p < 0.001). Discussion: This Project is the first to report a comparative analysis of factors affecting ureteroscopy success in adults and children. SFRs were higher in all ureteral locations for LL. LL, lower ureteral location and < 6 mm ureteral stone were determined as the predictors of success for both pediatric and adult patients. The presence of multiple surgeons with different levels of experience is the main limitation of this project. Conclusion: Both LL and PL are safe in children and adults with similar clinically insignificant complication rates. However, in the short term, LL provides better SFRs in both children and adults, especially in the upper ureteral stones. Surgeons should decide the energy technique to be used in ureteroscopy according to the characteristics of the stone rather than the patient's age group.