DefinePK

Research Objective

To compare the outcomes of pneumatic and laser lithotripsy among patients with proximal ureteric stones, specifically focusing on stone clearance, migration, and the need for secondary interventions.

Methodology

Prospective randomized control trial conducted at the Department of Urology, Sindh Institute of Urology & Transplantation (SIUT), Karachi. 70 patients (18-70 years old) with 8-15 mm proximal ureteric stones were included. Patients were randomly assigned to either pneumatic lithotripsy (n=35) or laser lithotripsy (n=35). Inclusion criteria: age 18-70, either gender, 8-15 mm proximal ureteric stones, ASA status I or II. Exclusion criteria: anomalous renal systems, ureteric strictures, UTIs, bleeding disorders, malignancies, participation in other trials, pregnant or lactating females. Procedures were performed under general anesthesia with preoperative and postoperative antibiotics. Follow-up was conducted after 4 weeks. Data was analyzed using SPSS version 26.0 with a 95% confidence interval and 5% level of significance.

Methodology Flowchart

                        graph TD
    A[Patient Recruitment 18-70 yrs, 8-15mm proximal ureteric stones] --> B[Random Assignment];
    B --> C[Pneumatic Lithotripsy n=35];
    B --> D[Laser Lithotripsy n=35];
    C --> E[Pre-op Antibiotics];
    D --> E;
    E --> F[Procedure General Anesthesia];
    F --> G[Post-op Antibiotics ≥5 days];
    G --> H[4-Week Follow-up Assessment];
    H --> I[Data Analysis SPSS v26.0];
    I --> J[Outcome Comparison Clearance, Migration, Secondary Intervention];
    J --> K[Conclusion];                    

Discussion

Laser lithotripsy demonstrated superior stone clearance and reduced stone migration compared to pneumatic lithotripsy, aligning with previous studies. The ability of laser lithotripsy to generate smaller fragments is believed to contribute to its higher efficacy. While pneumatic lithotripsy is less expensive and uses simpler devices, the increased risk of stone migration and need for secondary interventions makes laser lithotripsy a preferable option despite its higher cost and requirement for specialized equipment and training.

Key Findings

Stone clearance was significantly higher in the laser group (74.3%) compared to the pneumatic group (48.6%) (p=0.027). Stone migration was more common in the pneumatic group (42.9%) compared to the laser group (14.3%) (p=0.008). The need for secondary intervention was higher in the pneumatic group (51.4%) than in the laser group (28.6%), though this difference was not statistically significant (p=0.051). Laser lithotripsy was found to be more efficacious with higher stone clearance and lower rates of migration.

Conclusion

Laser lithotripsy is more efficacious for treating proximal ureteric stones than pneumatic lithotripsy, offering higher stone clearance and lower migration rates. Despite higher time and expense, its reduced need for secondary interventions makes it the preferred choice for these high-risk cases. Further large, multicenter studies are recommended to validate these findings.

Fact Check

1. Stone Clearance: Laser group achieved 74.3% stone clearance, while the pneumatic group achieved 48.6%. This difference was statistically significant (p=0.027).
2. Stone Migration: Stone migration occurred in 42.9% of patients in the pneumatic group versus 14.3% in the laser group, a statistically significant difference (p=0.008).
3. Sample Size: A total of 70 patients were included in the study, with 35 in each group.

Mind Map