Comparison of pneumatic lithotripsy versus laser lithotripsy for upper ureteral calculi

Ershad Hussain Galeti, Saqib Shahab, Mriganka Deuri Bharali


Background: Several modalities are available for upper ureteric stone fragmentation. From them pneumatic and holmium: yttrium-aluminum-garnet lithotripsy has favourable outcomes. In this study we studied 50 patients who underwent ureteroscopic pneumatic lithotripsy or laser lithotripsy. This study aims to to compare the outcome of PL and LL in the management of upper ureteric calculi.

Methods: This is a prospective, randomized study of 50 cases; 25 cases of TUL with pneumatic lithotripter and 25 cases of TUL with laser lithotripter over two years. The purpose of this study was to analyze the factors predicting the stone-free rate, assess the complications following PL and LL, and assess the need for a second procedure if retropulsion of calculi occurs.

Results: Two groups were similar in age, gender, mean size of stones, retropulsion and complications. There was a statistical difference in terms of stone free rate in favour of LL group (p≤0.05) and mean operative time in favor of the PL group (p≤ 0.05).

Conclusions: In conclusion, we found that both the PL and LL approaches were effective and safe for upper ureteric calculi, but the LL method had advantages, especially in stone free rate, over the PL treatment. Another advantage of the LL method was safe stone fragmentation in upper ureteral calculi due to lower retropulsion rate in contrast with the PL method.


Laser lithotripsy, Pneumatic lithotripsiy, Ureteroscopy

Full Text:



Ramello A, Vitale C, Marangella M. Epidemiology of nephrolithiasis. J Nephrol. 2000;13:45-50.

Segura JW, Preminger GM, Assimo DG, Dretler SP, Kahn RI, Lingeman JE, et al. Ureteral stones guidelines panel summary report on the management of ureteral calculi. Am Urol Assoc. 1997;158:1915-21.

Anagnostou S, Tolley D. Mannagent of ureteric stones. Eur Urol. 2004;45:714-21.

AUA/EAU clinicalguidelines 2017. Available at: uretcal07/chapter1.pdf. Accessed on 20 April 2021.

Mahmood A, Silberglect A, Olson R, Cotant M. The influence of stone size on management. Nat Clin Pract Urol. 2007;4:570-3.

Abdel-Razzak O, Bagley DH. The 6.9F ureteroscope in clinical use. Urol. 1993;41:45-8.

Denstedt JD, Eberwein PM, Singh RR. The Swiss Lithoclast: A new device for intracorporeal lithotripsy. J Urol. 1992;148:1088-90.

Minevich E, Defoor W, Reddy P, Nishinaka K, Wacksman J, Sheldon C, et al. Ureteroscopy is safe and effective in prepubertal children. J Urol. 2005; 174:276-9.

Park H, Park M, Park T. Two years experience with ureteral stones: extracorporial shock wave lithotripsy v ureterorenoscopic manipulation. J Endourol. 1998; 13:501-4.

Hollenback BK, Schuster TG, Facber GJ, Wolf JS. Safety and efficacy of same session bilateral ureteroscopy. J Endourol. 2003;17:881.

Teichman JM. The use of holmium:YAG laser in urology. AUA. 2001;20:154-8.

Teh CL, Zhong P, Preminger GM. Laboratory and clinical assessment of pneumatically driven intracorporeal lithotripsy. J Endourol. 1998;12:163-9.

Mahmood S, Bajalan D. Ureteroscopic Management of Ureteral Calculi: Pneumatic versus Holmium: YAG Laser Lithotripsy. J Urol. 2016;06(03):36-42.

Manohar T, Ganpule A, Desai M. Comparative evaluation of Swiss LithoClast 2 and holmium:YAG laser lithotripsy for impacted upper-ureteral stones. J Endourol. 2008;22:443-6.

Bapat SS, Pai KV, Purnapatre SS, Yadav BP, Padye AS. Comparison of holmium laser and pneumatic lithotripsy in managing upper uretral stones. J Endourol. 2007;21:1425-7.

Razaghi MR, Razi A, Mazloomfard MM, Mokhtarpour H, Javanmard B, Mohammadi R.Trans-ureteral ureterolithotripsy of ureteral calculi: which is the best; pneumatic or holmium laser technique?. J Lasers Med Sci. 2011;2(2):59-62.

Farhan SD. Evaluation of Holmium: YAG Laser versus Pneumatic Lithotripsy for the Intra Corporeal Lithotripsy of the Ureteric Stones. Iraqi Postgrad Med J. 2012;11:668-74.

Sarwar NM, Diar HB. Ureteroscopic management of ureteral calculi: pneumatic versus holmium: YAG Laser Lithotripsy. J Urol. 2016;6(3):55-9.

Akdeniz E, İrkılata L, Demirel HC, Saylık A, Bolat MS, Şahinkaya N, Zengin M, et al. A comparison of efficacies of holmium YAG laser, and pneumatic lithotripsy in the endoscopic treatment of ureteral stones. Turkish J Urol. 2008;40(3):138-43.