U J All Final for WEB.pdf 762 | 1Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sci- ences, Tehran, Iran 2Iranian National Center for Laser Science and Technology Mohammad Reza Razzaghi,1 Abdollah Razi, Mohammad Mohsen Mazloomfard,1 Amin Golmohammadi Taklimi,2 Reza Valipour,1 Zahra Razzaghi1 Safety and Efficacy of Pneumatic Lithotripters Versus Holmium Laser in Management of Ureteral Calculi A Randomized Clinical Trial Corresponding Author: Mohammad Mohsen Mazloomfard, MD Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sci- ences, Tehran, Iran Tel: +98 212 274 9221 Fax: +98 218 852 6901 E-mail: mazloomfard@ yahoo.com Received April 2012 Accepted January 2013 Purpose: management of ureteral stones. Materials and Methods: to delineate the ureteral anatomy. Results: the laser and pneumatic groups, respectively (P - Conclusion: Laser lithotripsy is a superior approach for the management of upper ureteral stones Keywords: ureteral calculi, lasers, lithotripsy ENDOUROLOGY AND STONE DISEASE Endourology and Stone Disease 763Vol. 10 | No. 1 | Winter 2013 |U R O LO G Y J O U R N A L INTRODUCTION Uuropathy can deteriorate renal function. The predictors for renal function loss. Furthermore, there is no clear time threshold for irreversible damage. Therefore, in- ureteral obstruction unless close monitoring of renal function is available.(2) Several reports have suggested that ureteroscopy should be - ible ureteroscopic lithotripsy using a variety of lithotripters, including ultrasonic, electrohydraulic, pneumatic, and laser. stone migration. Recently, there has been an increase in the use of the hol- - (6) The - mation of plasma bubble at the tip of the holmium:YAG laser (7) holmium:YAG laser and pneumatic lithotripter in transure- cm ureteral calculi. MATERIALS AND METHODS using pneumatic or holmium:YAG laser, respectively. One - gical procedures in both groups. The ethics committee of the Laser Application in Medical Sciences Research Center ap- - tained from all the subjects. pregnancy, severe musculoskeletal deformity, and history of - cluded from the study. Before the procedure, urine cultures All of the subjects should have negative urine cultures pre- ureteroscope in both holmium:YAG laser and pneumatic lith- - pumped manually and intermittently during the procedure. - ing in pneumatic lithoclast group. under direct vision to detect any residual stone or injury to - st postoperative - the ureteral anatomy and renal function status at 3 months postoperatively. - cations, such as hematuria, mucosal damage (evidenced by edema or hemorrhage), ureteral perforation, and postopera- - months after the treatment routinely. - t test and - spectively. A P Pneumatic Lithotripters Versus Holmium Laser for Ureteral Calculi | Razzaghi et al 764 | RESULTS pneumatic group (P groups, respectively (P P - - - - P Table 2 summarizes the intra-operative and postoperative such as perforation, mucosal injury, and bleeding, there - group (P intravenous pyelography. DISCUSSION include ESWL, ureteroscopy, percutaneous nephrolithotomy, laparoscopy, and rarely open surgery.(2) Park and colleagues compared the results of ESWL and ureteroscopy for ureteral - ureteroscopic manipulation did not change by the stone size In fact, endourologic procedures - source affects the ureteroscopic method and the type of used instruments, varying results have been reported. Lithoclast lithotripsy fragments calculi in a mechanism similar to that of a pneumatic jackhammer. Compressed - ond. Breakup occurs as the probe tip repetitively impacts Holmium:YAG lithotripsy mainly uses photothermal mecha- nism to fragment stones. Holmium:YAG laser makes stone crater and small fragments by its thermal effect on the stone Endourology and Stone Disease Table 1. Demographic and clinical characteristics of patients.* Variable Laser (n = 56) Pneumatic (n = 56) P Mean age ± SD, y 35.9 ± 13.4 36.4 ± 12.5 .90 Male, n (%) 44 (78.5) 40 (71.5) .383 Previous history of TUL, n (%) 4 (7.1) 8 (14.3) .222 Stone laterality Right side, n (%) Left side, n (%) 35 (62.5) 21 (37.5) 30 (53.6) 26 (46.4) .338 Stone location Proximal, n (%) Middle, n (%) Distal, n (%) 12 (21.4) 12 (21.4) 32 (57.1) 14 (25) 12 (21.4) 30 (53.6) .897 Stone diameter, mm 11.7 ± 4.5 10.0 ± 5.6 .434 *SD indicates standard deviation; and TUL, transurethral ureterolithotripsy. 765Vol. 10 | No. 1 | Winter 2013 |U R O LO G Y J O U R N A L Pneumatic Lithotripters Versus Holmium Laser for Ureteral Calculi | Razzaghi et al - During the pneumatic procedure, there is no electricity, and mild and transitory. - Holmium:YAG laser energy is delivered in a pulsatile man- as the lithotripsy is performed under direct vision. for holmium laser lithotripsy for the management of the For this purpose, a better out- many centers, the use of holmium laser is appropriate and - matic procedure. In this study, the operation time considered for stone frag- - has to change position of the ureteroscope to seek out the mobile stones. Furthermore, lithoclast lithotripsy fragments the calculi into multiple chunks that need to be basketed and removed. holmium:YAG laser can be used for a variety of urological procedures, such as prostate resection and ablation, stric- tures incision, and urothelial tumors ablation. The small methods. CONCLUSION Holmium:YAG laser is a more safe and effective lithotripter large scale studies are needed. CONFLICT OF INTEREST None declared. Table 2. Patients intra-operative and postoperative data. Group Laser (n = 56) Pneumatic (n = 56) P Complications Hematuria, n (%) Mucosal damage, n (%) Ureteral perforation, n (%) Postoperative fever, n (%) 0 (0) 2 (3.6) 0 (0) 1 (1.8) 0 (0) 1 (1.8) 0 (0) 2 (3.6) - 1 - 1 Mean operation time ± SD, min 13.7 ± 12.6 7.9 ± 4.2 .029 Mean hospital stay ± SD, hr 24.4 ± 3.2 25.3 ± 0.3 .89 Immediate stone-free status, n (%) 56 (100) 46 (82.1) .001 3-month stone-free status, n (%) 56 (100) 49 (87.5) .013 Stone location stone-free status Proximal, n (%) Middle, n (%) Distal, n (%) 12/12 (100) 12/12 (100) 32/32 (100) 6/14 (42.9) 10/12 (83.3) 30/30 (100) .002 .478 - SD indicates standard deviation. 766 | Endourology and Stone Disease 15. Sun Y, Wang L, Liao G, et al. Pneumatic lithotripsy versus laser lithotripsy in the endoscopic treatment of ureteral calculi. J Endourol. 2001;15:587-90. 16. Karami H, Arbab AH, Hosseini SJ, Razzaghi MR, Simaei NR. 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