COMPARATIVE EVALUATION OF PNEUMATIC AND LASER LITHOTRIPSY FOR THE MANAGEMENT OF PROXIMAL URETERIC STONES

Abstract

This study aimed to compare the outcomes of pneumatic and laser lithotripsy in patients with proximal ureteric stones. A prospective randomized controlled trial was conducted in the Department of Urology at the Sindh Institute of Urology and Transplantation (SIUT), Karachi. Patients aged 18–70 years of either gender with proximal ureteric stones measuring 8–15 mm were enrolled using non-probability consecutive sampling and randomly assigned to two equal groups: pneumatic lithotripsy and laser lithotripsy. The diagnosis and stone size were confirmed using CT KUB scans. Empirical antibiotics were administered preoperatively and for at least five days postoperatively. Follow-up evaluations were performed at four weeks to assess stone clearance, migration, and the need for secondary interventions. Data were analyzed using SPSS version 26.0 with a 95% confidence interval and a 5% level of significance. The mean age was 40.83 ± 14.09 years in the pneumatic group and 40.40 ± 14.28 years in the laser group. Stone clearance was significantly higher in the laser group (74.3%) compared to the pneumatic group (48.6%). Stone migration occurred more frequently in the pneumatic group (42.9%) than in the laser group (14.3%), and secondary interventions were required more often in the pneumatic group (51.4%) than in the laser group (28.6%). These findings demonstrate that laser lithotripsy is more effective than pneumatic lithotripsy for managing proximal ureteric stones, offering higher stone clearance rates and reduced migration. Although laser lithotripsy requires greater time and cost, its lower rate of secondary intervention supports its preference in clinical practice. Further large-scale studies are recommended to confirm these findings and refine treatment guidelines.