Stone Clearance and Duration of Surgery in Percutaneous Nephrolithotomy Using Laser versus Pneumatic Lithotripsy

Laser versus Pneumatic Lithotripsy in Kidney Stone Surgery

Authors

  • Usama Muhammad Kathia Department of Urology, Lahore General Hospital, Lahore, Pakistan
  • Azfar Ali Department of Urology, Lahore General Hospital, Lahore, Pakistan
  • Mohammad Ahmad Department of Urology, Lahore General Hospital, Lahore, Pakistan
  • Umair Hayat Khan Department of Urology, Lahore General Hospital, Lahore, Pakistan
  • Qaisar Abbas Khan Department of Urology, Lahore General Hospital, Lahore, Pakistan
  • Ammar Tariq Alvi Department of Urology, Lahore General Hospital, Lahore, Pakistan
  • Muhammad Faizan Akbar Department of Urology, Lahore General Hospital, Lahore, Pakistan
  • Khizar Hayat Gondal Department of Urology, Lahore General Hospital, Lahore, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v6i6.3006

Keywords:

Nephrolithiasis, Percutaneous nephrolithotomy,, Holmium:Yag Laser, Pneumatic Lithoclast

Abstract

Nephrolithiasis is common ailment causing pain and renal impairment. Management strategies depend on stone size and location, with stones larger than 2 cm treated with Percutaneous Nephrolithotomy (PCNL). This study compares two energy sources pneumatic lithoclast and Holmium: YAG laser used in PCNL, focusing on stone-free rate and surgery duration. Objective: To know of any difference in Ho:YAG laser and pneumatic probe in terms of stone free rate and surgery duration during PCNL. Methods: This study was conducted retrospectively at the Department of Urology, Lahore General Hospital. The data of patients admitted from June 13, 2021, to June 12th, 2022, was taken. 120 patients were enrolled in this study (60 each for pneumatic lithoclast and Ho: YAG laser), using a non-purposive consecutive sampling technique. Data collection included demography, stone size, site, side, clearance status, and surgery duration. Analysis was conducted using SPSS version 21.0, with quantitative variables assessed via t-tests and qualitative variables via chi-square tests. A p-value ≤ 0.05 was considered statistically significant. Results: Mean age was 36.6±12.68 years in the pneumatic group and 40.40±8.29 years in the laser group. Stone clearance rates were 60% (n=36) for the pneumatic group and 70% (n=42) for the laser group. Mean surgery duration was shorter in pneumatic group (44.87±22.85 minutes) compared to laser group (142±29.41 minutes). Conclusion: Pneumatic lithoclast and Holmium: YAG laser provides comparable stone clearance rates for PCNL. However, the pneumatic probe reduces surgery duration.

References

Diri A and Diri B. Management of staghorn renal stones. Renal failure. 2018 Oct; 40(1): 357-62. doi: 10.1080/0886022X.2018.1459306. DOI: https://doi.org/10.1080/0886022X.2018.1459306

Letavernier E and Daudon M. Vitamin D, hypercalciuria and kidney stones. Nutrients. 2018 Mar; 10(3): 366. doi: 10.3390/nu10030366. DOI: https://doi.org/10.3390/nu10030366

Leslie SW and Sajjad H. Hypercalciuria. InStatPearls [Internet]. 2022 May.

Cong X, Shen L, Gu X. Current opinions on nephrolithiasis associated with primary hyperparathyroidism. Urolithiasis. 2018 Oct; 46(5): 453-7. doi: 10.1007/s00240-018-1038-x. DOI: https://doi.org/10.1007/s00240-018-1038-x

Cameli P, Caffarelli C, Refini RM, Bergantini L, d'Alessandro M, Armati M et al. Hypercalciuria in sarcoidosis: a specific biomarker with clinical utility. Frontiers in Medicine. 2020 Oct; 7: 568020. doi: 10.3389/fmed.2020.568020. DOI: https://doi.org/10.3389/fmed.2020.568020

Quilao RJ, Greer M, Stack Jr BC. Investigating the potential underdiagnosis of primary hyperparathyroidism at the University of Arkansas for Medical Sciences. Laryngoscope Investigative Otolaryngology. 2020 Aug; 5(4): 773-7. doi: 10.1002/lio2.415. DOI: https://doi.org/10.1002/lio2.415

Usman KD, Golan S, Abdin T, Livne PM, Pode D, Duvdevani M et al. Urinary stone composition in Israel: current status and variation with age and sex-a bicenter study. Journal of Endourology. 2013 Dec; 27(12): 1539-42. doi: 10.1089/end.2013.0236. DOI: https://doi.org/10.1089/end.2013.0236

Popov E, Almusafer M, Belba A, Bello JO, Bhatti KH, Boeri L et al. Obesity rates in renal stone formers from various countries. Archivio Italiano di Urologia e Andrologia. 2021 Jun; 93(2): 189-94. doi: 10.4081/aiua.2021.2.189. DOI: https://doi.org/10.4081/aiua.2021.2.189

Halinski A, Bhatti KH, Boeri L, Cloutier J, Davidoff K, Elqady A et al. Stone composition of renal stone formers from different global regions. Archivio Italiano di Urologia e Andrologia. 2021 Oct; 93(3): 307-12. doi: 10.4081/aiua.2021.3.307. DOI: https://doi.org/10.4081/aiua.2021.3.307

Tzelves L, Türk C, Skolarikos A. European association of urology urolithiasis guidelines: where are we going?. European Urology Focus. 2021 Jan; 7(1): 34-8. doi: 10.1016/j.euf.2020.09.011. DOI: https://doi.org/10.1016/j.euf.2020.09.011

Migliozzi MT, Biebel MG, Kurtz MP. PCNL. InMinimally Invasive and Robotic-Assisted Surgery in Pediatric Urology 2020 Nov: 251-273. doi: 10.1007/978-3-030-57219-8_18. DOI: https://doi.org/10.1007/978-3-030-57219-8_18

Noureldin YA, Kallidonis P, Liatsikos EN. Lasers for stone treatment: how safe are they?. Current Opinion in Urology. 2020 Mar; 30(2): 130-4. doi: 10.1097/MOU.0000000000000706. DOI: https://doi.org/10.1097/MOU.0000000000000706

Rajeev TP, Pratihar SK, Sarma D, Baruah SJ, Barua SK, Bagchi PK et al. A comparative study between holmium laser, pneumatic lithotripsy and shock pulse in terms of efficacy and safety in percutaneous nephrolithotomy (PCNL): a prospective randomized study. Journal of Endoluminal Endourology. 2020 Jan; 3(1): e1-8. doi: 10.22374/jeleu.v3i1.75. DOI: https://doi.org/10.22374/jeleu.v3i1.75

Wollin DA and Lipkin ME. Emerging technologies in ultrasonic and pneumatic lithotripsy. Urologic Clinics of North America. 2019 May; 46(2): 207-13. doi: 10.1016/j.ucl.2018.12.006. DOI: https://doi.org/10.1016/j.ucl.2018.12.006

Zehri AA, Patel M, Adebayo PB, Ali A. Inadvertent stone migration during pneumatic lithotripsy: still a conundrum in the 21st century. Cureus. 2020 Sep; 12(9). doi: 10.7759/cureus.10521. DOI: https://doi.org/10.7759/cureus.10521

Malik HA, Tipu SA, Mohayuddin N, Sultan G, Hussain M, Hashmi A et al. Comparison of holmium: Yag laser and pneumatic lithoclast in percutaneous nephrolithotomy. Journal of the Pakistan Medical Association. 2007 Aug; 57: 385-7.

Liu C, Zhou H, Jia W, Hu H, Zhang H, Li L. The efficacy of percutaneous nephrolithotomy using pneumatic lithotripsy vs. the holmium laser: a randomized study. Indian Journal of Surgery. 2017 Aug; 79(4): 294-8. doi: 10.1007/s12262-016-1473-2. DOI: https://doi.org/10.1007/s12262-016-1473-2

Hong Y, Lin H, Yang Q, Zhou D, Hou G, Chen X et al. Pneumatic lithotripsy versus holmium laser lithotripsy in percutaneous nephrolithotomy for patients with Guy's stone score grade IV kidney stone. Urologia Internationalis. 2021 Jan; 105(1-2): 45-51. doi.org/10.1159/000509043. DOI: https://doi.org/10.1159/000509043

Życzkowski M, Bogacki R, Nowakowski K, Muskała B, Rajwa P, Bryniarski P et al. Application of pneumatic lithotripter and holmium laser in the treatment of ureteral stones and kidney stones in children. BioMed Research International. 2017; 2017(1): 2505034. doi: 10.1155/2017/2505034. DOI: https://doi.org/10.1155/2017/2505034

Ganesamoni R, Sabnis RB, Mishra S, Parekh N, Ganpule A, Vyas JB et al. Prospective randomized controlled trial comparing laser lithotripsy with pneumatic lithotripsy in miniperc for renal calculi. Journal of Endourology. 2013 Dec; 27(12): 1444-9. doi: 10.1089/end.2013.0177. DOI: https://doi.org/10.1089/end.2013.0177

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Published

2025-06-30
CITATION
DOI: 10.54393/pjhs.v6i6.3006
Published: 2025-06-30

How to Cite

Kathia, U. M., Ali, A., Ahmad, M., Khan, U. H., Khan, Q. A., Alvi, A. T., Akbar, M. F., & Gondal, K. H. (2025). Stone Clearance and Duration of Surgery in Percutaneous Nephrolithotomy Using Laser versus Pneumatic Lithotripsy: Laser versus Pneumatic Lithotripsy in Kidney Stone Surgery. Pakistan Journal of Health Sciences, 6(6), 247–251. https://doi.org/10.54393/pjhs.v6i6.3006

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