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Safety and efficacy of ureteroscopic pneumatic lithotripsy.

OBJECTIVE
To determine the safety and efficacy of ureteroscopic pneumatic lithotripsy (PL) for the clearance of ureteral calculi (UC).


STUDY DESIGN
Experimental study.


PLACE AND DURATION OF STUDY
Department of Urology, KRL Hospital, Islamabad, from March 2006 till December 2008.


METHODOLOGY
Ureteroscopic PL was performed on 104 patients with ureteric calculus measuring > 6 mm; using Swiss Lithoclast through a 9.5 French semi-rigid ureteroscope. At the end of the procedure, a DJ stent was inserted. Complications were noted. Stone clearance was assessed through X-ray KUB. DJ stent was removed within 3 - 6 weeks after the procedure.


RESULTS
Sixty-eight patients (65.4%) were males and 36 (34.6%) females. The average hospital stay was 2.6 + 2.8 days; 72 (69.6%) patients were discharged on the first post-procedure day. Complete stone clearance was achieved in 98 (94.2%) patients, at 3-6 weeks. Four patients (26.7% of upper ureteral stones) had stone retropulsion. The only major complication was perforation occurring in 2 (1.9%) distal ureters. One case was successfully managed by endoscopic DJ stent placement, the other required open repair.


CONCLUSION
Ureteroscopic PL is effective in clearing majority of middle and distal UC. Patients with proximal stones may have stone retropulsion. Ureteric perforation is an uncommon complication.