Efficacy of Holmium Laser Lithotripsy and Shock Pulse Lithotripsy in Terms of Stone Clearance Rate in Patients with Upper Ureteric Calculus in a Tertiary Care Centre: A Prospective Observational Study

Abstract

Introduction: As the popularity of retrograde ureteroscopy continues to rise, it is becoming more common for patients to have it done for the treatment of ureteric calculi. Although the use of new technologies such as laser and shock pulse lithotripsy has increased the number of options for the treatment of proximal calculi, the exact guidelines regarding the optimal energy source for this condition in URSL is still not clear. Materials and Methods : This is a prospective observational pilot study done in the Department of Urology, AIIMS Rishikesh from September 2020 till June 2022 with sample size of 30 in each arm (Holmium Laser—HL and Shock Pulse—SP) involving those participants planned for either Holmium Laser or shock pulse Ureteroscopic lithotripsy fulfilling inclusion and exclusion criteria. Results: In our study we have found that stone clearance rate of shock pulse (HL and SP, 8.028 ± 3.69 and 12.70 ± 8.19 mm 3 /mins, p value: 0.05) to be significantly higher than Holmium laser lithotripsy. We have also found significant reduction in operating time (64.68 ± 10.62 mins and 36.78 ± 5.24 mins, p value < 0.05). Stone fragmentation quality of shock pulse is superior to that of Holmium Laser (Time taken for stone fragmentation, HL and SP, 59.09 ± 10.47 mins and 32.75 ± 7.53 mins, p value < 0.05). Conclusion: Our study has aided in better understanding the efficacy of the two lithotripter modalities. In order to build a deeper knowledge of the benefits and drawbacks connected with the device, large sample size and long term follow up are required.