EFFICACY OF SEMIRIGID URETEROSCOPE WITH PNEUMATIC LITHOTRIPSY IN MANAGEMENT OF URETERIC CALCULUS

Authors

  • Siraj ul Islam Lady Reading Hospital, Peshawar, Pakistan. Author
  • Asif Lady Reading Hospital, Peshawar, Pakistan.] Author

DOI:

https://doi.org/10.71000/8fkrbh78

Keywords:

Ureteric Calculi, Body Mass Index, Lithotripsy, Minimally Invasive Surgical Procedures, Pneumatic Devices, Stone-Free Rate, Ureteroscopy,

Abstract

Background: Ureteric calculi are a common clinical concern and present a therapeutic challenge, particularly in resource-limited settings. While various global studies have documented the efficacy of pneumatic lithotripsy, there is a noticeable gap in regional data from Khyber Pakhtunkhwa, Pakistan. Given the province's socioeconomic constraints and limited access to advanced technology, semi-rigid ureteroscopy with pneumatic lithotripsy offers a cost-effective and minimally invasive treatment alternative. This study was conducted to assess its efficacy in the local population.

Objective: To determine the stone-free rate of pneumatic lithotripsy in adults diagnosed with ureteric calculi.

Methods: This descriptive study was conducted at the Department of Urology, Lady Reading Hospital, Peshawar, from January 16 to July 15, 2021. A total of 109 adult patients aged 18 to 60 years with ureteric stones confirmed on ultrasonography were enrolled using non-probability consecutive sampling. Patients with anatomical abnormalities, prior interventions in the same ureter, chronic kidney disease, or contraindications to the procedure were excluded. All patients underwent semi-rigid ureteroscopy using a Karl Storz 6.4×8.0 Fr ureteroscope under general anesthesia, with stone fragmentation performed via Swiss LithoClast pneumatic lithotripsy. Postoperative follow-up at 4 weeks included KUB ultrasound to confirm stone clearance, defined as complete absence of echogenic foci or residual fragments ≤4 mm. Data were analyzed using SPSS version 26.

Results: The mean age was 41.28 ± 10.33 years, mean stone size 33.55 ± 5.33 mm, and mean BMI 24.02 ± 2.66 kg/m². Of 109 participants, 70 (64.2%) were male and 58 (53.2%) were aged above 40 years. Stones >30 mm were observed in 66 patients (60.6%). The overall stone-free rate achieved was 85.3% (n=93).

Conclusion: Semi-rigid ureteroscopy with pneumatic lithotripsy is a safe, effective, and economically feasible option for managing ureteric stones in adults, especially in settings with limited healthcare resources.

Author Biographies

  • Siraj ul Islam, Lady Reading Hospital, Peshawar, Pakistan.

    Department of Urology, Lady Reading Hospital, Peshawar, Pakistan.

  • Asif, Lady Reading Hospital, Peshawar, Pakistan.]

    Department of Urology, Lady Reading Hospital, Peshawar, Pakistan.

References

Huang X, He X, Zhai Q, Song L, Du C, Deng X. Ureteroscopic lithotripsy with pressure-measuring ureteral access sheath for large ureteral stones. Minim Invasive Ther Allied Technol. 2024;33(3):157-62.

Huang HS, Lu ZH, Liu CJ. Ureterorenoscopic (URS) Lithotripsy and Balloon Dilation Cause Acute Kidney Injury and Distal Renal Tubule Damage: A Prospective Study. Biomed Res Int. 2022;2022:5505969.

Tamiya T, Takazawa R, Uchida Y, Waseda Y, Kobayashi M, Fuse H. Stone-event-free survival after ureteroscopic lithotripsy by age: comparison between young and older patients. Urolithiasis. 2023;51(1):74.

Guo Z, Wang Z, Weng X, Tang Y, Wu D, Cheng F, et al. The safety and efficacy of Sotn ureteroscopy for renal and upper ureteral calculi: a prospective multicenter randomized controlled trial. Minerva Urol Nephrol. 2024;76(2):221-9.

Yuming Z, Lei Y, Qiliang Z, Xin H, Jin K, Song L, et al. Rigid ureteroscopic lithotripsy with a pressure-controlling ureteral access sheath for complex steinstrasse. BMC Urol. 2024;24(1):112.

Shrestha B, Koju R, Makaju Shrestha S, Shrestha K, Karmacharya RM. Predictors of Stone Free Rate and Application of the Size, Topography, Obstruction, Number and Evaluation of Hounsfield Units (S.T.O.N.E) Scoring System in Predicting the Outcome in Patients Undergoing Semi-rigid Ureteroscopic Lithotripsy for Ureteric Calculi at a University Hospital of Nepal. Kathmandu Univ Med J (KUMJ). 2024;22(85):31-5.

Thomas F, Córdoba A, López Silva M, Caruso D, Hernández R, Sanguinetti H. [Pneumatic lithotripsy vs Holmium: YAG Laser lithotripsy for the treatment of ureteral stones.]. Arch Esp Urol. 2021;74(8):768-73.

Yang J, Wu Z, Dai M, Xu C, Pan T, Yin G, et al. Novel pressure- and temperature-controlled flexible ureteroscope system with a suction ureteral access sheath: a multicenter retrospective feasibility study. World J Urol. 2024;43(1):38.

Hori S, Otsuki H, Fujio K, Nakajima K, Mitsui Y. Impact of eliminating urethral catheterization following ureterorenoscopic lithotripsy. Int J Urol. 2022;29(4):337-42.

Wu W, Wan W, Yang J, Amier Y, Li X, Zhang J, et al. For upper ureteral stone, semirigid ureteroscopy or flexible ureteroscopy? Strengths and weaknesses. BMC Urol. 2024;24(1):261.

Bangash M, Nazim SM, Jamil S, Abdul Ghani MO, Naeem S. Efficacy and Safety of Semi-rigid Ureteroscopic Lithotripsy (URS) for Proximal Ureteral Stone ≥10 mm. J Coll Physicians Surg Pak. 2020;30(10):1058-62.

Ibrahim RM, Sayed O, Lotfy AM, Sultan H, Elmarakbi AA. Extracorporeal shock wave lithotripsy versus laser lithotripsy in the treatment of post-SWL steinstrasse: a randomized comparative study. World J Urol. 2024;42(1):345.

Tsaturyan A, Faria-Costa G, Peteinaris A, Lattarulo M, Martinez BB, Vrettos T, et al. Endoscopic management of encrusted ureteral stents: outcomes and tips and tricks. World J Urol. 2023;41(5):1415-21.

Herout R, Putz J, Borkowetz A, Thomas C, Oehlschläger S. Emergency treatment of symptomatic ureteral calculi: predictors of prolonged hospital stay. Int Urol Nephrol. 2023;55(12):3039-44.

Abu Ahmed M, Abu Nasra W, Safadi A, Visoky A, Elias I, Katz R. Fluoroless Ureteroscopy: Experience in More Than 100 Patients. Isr Med Assoc J. 2022;24(1):47-51.

Taguchi M, Kinoshita H, Anada N, Yasuda K, Ueno O, Matsuda T. Effectiveness and Safety of Ureteroscopic Lithotripsy in Young, Old-Old, and Oldest Old Patients. J Endourol. 2022;36(4):439-43.

Zoeir A, Zaghloul T, Gameel T, Mousa A, El Tatawy H, Ragab M, et al. Comparison of laparoscopic ureterolithotomy, retrograde flexible ureteroscopy, and mini-percutaneous antegrade flexible ureteroscopic lithotripsy for treating large (≥ 15 mm) impacted proximal ureteric stones: a prospective randomized trial. Urolithiasis. 2024;52(1):107.

Mancuso M, Lavoie C, Assmus M, De S. Characterizing patients with multiple same-sided ureteric stones. World J Urol. 2022;40(7):1763-7.

Hanna B, Zhuo K, Chalasani V, Vass J, Rasiah K, Wines M, et al. Association between ureteric stent dwell time and urinary tract infection. ANZ J Surg. 2021;91(1-2):187-91.

Huang WN, Huang HL, Wang YH, Chen WX, Deng H, Zhong MZ. Application of 11/13Fr suctioning ureteral access sheath and 8.55Fr single-use digital flexible ureteroscope in one-stage flexible ureteroscopic lithotripsy: an initial experience of 900 cases. Urolithiasis. 2024;52(1):112.

Ogreden E, Demirelli E, Aksu M, Tok DS, Oğuz U. Early ureteroscopic lithotripsy in acute renal colic caused by ureteral calculi. Int Urol Nephrol 2020; 52:15-19.

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Published

2025-06-10