Impacted ≥ 10-mm pelvic ureteric stone treatment: laser lithotripsy alone or in combination with pneumatic lithotripsy—a prospective, comparative study

Abstract
Background
The aim of this study is to evaluate the outcome of ureteroscopic lithotripsy of combined pneumatic and laser versus laser lithotripsy alone for the treatment of impacted pelvic ureteral stones. Ninety patients with impacted stones 10 mm or more were selected and divided into two equal groups. The combined group included patients who treated by pneumatic lithotripsy (PL) and laser lithotripsy (LL), while those in the laser group were treated by LL alone via retrograde semirigid ureteroscopy. Exclusion criteria included urinary tract infection, radiolucent stones, ipsilateral concurrent stone, previous ureteral surgery, urinary tract anomalies, musculoskeletal deformities, renal failure and pregnancy. Any stone retropulsion or any residual stone detected 1 month postoperative was considered failure.

Results
The stone-free rate was 88.8% and 91.1% for laser and combined groups, respectively, which was statistically insignificant (p ≥ 0.05). Operative complications were 11.11% versus 4.4% for laser and combined groups, respectively, which is significant statistically (p ˂ 0.05). No ureteral perforation and no stricture were developed in the combined group, while one perforation and two strictures were developed in the laser group. The DJ stenting and second session lithotripsy requirements were 64.4% versus 51.1% and 15.5% versus 8.8% for laser versus combined group, respectively, and each was statistically significant.

Conclusion
When treating impacted stones, combining PL to LL can decrease the complication rate, DJ stenting and second session lithotripsy requirement, while preserving laser fragmentation capabilities.