Treatment of Distal Ureteric Stones- Comparative Efficacy of Transurethral Pneumatic Lithotripsy and Extracorporeal Shock Wave Lithotripsy

Jamil Ahmed  Khan

doi:10.54112/bcsrj.v6i8.1984

Authors

Jamil Ahmed Khan Department of Urology, Postgraduate Medical Institute, Quetta, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v6i8.1984

Keywords:

ureteric stones, TPL, ESWL

Abstract

Ureteric stones are treated with two minimally invasive procedures: transurethral pneumatic lithotripsy and extracorporeal shock wave lithotripsy. Objective: This study aimed to find out the comparative efficacy of transurethral pneumatic lithotripsy and extracorporeal shock wave lithotripsy in the treatment of distal ureteric stones. Method: The present randomized controlled study was conducted at the Department of Urology, Postgraduate Medical Institute (PGMI), Quetta, from January 2025 to June 2025, after obtaining approval from the institute's ethical board. A total of 232 individuals presented to OPD, following a thorough clinical assessment (history, examination, pertinent tests such as urine culture, X-ray KUB, ultrasound KUB, and excretory urography) of different age groups and both genders who had distal ureteric stones ranging in size from 6 to 12 mm, were included in this study. The study participants were equally divided into two groups: Group A received TPL (transurethral pneumatic lithotripsy), and Group B received ESWL (extracorporeal shock wave lithotripsy) treatment. Two weeks following the procedure, each patient underwent monitoring with an ultrasound and a KUB X-ray. The procedure was considered effective if the X-ray KUB revealed no stones or fragments less than four millimeters in diameter, as these are meant to pass through the urine, or if the ultrasound revealed no stones. All of the data was entered into a pre-made pro forma. SPSS 10.0 was used to analyze the data. For quantitative characteristics, such as stone size and age, the mean ± SD was computed. For categorical factors, such as efficacy and gender, percentages and frequencies were calculated. The effectiveness of the treatment methods was compared using Fisher's exact test. A p-value of less than 0.05 was considered significant. Results: A total of 232 individuals were enrolled in this study. The overall male-to-female ratio was 2.2:1. The mean age in Group A was 46.74±16.24 years, and in Group B, it was 44±13.57 years. The study found that the majority of our ureteric stone participants (30.6%) were between the ages of 31 and 45. Groups A and B each had 38 (32.7%) and 35 (30.1%) stones that were 6–8 mm in size. Extracorporeal Shock Wave Lithotripsy was successful in 80 (69%) of the individuals at the 2-week follow-up, whereas transurethral pneumatic lithotripsy was effective in 111 (95%) of the participants. P-value was statistically significant (p < 0.0001). Conclusion: The present study concluded that TPL was effective in 95% of participants, indicating it is superior to ESWL in treating distal ureteric stones.

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References

Krambeck AE, Murat FJ, Gettman MT, Chow GK, Patterson DE, Segura JW. The evolution of ureteroscopy: a modern single-institution series. Mayo Clin Proc. 2006;81(4):468–73. https://doi.org/10.4065/81.4.468

Furyk JS, Chu K, Banks C, Greenslade J, Keijzers G, Thom O, et al. Distal ureteric stones and tamsulosin: a double-masked, placebo-controlled randomized, multicenter trial. Ann Emerg Med. 2016;67(1):86–95. https://doi.org/10.1016/j.annemergmed.2015.06.001

Bader MJ, Eisner BH, Porpiglia F, Preminger GM, Tiselius HG. Contemporary management of ureteral stones. Eur Urol. 2012;61(4):764–72. https://doi.org/10.1016/j.eururo.2012.01.064

Cui X, Ji F, Yan H, Ou TW, Jia CS, He XZ, et al. Comparison between extracorporeal shock wave lithotripsy and ureteroscopic lithotripsy for treating large proximal ureteral stones: a meta-analysis. Urology. 2015;85(4):748–56. https://doi.org/10.1016/j.urology.2014.12.056

Nomikos MS, Sowter SJ, Tolley DA. Outcomes using a fourth-generation lithotripter: a new benchmark for comparison? BJU Int. 2007;100(6):1356–60. https://doi.org/10.1111/j.1464-410X.2007.07117.x

Tipu SA, Malik HA, Mohhayuddin N, Sultan G, Hussain M, Hashmi A, et al. Treatment of ureteric calculi—use of Holmium: YAG laser lithotripsy versus pneumatic lithoclast. J Pak Med Assoc. 2007;57(9):440–3.

Elganainy E, Hameed DA, Elgammal MA, Abd-Elsayed AA, Shalaby M. Experience with impacted upper ureteral stones; should we abandon using semi-rigid ureteroscopes and pneumatic lithoclast? Int Arch Med. 2009;2:13. https://doi.org/10.1186/1755-7682-2-13

Tan PK, Tan SM, Consigliere D. Ureteroscopic lithoclast lithotripsy: a cost-effective option. J Endourol. 1998;12(4):341–4. https://doi.org/10.1089/end.1998.12.341

Nikoobakht MR, Emamzadeh A, Abedi AR, Moradi K, Mehrsai A. Transureteral lithotripsy versus extracorporeal shock wave lithotripsy in management of upper ureteral calculi: a comparative study. Urol J. 2007;4(4):207–11.

Brito AH, Mitre AI, Srougi M. Ureteroscopic pneumatic lithotripsy of impacted ureteral calculi. Int Braz J Urol. 2006;32(3):295–9. https://doi.org/10.1590/S1677-55382006000300006

Muslumanoglu AY, Tefekli AH, Altunrende F, Karadag MA, Baykal M, Akcay M. Efficacy of extracorporeal shock wave lithotripsy for ureteric stones in children. Int Urol Nephrol. 2006;38(2):225–9. https://doi.org/10.1007/s11255-005-4792-y

Bromwich EJ, Lockyer R, Keoghane SR. Day-case rigid and flexible ureteroscopy. Ann R Coll Surg Engl. 2007;89(5):526–8. https://doi.org/10.1308/003588407X187676

Chen JJ, Yip SK, Wong MY, Cheng CW. Ureteroscopy as an out-patient procedure: the Singapore General Hospital Urology Centre experience. Hong Kong Med J. 2003;9(3):175–8.

Hofmann R. Ureteroscopy (URS) for ureteric calculi. Urologe A. 2006;45(6):637–46. https://doi.org/10.1007/s00120-006-1035-5

Geavlete P, Georgescu D, Nita G, Mirciulescu V, Cauni V. Complications of 2735 retrograde semirigid ureteroscopy procedures: a single-center experience. J Endourol. 2006;20(3):179–85. https://doi.org/10.1089/end.2006.20.179

Hong YK, Park DS. Ureteroscopic lithotripsy using Swiss Lithoclast for treatment of ureteric calculi: 12-year experience. J Korean Med Sci. 2009;24(4):690–4. https://doi.org/10.3346/jkms.2009.24.4.690

Ather MH, Nazim SM, Sulaiman MN. Efficacy of semirigid ureteroscopy with pneumatic lithotripsy for ureteral stone surface area greater than 30 mm². J Endourol. 2009;23(4):619–22. https://doi.org/10.1089/end.2008.0182

Wazir BG, Orakzai AN, Nawaz A. Treatment of distal ureteric stones—comparative efficacy of transureteral pneumatic lithotripsy and extracorporeal shock wave lithotripsy. J Ayub Med Coll Abbottabad. 2015;27(1):140–2.

Ahmad S, Shah A, Khan RA, Kalim M, Ali S. To compare the effectiveness of transurethral pneumatic lithotripsy and extracorporeal shock wave lithotripsy in the treatment of lower ureteric stones. J Saidu Med Coll Swat. 2021;11(4):223–9. https://doi.org/10.52206/jsmc.2021.11.4.683