Objective: The aim of this prospective single-blinded study was to analyze the stone-free (SF) rates between pneumatic lithotripsy (PL) and laser lithotripsy (LL) for the treatment of single and primary ureteral stones and to evaluate potentially predictive factors of a SF status. Material and Methods: From January 2010 to January 2011, 133 consecutive patients with single and primary ureteral stones were prospectively enrolled. Uni- and multivariate logistic regression were performed to estimate predictive factors of a SF status. Results: The SF rate in the PL group was 80.7 and 86.1% in the LL group (p = 0.002). Success rates with regard of stone position were not significantly different between groups. At univariate logistic regression, middle ureteral stone (OR 3.33, p = 0.04), distal ureteral stone (OR 4.4, p = 0.02), LL (OR 3.05, p = 0.04) and Hounsfield units (HUs) (OR 1.07, p = 0.03) were significantly predictive factors of a SF status. At a multivariate logistic regression, middle ureteral stone (OR 5.58, p = 0.01), distal ureteral stone (OR 7.87, p < 0.01), LL (OR 2.4, p = 0.02) and HUs ≥1,200 (OR 1.15, p = 0.02) were significantly associated with a SF status. Conclusions: LL significantly influences the SF status after ureteroscopy, allowing a higher SF rate when compared to PL. HUs may significantly influence this success rate.

Keywords:
Ureteroscopy, Lithiasis, Stone-free rate, Laser lithotripsy, Predictive factors, Hounsfield unit
1.
Bader MJ, Eisner B, Porpiglia F, Preminger GM, Tiselius HG: Contemporary management of ureteral stones. Eur Urol 2012;61:764-772.
2.
Knispel HH, Klan R, Heicappell R, Miller K: Pneumatic lithotripsy applied through deflected working channel of mini-ureteroscope: results in 143 patients. J Endourol 1998;12:513-515.
3.
Sofer M, Denstedt J: Flexible ureteroscopy and lithotripsy with the holmium:YAG laser. Can J Urol 2000;7:952-956.
4.
Vassar GJ, Chan KF, Teichman JM, Glickman RD, Weintraub ST, Pfefer TJ, et al: Holmium:YAG lithotripsy: photothermal mechanism. J Endourol 1999;13:181-190.
5.
Floratos DL, de la Rosette JJ: Lasers in urology. BJU Int 1999;84:204-211.
6.
Ito H, Kawahara T, Terao H, Ogawa T, Yao M, Kubota Y, et al: Evaluation of preoperative measurement of stone surface area as a predictor of stone-free status after combined ureteroscopy with holmium laser lithotripsy: a single-center experience. J Endourol 2013;27:715-721.
7.
Aghamir SK, Mohseni MG, Ardestani A: Treatment of ureteral calculi with ballistic lithotripsy. J Endourol 2003;17:887-890.
8.
Delvecchio FC, Kuo RL, Preminger GM: Clinical efficacy of combined lithoclast and lithovac stone removal during ureteroscopy. J Urol 2000;164:40-42.
9.
Devarajan R, Ashraf M, Beck RO, Lemberger RJ, Taylor MC: Holmium:YAG lasertripsy for ureteric calculi: an experience of 300 procedures. Br J Urol 1998;82:342-347.
10.
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;57:440-443.
11.
Yu W, Cheng F, Zhang X, Yang S, Ruan Y, Xia Y, et al: Retrograde ureteroscopic treatment for upper ureteral stones: a 5-year retrospective study. J Endourol 2010;24:1753-1757.
12.
Yin X, Tang Z, Yu B, Wang Y, Li Y, Yang Q, et al: Holmium:YAG laser lithotripsy versus pneumatic lithotripsy for treatment of distal ureteral calculi: a meta-analysis. J Endourol 2013;27:408-414.
13.
Yencilek F, Sarica K, Erturhan S, Yagci F, Erbagci A: Treatment of ureteral calculi with semi-rigid ureteroscopy: where should we stop? Urol Int 2010;84:260-264.
14.
Lam HS, Lingeman JE, Barron M, Newman DM, Mosbaugh PG, Steele RE, et al: Staghorn calculi: analysis of treatment results between initial percutaneous nephrostolithotomy and extracorporeal shock wave lithotripsy monotherapy with reference to surface area. J Urol 1992;147:1219-1225.
15.
Tan PK, Tan EC, Tung KH, Foo KT: Extracorporeal shock wave lithotripsy monotherapy for selected staghorn stones. Singapore Med J 1995;36:53-55.
16.
Ito H, Kawahara T, Terao H, Ogawa T, Yao M, Kubota Y, et al: The most reliable preoperative assessment of renal stone burden as a predictor of stone-free status after flexible ureteroscopy with holmium laser lithotripsy: a single-center experience. Urology 2012;80:524-528.
17.
El-Assmy A, Abou-el-Ghar ME, el-Nahas AR, Refaie HF, Sheir KZ: Multidetector computed tomography: role in determination of urinary stones composition and disintegration with extracorporeal shock wave lithotripsy - an in vitro study. Urology 2011;77:286-290.
18.
Saw KC, McAteer JA, Monga AG, Chua GT, Lingeman JE, Williams JC Jr: Helical CT of urinary calculi: effect of stone composition, stone size, and scan collimation. AJR Am J Roentgenol 2000;175:329-332.
19.
Ito H, Kawahara T, Terao H, Ogawa T, Yao M, Kubota Y, et al: Predictive value of attenuation coefficients measured as Hounsfield units on non-contrast computed tomography during flexible ureteroscopy with holmium laser lithotripsy: a single-center experience. J Endourol 2012;26:1125-1130.
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2014
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