JOCS

The aim of the Comprehensive Surgery is to publish original research articles of the highest scientific and clinical value at the international level in all surgical fields.

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Original Article
Comparison of the efficacy of extracorporeal shock wave lithotripsy, pneumatic lithotripsy, and laser lithotripsy in the treatment of proximal ureteral calculi
Aims: This study aimed to compare the efficacy of extracorporeal shock wave lithotripsy (ESWL), pneumatic lithotripsy, and laser lithotripsy in the treatment of proximal ureteral calculi, focusing on stone-free rates, complication profiles, and the need for additional interventions.
Methods: A retrospective analysis was conducted on 150 patients with proximal ureteral calculi treated with ESWL, pneumatic lithotripsy, or laser lithotripsy. Patients were divided into three equal groups (50 per treatment arm). Demographic and clinical characteristics, procedural outcomes, and complication rates were evaluated. Stone-free status was assessed on postoperative day 1 via direct urinary system radiography and at 1 month using intravenous urography.
Results: For stones smaller than 10 mm, the stone-free rates were 93% in the ESWL group, 80% for pneumatic lithotripsy, and 84% for laser lithotripsy. In stones ?10 mm, the rates dropped to 55.0%, 52.6%, and 75%, respectively. There were no statistically significant differences in the distributions of stone-free status, minimal residue, or the requirement for post-procedure URS across procedure types. A higher frequency of pusback was observed in the pneumatic lithotripsy group compared to the other groups (Pneumatic lithotripsy: 31.6% vs. Laser lithotripsy: 12.5% vs. ESWL: 0%, p = 0.012). However, for stones smaller than 10 mm, this difference was not statistically significant. The mean operative duration was longest for laser lithotripsy compared to pneumatic lithotripsy and ESWL (Pneumatic lithotripsy: 36.6 ± 5.2 vs. Laser lithotripsy: 62.8 ± 11.1 vs. ESWL: 28.2 ± 6.4 minutes, p = 0.001). Complication rates were comparable across groups.
Conclusion: In smaller ureteral calculi, the three modalities exhibit comparable efficacy. For large ureteral stones, laser lithotripsy achieves better stone-free rates and requires fewer repeat interventions but has a longer operative time. Treatment decisions should be individualized according to stone size, patient factors, and available resources.


1. Lai S, Jiao B, Diao T, et al. Optimal management of large proximal ureteral stones (>10 mm): a systematic review and meta-analysis of 12 randomized controlled trials. Int J Surg. 2020;80:205-217. doi:10.1016/j.ijsu.2020.06.025
2. Ordon M, Andonian S, Blew B, Schuler T, Chew B, Pace KT. CUA guideline: management of ureteral calculi. Can Urol Assoc J. 2015;9(11-12): E837-E851. doi:10.5489/cuaj.3483
3. Bhanot R, Jones P, Somani B. Minimally invasive surgery for the treatment of ureteric stones-state-of-the-art review. Res Rep Urol. 2021; 13:227-236. doi:10.2147/RRU.S311010
4. Bader MJ, Eisner B, Porpiglia F, Preminger GM, Tiselius HG. Contemporary management of ureteral stones. Eur Urol. 2012;61(4):764-772. doi:10.1016/j.eururo.2012.01.009
5. Cui X, Ji F, Yan H, et al. Comparison between extracorporeal shock wave lithotripsy and ureteroscopic lithotripsy for treating large proximal ureteral stones: a meta-analysis. Urology. 2015;85(4):748-756. doi:10. 1016/j.urology.2014.11.041
6. Abedi AR, Razzaghi MR, Allameh F, Aliakbari F, FallahKarkan M, Ranjbar A. Pneumatic lithotripsy versus laser lithotripsy for ureteral stones. J Lasers Med Sci. 2018;9(4):233-236. doi:10.15171/jlms.2018.42
7. Young MJ, Pang KH, Elmussarah M, Hughes PF, Browning AJ, Symons SJ. Acute extracorporeal shockwave lithotripsy for ureteric stones-7-years’ experience from a busy district general hospital. BJU Int. 2022; 130(5):655-661. doi:10.1111/bju.15820
8. Cho CO, Yu JH, Sung LH, Chung JY, Noh CH. Comparison of percutaneous nephrolithotomy using pneumatic lithotripsy [lithoclast (R)] alone or in combination with ultrasonic lithotripsy. Korean J Urol. 2010;51(11):783-787. doi:10.4111/kju.2010.51.11.783
9. Nour HH, Kamel AI, Elmansy H, et al. Pneumatic vs laser lithotripsy for mid-ureteric stones: clinical and cost effectiveness results of a prospective trial in a developing country. Arab J Urol. 2020;18(3):181-186. doi:10.1080/2090598X.2020.1749800
10. Bahçeci T, Başer A. Comparison the efficacy of pneumatic and holmium laser ureteroscopic lithotripsy for the treatment of ureteral stones: a retrospective observational study. Pamukkale Med J. 2022;15(4):648-655. doi:10.31362/patd.1055563
11. İrer B, Şen V, Erbatu O, et al. Comparison of efficacy and complications of holmium laser and pneumatic lithotripters used in the ureterorenoscopic treatment of proximal ureter stones, a multi-center study of society of urological surgery aegean study group. J Urol Surg. 2018;5(3):158-163. doi:10.4274/jus.2143
12. Breda A, Ogunyemi O, Leppert JT, Schulam PG. Flexible ureteroscopy and laser lithotripsy for multiple unilateral intrarenal stones. Eur Urol. 2009;55(5):1190-1196. doi:10.1016/j.eururo.2008.06.019
13. Tiselius HG, Ackermann D, Alken P, et al. Guidelines on urolithiasis. Eur Urol. 2001;40(4):362-371. doi:10.1159/000049803
14. Preminger GM, Tiselius HG, Assimos DG, et al. 2007 guideline for the management of ureteral calculi. J Urol. 2007;178(6):2418-2434. doi:10. 1016/j.juro.2007.09.107
15. 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):468-473. doi:10.4065/81.4.468
16. Günlüsoy B, Arslan M, Değirmenci T, Nergiz N, Minareci S, Ayder AR. Değişik yerleşimli üreter taşlarının üreteroskopik tedavisinde farklı litotripsi yöntemlerinin karşılaştırılması. Türk Ürol Derg. 2006;32(2): 234-239.
17. Wu CF, Shee JJ, Lin WY, Lin CL, Chen CS. Comparison between extracorporeal shock wave lithotripsy and semirigid ureterorenoscope with holmium: YAG laser lithotripsy for treating large proximal ureteral stones. J Urol. 2004;172(5 Pt 1):1899-1902. doi:10.1097/01.ju.0000142848. 43880.b3
18. Bahçeci T, Kızılay F, Çal AÇ, Şimşir A. Comparison of shockwave lithotripsy and laser ureterolithotripsy for ureteral stones. J Urol Surg. 2021;8(3):167-172. doi:10.4274/jus.galenos.2021.2021.0006
19. Mustafa G, Mahar NA, Qureshi HH, Mustafa M, Fayaz M, Hassan AS. Comparison of outcomes of extracorporeal shockwave lithotripsy with ureteroscopic lasertripsy for management of proximal ureteral stones. J Coll Physicians Surg Pak. 2024;34(1):101-104. doi:10.29271/jcpsp.2024. 01.101
20. Eisner BH, Kurtz MP, Dretler SP. Ureteroscopy for the management of stone disease. Nat Rev Urol. 2010;7(1):40-45. doi:10.1038/nrurol.2009.233
21. Leone NT, Garcia-Roig M, Bagley DH. Changing trends in the use of ureteroscopic instruments from 1996 to 2008. J Endourol. 2010;24(3): 361-365. doi:10.1089/end.2009.0222
22. Alenezi H, Denstedt JD. Flexible ureteroscopy: technological advancements, current indications and outcomes in the treatment of urolithiasis. Asian J Urol. 2015;2(3):133-141. doi:10.1016/j.ajur.2015.06. 002
23. Kartal I, Cakici MC, Selmi V, Sari S, Ozdemir H, Ersoy H. Retrograde intrarenal surgery and percutaneous nephrolithotomy for the treatment of stones in horseshoe kidney; what are the advantages and disadvantages compared to each other? Cent European J Urol. 2019;72(2):156-162. doi: 10.5173/ceju.2019.1906
24. Teichman JM. Laser lithotripsy. Curr Opin Urol. 2002;12(4):305-309. doi:10.1097/00042307-200207000-00008
25. Tran T, Pareek G. Selecting the appropriate treatment modality for ureteral calculi. ureteral stone management: a practical approach. Springer; 2014:41-62. doi:10.1007/s00240-017-1020-z
26. Wolf JS, Jr., Carroll PR, Stoller ML. Cost-effectiveness v patient preference in the choice of treatment for distal ureteral calculi: a literature-based decision analysis. J Endourol. 1995;9(3):243-248. doi:10. 1089/end.1995.9.243
27. Gerhard RS, Shrewsberry A, Solomon T, et al. Ureteroscopy versus shock wave lithotripsy: factors influencing patient treatment preferences. Urol Pract. 2016;3(6):423-429. doi:10.1016/j.urpr.2015.11.001
28. Giulioni C, Castellani D, Somani BK, et al. The efficacy of retrograde intra-renal surgery (RIRS) for lower pole stones: results from 2946 patients. World J Urol. 2023;41(5):1407-1413. doi:10.1007/s00345-023-04363-6
29. Mazzucchi E, Berto FCG, Denstedt J, et al. Treatment of renal lower pole stones: an update. Int Braz J Urol. 2022;48(1):165-174. doi:10.1590/S1677-5538.IBJU.2020.1023
30. Eisner BH, Reese A, Sheth S, Stoller ML. Ureteral stone location at emergency room presentation with colic. J Urol. 2009;182(1):165-168. doi:10.1016/j.juro.2009.02.131
31. Mustafa M, Al Zabadi H, Mansour S, Nabulsi A. Endoscopic management of upper and lower ureteric stones using pneumatic lithotripter: a retrospective medical records review. Res Rep Urol. 2023; 15:77-83. doi:10.2147/RRU.S392881
32. Binbay M, Tepeler A, Singh A, et al. Evaluation of pneumatic versus holmium:YAG laser lithotripsy for impacted ureteral stones.Int Urol Nephrol. 2011;43(4):989-995. doi:10.1007/s11255-011-9951-8
33. Naqvi SA, Khaliq M, Zafar MN, Rizvi SA. Treatment of ureteric stones. Comparison of laser and pneumatic lithotripsy. Br J Urol. 1994;74(6):694-698. doi:10.1111/j.1464-410x.1994.tb07108.x
34. Scarpa RM, De Lisa A, Porru D, Usai E. Holmium: YAG laser ureterolithotripsy. Eur Urol. 1999;35(3):233-238. doi:10.1159/000019852
35. Lam JS, Greene TD, Gupta M. Treatment of proximal ureteral calculi: holmium:YAG laser ureterolithotripsy versus extracorporeal shock wave lithotripsy. J Urol. 2002;167(5):1972-1976.
36. Bader MJ, Sroka R, Gratzke C, et al. Laser therapy for upper urinary tract transitional cell carcinoma: indications and management. Eur Urol. 2009;56(1):65-71. doi:10.1016/j.eururo.2008.12.012
37. Xiao K, Zhou L, Zhu S, Lin L, Di X, Li H. Which frequency is better for pediatric shock wave lithotripsy? Low intermediate or high: a systematic review and meta-analysis. Front Surg. 2023;10:1063159. doi:10.3389/fsurg.2023.1063159
38. Ghalayini IF, Al-Ghazo MA, Khader YS. Extracorporeal shockwave lithotripsy versus ureteroscopy for distal ureteric calculi: efficacy and patient satisfaction. Int Braz J Urol. 2006;32(6):656-664. doi:10.1590/s1677-55382006000600006
39. Leveillee RJ, Lobik L. Intracorporeal lithotripsy: which modality is best? Curr Opin Urol. 2003;13(3):249-253. doi:10.1097/00042307-200305000-00014
40. Zheng W, Denstedt JD. Intracorporeal lithotripsy. Update on technology. Urol Clin North Am. 2000;27(2):301-313. doi:10.1016/s0094-0143(05)70259-7
Volume 3, Issue 1, 2025
Page : 9-14
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