UPPER URETERIC STONES

COMPARISON OF EXTRA CORPOREAL SHOCK WAVE LITHOTRIPSY WITH PNEUMATIC LITHOTRIPSY IN THE MANAGEMENT.

Abstract

Objectives: Compare the efficacy of Extracorporeal Shock Wave Lithotripsy with
Pneumatic Lithotripsy in the management of upper ureteric stones. Settings: Department of
Urology, Lahore General Hospital, Lahore. Duration of Study: From November 2008 to August
2009. Results: In our study, the patients were divided into two groups ie; Extracorporeal Shock
Wave Lithotripsy group (ESWL) and Pneumatic Lithotripsy group (PnL). The mean age in
Pneumatic Lithotripsy (PnL) was 39+15.23 years, whereas mean age was 40.6+14.62 years in
Extracorporeal Shock Wave Lithotripsy group (ESWL). In Extracorporeal Shock Wave Lithotripsy
group (ESWL), 38(76%) patients were male and 12(24%) patients were female while number
was 34(68%) and 16(32% in Pneumatic Lithotripsy group (PnL) respectively. In both groups,
there was male preponderance. In ESWL group, majority of patients were treated as outdoor
patients. 95% of them received intramuscular analgesia where as 5% required intravenous
sedation. All patients were followed at two weekly interval up till 6 weeks. Fifty patients required
more than 125 sessions of ESWL with mean shock waves 2960+222.23 at at mean energy
6.46+0.503kv, 2952+327.77 at 6.45+0.504 kv and 2842+410.03 at 6.76 0.436 kv at 2, 4 and 6
weeks respectively. The partial clearance was achieved in 34 patients at 2 weeks, 26 patients
at 4 weeks and 5 patients at 2 weeks. Stone free status at 2 weeks, 4 weeks and 6 weeks were
18%, 40% and 84% respectively. In Pneumatic Lithotripsy group (PnL) all of the 50 patients
were given general anesthesia. DJ stent was placed in all patients after the procedure for six
weeks follow up. 42(84%) of patients received shots of Pneumatic Lithotripsy on pulse mode
while in 8(16%) patients, shots were on continuous mode. The partial clearance was achieved in
5(10%), 3(6%) and 2(4%) patients at 2, 4 and 6 weeks respectively. Stone free status was 48%,
52% and 54% at 2, 4 and 6 weeks respectively. In 20(40%) patients, stone migrated into calyces.
Only in 1(2%) patients, there was no effect on stone. All patients in both groups were needed
two weekly follow up till six weeks. Stone clearance was 84% in Extracorporeal Shock Wave
Lithotripsy (ESWL) group while it was 54% in Pneumatic Lithotripsy group (PnL), p<0.001.
Conclusion: Extracorporeal Shock Wave Lithotripsy offers higher stone free rates with minimal
invasiveness and high safety compared to Pneumatic Lithotripsy, which provides immediate
high stone free rates, but with high risk of treatment failure.