Efficacy of Holmium Laser vs Pneumatic Lithotripsy for Mid and Distal Ureteric Stones Above 10 Mm Size
Authors: ARVIND ARVIND , SINGH SUDIPTA KUMAR , mondal partha protim , TEWARY SHASHI KANT , AGARWAL ANKIT , shukla apurv , dutta shiva manohar 
Published: February 2025

Introduction
Over the past 15 years, ureteral stone treatment has evolved significantly. Management now depends on stone size, location, composition, patient circumstances, available equipment, and urologist expertise. Pneumatic lithotripsy is common but prone to stone migration. Holmium laser use has increased due to fewer complications and lower stone migration rates.
Aims and objectives
The purpose of the present study is to compare Lithoclast with holmium: YAG laser lithotripsy for mid and lower ureteral stone clearance rate, operative time, evaluate the complication rate and assess the safety of Ho: YAG laser and pneumatic intracorporeal lithotripsy for the endoscopic management of ureteric stone
Ethical approval
The procedures followed in accordance with the ethical standards of the responsible committee of the institution with addition of approved study design in the title.
Statistical analysis
Data was analyzed using Microsoft Excel, SPSS (v27.0), and GraphPad Prism (v5), employing two-sample and paired t-tests (significance at p ≤ 0.05).
Methods
This 2-year comparative study at R.G. Kar Medical College & Hospital involved 200 patients with ureteric stones ≥ 10 mm. Patients aged > 12 years with single/multiple stones and no prior stone surgery were included. Exclusions were unwilling/unfit for surgery, ureteric stricture, previous ureteric surgery, chronic kidney disease, active sepsis, coagulopathy, pregnancy, stones < 10 mm, and duplex ureter. Patients were randomized to pneumatic or laser lithotripter groups. Recorded metrics included procedure duration, complication rates, and post-procedural ureteroscopic evaluations.
Results
Most participants were aged 21–50 years; no significant correlation was found between age and treatment group (p = 0.6763). The Laser and Lithoclast groups had similar mean ages (38.21 vs. 39.83 years); no significant difference (p = 0.4241). The Laser and Lithoclast groups showed no significant difference in mean stone size (13.31 mm vs. 13.74 mm, p = 0.1987). The Laser and Lithoclast procedures had similar operative durations (41.58 ± 12.99 vs. 38.49 ± 16.81 minutes; p = 0.1473). Association between Hematuria in immediate post op period was significantly more common with Lithoclast (91%) than Laser treatment (69%) (p = 0.0001). Submucosal hematoma occurred significantly more with Lithoclast (18%) than Laser treatment (2%) (p = 0.0001). Ureteric perforation was significantly more common with Lithoclast (7%) than Laser treatment (0%) (p = 0.0070). 98% of the Laser group and 94% of the Lithoclast group were discharged on POD2, with no significant difference (p = 0.1489). At 14 days postoperatively, 8% of the Lithoclast group had residual stones, while the Laser group had a 100% stone-free rate (p = 0.0038). The Laser group had a 99% DJ stent removal rate at 14 days, compared to 90% in the Lithoclast group (p = 0.0052).
Conclusions
This study highlights the comparative efficacy of laser and pneumatic lithotripsy for ureteric stones. Both methods showed similar outcomes in demographics, stone characteristics, and operative duration. However, the laser group had a higher stone-free rate, fewer complications like hematuria and ureteric perforation, and fewer residual stones, supporting its growing preference.