Safety and Efficacy of Thulium Fiber Laser Versus Pneumatic Lithotripsy in Ureteric Stones During Semirigid Ureteroscopy.

Objective: During the treatment of ureteric stones by semirigid ureteroscopy, pneumatic, and laser lithotripsy are commonly used for stone lithotripsy. This is the first prospective study to compare pneumatic with thulium fiber laser (TFL) lithotripsy for ureteric stones during semirigid ureteroscopy. Methods: A prospective evaluation was conducted on 100 patients, divided into group A (50 patients) who underwent TFL lithotripsy and group B (50 patients) who underwent pneumatic lithotripsy for ureteric stones treated by ureteroscopy. Urine culture and plain computed tomography (CT) scan were done in all the patients. Intraoperative stone clearance was assessed by endoscopic inspection and fluoroscopic evaluation. Postoperative stone clearance was evaluated at 7 days and 3 months by sonography and plain x-ray. Those patients with persistent or increased hydroureteronephrosis were further evaluated by CT scan to detect residual fragments and/or ureteric strictures. Results: The stone size, volume, and HU were comparable in both the groups. The lithotripsy time with TFL was significantly longer compared to pneumatic (12.41 vs. 5.16 minutes). Intraoperatively, the vision was better with TFL as compared to the pneumatic group (2 vs. 10 patients). Retropulsion was significantly less with TFL com- pared to pneumatic lithotripsy (2 vs. 10 patients). The complications and the stone-free rates were comparable in both the groups. Conclusion: Thulium fiber laser has distinct advantage of better vision and less retropulsion compared to pneumatic lithotripsy. It is also a safer modality as compared to the conventional pneumatic lithotripsy during the treatment of ureteric stones with ureteroscopy.