Efficacy Of Minimally Invasive Percutaneous Nephrolithotomy By Pneumatic Lithoclast/Ultrasound Or Holmium Laser Lithotripsy In Management Of Complex Renal And Upper Ureteral Calculi

Objective: To investigate the clinical efficacy of minimally invasive percutaneous nephrolithotomy by pneumatic lithoclast/ultrasound or ho- lmium laser lithotripsy in management of complex renal and upper ureteral calculi.Methods: Sixty patients with clinically confirmed complex renal and upper ureteral calculi were performed percutaneous nephrolithotomy from Dec2006 to Dec 2008 in our hospital. The patients were randomly divided into two groups, with 28 cases in the group of pneumatic lithoclast/ ultrasound lithotripsy and 32 in the group of holmium laser lithotripsy. The two groups were well matched for patients'age, stone duration, stone size, number, location, distribution and severity of hydronephrosis. The clinical results were followed up and analyzed in referring to the whole surgical time, duration of stone fragmentation, average blood loss, one-phase stone free rate, the time of clear urine, the length of hospitalization, the rate of postoperative complications, recovery of hydronephrosis 3 months after operation, and calculi recurrence rate 12 months post surgery.Results: There was no significant difference for the two groups in regarding of average blood loss, one-phase stone free rate, recovery of hydronephrosis 3 months after operation. While the group of pneumatic lithoclast/ultrasound was significant better than the counterpart in refer to the whole surgical time, duration of stone fragmentation, the time of clear urine and the length of hospitalization (P<0.05). The stone recurrence rate was 10.71%(3/25) in the group of pneumatic lithoclast/ultrasound, in com- pared with 12.50% (4/28) in that of holmium laser lithotripsy. The diff- erence was not significant (P>0.05).Conclusion: Minimally invasive percutaneous nephrolithotomy by pneumatic lithoclast/ultrasound or holmium laser lithotripsy is an effective approach in management of complex renal and upper ureteral stones. While the PCNL by pneumatic lithoclast/ultrasound has more advantage in stone location, working channel establishment, one-phase stone free rate, oper- ation time, urine clear time and the length of hospitalization. PCNL by holmium laser lithotripsy is more effective in management of complex stones with ureteral stricture and polyp.