Safety and efficacy of ureteroscopic pneumatic lithotripsy.

OBJECTIVE: To determine the safety and efficacy of ureteroscopic pneumatic lithotripsy (PL) for the clearance of ureteral calculi (UC). STUDY DESIGN: Experimental study. PLACE AND DURATION OF STUDY: Department of Urology, KRL Hospital, Islamabad, from March 2006 till December 2008. METHODOLOGY: Ureteroscopic PL was performed on 104 patients with ureteric calculus measuring > 6 mm; using Swiss Lithoclast through a 9.5 French semi-rigid ureteroscope. At the end of the procedure, a DJ stent was inserted. Complications were noted. Stone clearance was assessed through X-ray KUB. DJ stent was removed within 3 - 6 weeks after the procedure. RESULTS: Sixty-eight patients (65.4%) were males and 36 (34.6%) females. The average hospital stay was 2.6 + 2.8 days; 72 (69.6%) patients were discharged on the first post-procedure day. Complete stone clearance was achieved in 98 (94.2%) patients, at 3-6 weeks. Four patients (26.7% of upper ureteral stones) had stone retropulsion. The only major complication was perforation occurring in 2 (1.9%) distal ureters. One case was successfully managed by endoscopic DJ stent placement, the other required open repair. CONCLUSION: Ureteroscopic PL is effective in clearing majority of middle and distal UC. Patients with proximal stones may have stone retropulsion. Ureteric perforation is an uncommon complication.