Effect of Stone Composition on the Outcomes of Semi-Rigid Ureteroscopy Using Holmium: Yttrium-Aluminum-Garnet Laser or Pneumatic Lithotripsy.

OBJECTIVE: To compare the effectiveness of laser lithotripsy (LL) and pneumatic lithotripters (PL) in calcium oxalate (CaOx) and calcium phosphate (CaP) stones and assess whether these stone compositions affect the outcomes of LL and PL. STUDY DESIGN: Comparative, descriptive study. PLACE AND DURATION OF STUDY: Istanbul Training and Research Hospital, Turkey, from August 2010 to August 2015. METHODOLOGY: A total of 114 patients underwent ureteroscopy using LL and PL. Fifty-eight (50.9%) had CaOx stones and 56 (49.1%) had CaP stones. The lithotripters were compared in stone composition groups, and stone compositions were compared in lithotripter groups. Patient characteristics, perioperative parameters, and postoperative complications were compared. RESULTS: The baseline patient and stone characteristics were similar in all groups. The operation time of the PL and LL for the patients with CaP stones (68.75 ±32.88 and 44.48 ±34.37 minutes, respectively) was significantly shorter than the operation time of the PL and LL for the patients with CaOx stones (91.56 ±30.54 and 65.75 ±37.74 minutes, (p=0.012 and p=0.009, respectively). Moreover, the patients with CaOx or CaP treated with LL 65.75±37.74 and 44.48 ±34.37 minutes, respectively) had significant shorter operation time than the PL (91.56 ±30.54 and 68.75 ±32.88 minutes, (p=0.046 and p=0.01, respectively). Stone-free rates were similar in all groups. The PL for the patients with CaP stones caused more postoperative fever and infection than the other groups (p=0.050). CONCLUSION: Though both PL and LL are effective in the treatment of CaOx and CaP stones, LL had a significantly shorter operation and hospitalization time and complication rates in patients with CaOx and CaP stones. So LL is a more feasible and safer modality in the treatment of recurrent CaP stones.