Efficacy of Electrohydraulic Lithotripsy v Laser Lithotripsy in the Ureter
Since endourological procedures were first introduced at the Atlanta Stone Center in 1982, electrohydraulic lithotripsy (EHL) has been utilized to fracture 62 ureteral calculi, via antegrade (percutaneous) or retrograde (ureteroscopic) techniques. Using a 5 Fr. or a 3 Fr. probe, success was achieved in 60 cases (97%). Intravenous pyelograms were performed in 60 patients after treatment, and only one revealed mild hydronephrosis. Six perforations of the ureter and two ureteral stone extrusions were managed conservatively with good results.
Recently, having incorporated pulsed dye laser as an alternative modality to manage ureteral calculi, 22 patients with ureteral stones have been treated at the center. Via either an antegrade or a retrograde approach, 20 stones (91%) were considered successfully fractured. Intravenous pyelograms were performed in only two patients, and both were normal. There were no perforations directly attributed to the laser probe. The two failures were calcium oxalate monohydrate stones.
In summary, both modalities proved safe and efficacious. There is a significant cost difference favoring electrohydraulic lithotripsy; however, at this time the laser probe offers the advantages of more flexibility and a smaller diameter.
KeywordsLaser Fiber Calcium Oxalate Ureteral Stone Ureteral Calculus Laser Lithotripsy
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