A prospective comparative study to evaluate safety and efficacy of pneumatic versus laser lithotripsy in mini-percutaneous nephrolithotomy

Objective: The choice of lithotripter is an important part of planning in mini-percutaneous nephrolithotomy (mini perc) as the operating time is prolonged due to reduced sheath size and smaller working channel. Previous studies mostly reported the use of laser lithotripter for stone fragmentation while the literature on pneumatic lithotripter use in miniperc is scant. Methods: In this study, we compared the efficacy and safety of the laser lithotripter (LL) vs pneumatic lithotripter (PL) in miniperc for small to medium-sized renal/upper ureteric stones (size: 1-2 cm). All consecutive patients who underwent miniperc from September 2020 to August 2022 were included in the study. Laser lithotripter was used in 81 patients (group LL), while pneumatic was used in 75 patients (group PL). The preoperative, operative, and postoperative findings were compared. Results: Baseline patient characteristics (age, sex, body mass index, and co-morbid illness) and stone characteristics (size, stone number, laterality, presence of staghorn calculi, presence of hydronephrosis, Guy's stone scores) were comparable between the two groups (P>0.05). The mean operative time was comparable (P=0.38) while the mean fragmentation time was significantly higher in the PL group (35.42 +/- 6.34 vs 28.96 +/- 2.82 minutes; P<0.01). 29.3% required forceps/basket for stone removal in PL group as compared to 7.4% in LL group (P=0.02). Mean VAS (Visual Analog Scale) score on the first post-operative day, stone clearance, drop in hemoglobin, average hospital stay, stone clearance at 3 months postoperative, and complications were comparable (P>0.05). Conclusion: Lithotripsy with pneumatic lithotripter can be used as an equally effective and safe alternative to laser lithotripter in mini-perc for treatment of small-medium sized renal/upper ureteric calculi.