Prospective Randomized Controlled Trial Comparing Laser Lithotripsy with Pneumatic Lithotripsy in Miniperc for Renal Calculi

Background and Purpose: The energy source used for stone fragmentation is important in miniperc. In this study, we compared the stone fragmentation characteristics and outcomes of laser lithotripsy and pneumatic lithotripsy in miniperc for renal calculi. Patients and Methods: After Institutional Review Board approval, 60 patients undergoing miniperc for renal calculi of 15 to 30mm were equally randomized to laser and pneumatic lithotripsy groups. Miniperc was performed using 16.5F Karl Storz miniperc sheath and a 12F nephroscope. Laser lithotripsy was performed using a 550-m laser fiber and 30W laser with variable settings according to the need. Pneumatic lithotripsy was performed using the EMS Swiss lithoclast. Patient demographics, stone characteristics, intraoperative parameters, and postoperative outcomes were analyzed. Results: The baseline patient demographics and stone characteristics were similar in both groups. The total operative time (P=0.433) and fragmentation time (P=0.101) were similar between the groups. The surgeon assessed that the Likert score (1 to 5) for fragmentation was similar in both groups (2.10.8 vs 1.9 +/- 0.9, P=0.313). Stone migration was lower with the laser (1.3 +/- 0.5 vs 1.7 +/- 0.8, P=0.043), and fragment removal was easier with the laser (1.1 +/- 0.3 vs 1.7 +/- 1.1, P=0.011). The need for fragment retrieval using a basket was significantly more in the pneumatic lithotripsy group (10% vs 37%, P=0.002). The hemoglobin drop, complication rates, auxiliary procedures, postoperative pain, and stone clearance rates were similar between the groups (P>0.2). Conclusion: Both laser lithotripsy and pneumatic lithotripsy are equally safe and efficient stone fragmentation modalities in miniperc. Laser lithotripsy is associated with lower stone migration and easier retrieval of the smaller fragments it produces.