الفهرس 
Review of LiteratureOnly 14 pages are availabe for public view
 |  | from | 93 |  |  |
| | | from | 93 | | |
Abstract
SUMMARY
This study was performed to compare ureteroscopy using holmium: YAG laser lithotripsy versus shock wave lithotripsy in management of proximal ureteric stones (≤10 mm) regarding surgical efficacy, safety and cost effectiveness.
It included 52 patients with proximal ureteral stones and it was done in the period starting from September 2021 to February 2022.
All Patients were preoperatively evaluated in detail by medical history, physical examination including BMI, laboratory investigations including (urine analysis, urine culture if needed, serum creatinine and routine pre-operative investigations), and imaging evaluation including (abdomino-pelvic US, KUB and NCCT). Cases were randomized for either SWL or Laser, 26 cases in each group.
SWL group included 26 cases that were managed with Dornier compact sigma. Cases were evaluated by KUB 1 week later and need for further sessions.
Laser group included 26 cases were managed with semi-rigid ureteroscopy using Ho: YAG LASER lithotripsy and evaluated by KUB 1 week postoperatively.
There was no significant difference between the two groups as regarding the patient and stone characteristics, and operative time, post-operative complications, overall SFR.
There was a statistically significant difference between the both modalities in favor of Laser regarding the initial SFR, retreatment rate, the radiation exposure time, as SWL needs more than one visit to give near results as Laser.
Single session SFR of SWL was 38.5 % vs 88.5% in Laser. Retreatment rate was statistically significant higher in SWL than Laser (61.5% vs. 11.5%).Radiation exposure time was 163.46 ± 12.94 seconds and 50.19 ± 2.99 seconds in SWL and Laser groups respectively. For ESWL group, it was the time of exposure to fluoroscopy radiations during stone localization, monitoring fragmentation progress and confirming the stone focusing at intervals of 300-500 shocks, but for the URS group, it was the time of exposure to fluoroscopy radiations during stone localization, guide wire insertion, retrograde study and stenting at the end of the procedure.
There was a statistically significant difference between the both modalities in favor of SWL as regarding the anesthesia, the overall procedural time and overall cost as SWL group were treated as an outpatient cases.
There was a significant difference in used anesthesia (sedation for SWL and general anesthesia for Laser). Regarding Overall procedural time (hours), it was 4.55 ± 1.94 and was 36.88 ± 5.38 for SWL and Laser groups respectively. Overall cost; even if patients underwent three sessions of SWL, the cost between the two options was still significantly different. The overall cost of Laser was 15000 EP, with an efficiency of 80 %, while overall cost of SWL was (2500 EP), with an efficiency of 49.9 %.
CONCLUSION
• Laser is more effective, has the advantage of the higher SFR from the first session without need of multiple hospital visits and prolonged radiation exposure time
• SWL has lower treatment costs, while complications were comparable in both groups, so treatment decision depends on not only stone characteristics but also cost-effectiveness ratio and this should be considered when counseling the patient with proximal ureteric stone.
• Larger sample size is required for more convenience data.