URETEROSCOPIC MANAGEMENT OF URETERAL CALCULI - ELECTROHYDRAULIC VERSUS HOLMIUM-YAG LITHOTRIPSY

Purpose: This study compared electrohydraulic and holmium:YAG lithotri psy for ureteral calculi. Materials and Methods: Two cohorts of consec utive patients with ureteral calculi treated with ureteroscopic electr ohydraulic or holmium:YAG lithotripsy were retrospectively compared. E lectrohydraulic lithotripsy was done using a 1.9F fiber at energy sett ings between 50 and 100 v. Holmium:YAG lithotripsy was done using a 36 5 mu m. fiber at energy settings of 0.6 to 1.5 J. Results: A total of 23 and 47 consecutive patients underwent electrohydraulic and holmium: YAG lithotripsy, respectively. For preoperative calculi less than 15 mm. mean stone size plus or minus standard deviation was 9 +/- 3 versu s 9 +/- 3 mm. (p = 0.5), mean operative time was 72 +/- 21 versus 102 +/- 38 minutes (p = 0.004), stone-free rate at the end of ureteroscopy was 65 versus 97 (p <0.01) and 3-month stone-free rate was 94 versus 97% (p = 0.4) for electrohydraulic versus holmium:YAG lithotripsy. For preoperative calculi 15 mm. or greater stone size was 19 +/- 5 versus 19 +/- 4 mm. (p = 0.9), operative time was 159 +/- 61 versus 108 +/- 27 minutes (p = 0.01), stone-free rate at the end of ureteroscopy was 33 versus 87% (p = 0.001) and 3-month stone-free rate was 67 versus 10 0% (p = 0.02). Complications were not significantly different in eithe r comparison. Conclusions: The overall likelihood that a patient would be rendered stone-free at ureteroscopy and 3 months after ureteroscop y favored holmium:YAG over electrohydraulic lithotripsy. For ureteral calculi less than 15 mm. electrohydraulic lithotripsy was more rapid t han the holmium: YAG procedure but for ureteral calculi 15 mm. or grea ter the holmium:YAG technique was more rapid than electrohydraulic lit hotripsy. The outcomes differences may have resulted from the differen t mechanisms of electrohydraulic and holmium:YAG lithotripsy.