Efficacy and Safety of Pneumatic Lithotripsy for Ureteric Stones: A Retrospective Analysis From Sudan

Introduction Ureteric stone management has undergone a transformation since the advent of different types of lithotripters. Although holmium: yttrium-aluminum-garnet laser lithotripsy has been considered the gold standard of choice for several centers, it is limited in availability in underdeveloped/low-resource areas. Pneumatic lithotripsy (PL) is still a relatively inexpensive and widely available modality. The purpose of this study is to evaluate the effectiveness and safety of PL as an alternative to laser lithotripsy in low-income settings. Methods Retrospective data from 215 patients treated at our center using ureteroscopic PL for ureteric stones between January 2020 and January 2023 were used to conduct this analysis. Patient demographic information, characteristics of the stones (location and size), operating time, stone-free rate (SFR) of the patients, complications, and length of hospitalization were all documented and assessed.  Results The average age of the patients included in the study was 42.5 ± 11.8 years old; 147 (68.4%) patients were men. Most of the stones were in the lower ureter (153, 71.2%); the mean diameter of the stones was 12.1 ± 3.5 mm. The overall initial SFR was 192 (89.3%). Patients had a higher SFR for stones in the lower ureter (145, 94.7%) than the middle (31, 85.2%) and upper ureter (20, 76.9%) (p<0.05). The mean operative time was 45.2 ± 15.7 minutes. Complications were experienced by 45 (20.9%) patients. Minor complications were observed in 40 (18.6%) patients, most commonly postoperative hematuria and colic. Major complications were rare (5, 2.3%) and included two cases of ureteral perforation and three cases of steinstrasse, which required intervention.  Conclusion PL provides effective and safe treatment of ureteric stones, especially stones in the lower ureter. Due to cost, equipment availability, and other factors related to care in resource-poor countries such as Sudan, PL continues to be a valuable and appropriate first-line treatment for ureteric stones. Therefore, PL has secured its place in the contemporary urologic treatment arsenal as a reliable and affordable alternative to laser lithotripsy.