TO COMPARE THE FREQUENCY OF STONE CLEARANCE IN PATIENTS UNDERGOING ULTRASONIC LITHOTRIPSY WITH PNEUMATIC LITHOTRIPSY FOR THE TREATMENT OF LARGE RENAL CALCULI.

Introduction: Percutaneous approach to kidney was first described in 1955 by Goodwin and colleague.1 This approach, with the insertion of nephrostomy tube, was used to provide drainage for obstructed renal unit. This example led to recognition that same access could also be used as a working channel for the percutaneous removal of the kidney stone. Thus began era of percutaneous renal surgery.2 The indications for PCNL have gradually changed with improvement of techniques and with the introduction of extracorporeal shockwave lithotripsy (SWL) into clinical practice .3 PCNL is generally a safe treatment option and associated with a low but specific complications rate. Many complications develop from the initial puncture with injury of surrounding organs (e.g. colon, spleen, liver, pleura, and lung). Other specific complications include postoperative bleeding and fever.5,6 Objective: To compare the frequency of stone clearance in patients undergoing ultrasonic lithotripsy with pneumatic lithotripsy for the treatment of large renal calculi. Study Design: Randomized Clinical Trial. Setting: The study was completed at department of Urology, Sindh Institute of Urology and Transplantation Karachi. Duration Of Study: Six months after approval of synopsis. (Jan, 2018 to July 2018) Subject And Methods: After approval from research evaluation unit of college of Physicians and Surgeons of Pakistan (CPSP) and ethical committee of the hospital, patients who were present in urology department of Sindh Institute of Urology and Transplantation fulfilling the inclusion criteria were included in this study until the required sample size of 128 patients is completed. An informed consent was taken from all patients before including them in this study. Patients were divided into two groups using lottery method. Group I: Patients pneumatic lithotripsy was used for the treatment of renal calculi and in Group II patient’s ultrasonic lithotripsy was used. Both of these procedures were done by senior. Post-procedural X-ray KUB was done 3 days after the surgical procedure to determine the stone clearance in every patient. Results: 62(96.9%) patients had stone free rate in group ultrasonic lithotripsy, 51(79.7%) patients had stone free rate in group Pneumatic lithotripsy overall 113(88.3%) patients had stone free rate in both groups. Conclusion: , Pneumatic and ultrasonic lithotripters were compared, and both of them were found to be effective, safe, and reliable management modalities. However, the ultrasonic lithotripter provided higher stone-free rates. Key Words: Percutaneous Nephrolithotomy (PCNL), Stone free rate, large Renal Stones, pneumatic lithotripsy, ultrasonic lithotripsy