How to Cite
Abstract
Objective: Kidney stones are common. Mini-percutaneous nephrolithotomy (mini-PCNL) is important for treating renal stones. This randomized controlled trial was designed to compare the Holmium YAG (Ho: YAG) laser and pneumatic lithotripsy for achieving a stone-free rate (SFR) during mini-PCNL.
Methods: A total of 352 eligible patients (18–70 years old with renal calculi <2.5 cm) were enrolled at the Urology Department of Benazir Bhutto Hospital from 5 October 2025 to 5 January 2026. Patients were split into Group A (Ho: YAG laser, n=176) or Group B (pneumatic lithotripsy, n=176). All procedures were performed under general anesthesia using a 16–18 Fr tract. The stone-free rate (SFR) was defined as the absence of residual fragments or fragments <4 mm on non-contrast computed tomography (NCCT) one month post-operatively.
Results: The Ho: YAG laser group achieved an SFR of 71.6% (126/176), which was significantly higher than the 49.4% (87/176) SFR achieved by the Pneumatic Lithotripsy group (p < 0.0001).
Conclusion: Ho:YAG laser lithotripsy is significantly more effective than pneumatic lithotripsy in achieving stone clearance during mini-PCNL for renal calculi ≤ 2.5 cm. This finding supports the use of Ho: YAG laser as the preferred lithotripsy modality to optimize stone clearance and reduce the risk of residual disease and subsequent patient morbidity.
Keywords: Kidney Calculi; Lithotripsy, Laser; Nephrolithotomy, Percutaneous; Pneumatic Lithotripsy; Treatment Outcome
References
Akram M, Jahrreiss V, Skolarikos A, Geraghty R, Tzelves L, Emiliani E, et al. Urological guidelines for kidney stones: overview and comprehensive update. J Clin Med. 2024;13(4):1114. https://doi.org/10.3390/jcm13041114
Zhang L, Song Z, Hao Y, Liu W, Chen Y, Hao Z. Predictive factors of stone-free rate and complications in patients with proximal impacted ureteral stones undergoing percutaneous nephrolithotomy: based on a new scoring standard. Urolithiasis. 2024;52(1):149. https://doi.org/10.1007/s00240-024-01649-0
Hughes T, Ho HC, Pietropaolo A, Somani BK. Guideline of guidelines for kidney and bladder stones. BJU Int. 2022;129(4):442–56. https://doi.org/10.1111/bju.15522
Rice P, Somani BK. Percutaneous laser nephrolithotripsy: is it here to stay? Results of a systematic review. Curr Opin Urol. 2022;32(2):185–91. https://doi.org/10.1097/MOU.0000000000000963
Kamal WK, Alghamdi MM, Azhar RA, Bugis A, Abuzenada M, Alharthi M, et al. The impact of urolithiasis on urology services in a high-prevalence region: a multicenter study. Asian J Urol. 2025;12(1):59–65. https://doi.org/10.1016/j.ajur.2024.04.001
Axelsson TA, Cracco C, Desai M, Ganpule A, Geavlete P, Gutierrez J, et al. Consultation on kidney stones, Copenhagen 2019: lithotripsy in percutaneous nephrolithotomy. World J Urol. 2021;39(6):1663–70. https://doi.org/10.1007/s00345-020-03383-w
Brunaiova L, Sommer KG, Schneidewind L, Uhlig A, Heeger C, Kloth C, et al. Effectiveness of pneumatic versus laser lithotripsy for upper tract urolithiasis: a systematic review and meta-analysis. Urol Int. 2025 Dec 12. https://doi.org/10.1159/000550064
Franco T, Córdoba A, López Silva M, Caruso D, Hernández R, Sanguinetti H. Pneumatic lithotripsy vs. Ho: YAG laser lithotripsy in the management of ureteral lithiasis. Arch Esp Urol. 2021;74(8):768–73.
Sharma A, Giri A, Garg G, Sadasukhi N, Sadasukhi TC, Gupta H, et al. A prospective comparative study to evaluate safety and efficacy of pneumatic versus laser lithotripsy in mini-percutaneous nephrolithotomy. Am J Clin Exp Urol. 2023;11(3):258–64. Available from PMC: PMID 37441439
Ibis MA, Özsoy AF, Özkaya MF, Erdem E, Erkmen S, Güler AD, et al. Comparison of lithotripsy methods during mini-PNL: is there a role for ballistic lithotripsy in the era of high-power lasers? BMC Urol. 2024;24(1):54. https://doi.org/10.1186/s12894-024-01443-6
Shubham S, Jain P, Agarwal A, Trivedi S, Dwivedi US, Singh PB, et al. Comparative analysis of the thulium fiber laser, holmium:YAG laser, and pneumatic lithotripter in mini-percutaneous nephrolithotomy: a tertiary care center experience. Cureus. 2025;17(9):e93209. https://doi.org/10.7759/cureus.93209
Mahajan AD, Mahajan SA. Thulium fiber laser versus holmium:yttrium aluminum garnet laser for stone lithotripsy during mini-percutaneous nephrolithotomy: a prospective randomized trial. Indian J Urol. 2022;38(1):42–7. https://doi.org/10.4103/iju.iju_296_21.
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Copyright (c) 2026 Fakhar Munir Sial, Zeeshan Qadeer, Zein El Amir, Nauman Nabi, Muhammad Noman Qureshi, Zain Ali Sattar