No abstract

Objective To compare two in situ ballistic lithotripters, the lithoclast and the electrokinetic lithotripter (EKL), both of which can be used through the newer smallbore ureteroscopes, for their ease of use, robustness, fragmentation time, adequacy of fragmentation and stone-free rate. Patients and methods Forty-six consecutive patients with ureteric stones refractory to treatment by extracorporeal shock wave lithotripsy were randomized to undergo fragmentation using the lithoclast (23 patients) or the EKL (23 patients). One patient was excluded from analysis in the EKL group. The adequacy of fragmentation was recorded, with the degree and signi®cance of proximal migration for each device. After treatment patients were assessed by plain X-ray and the stone-free rate was determined. Results The mean (median) initial stone burdens in the lithoclast and EKL groups were 69 (50) mm 2 and 72 (52) mm 2 , respectively. The respective mean (median) procedure duration and fragmentation time were 54 (50) min and 90 (49) s in the lithoclast group, and 50 (42.5) min and 87 (52.5) s in the EKL group; the differences were not statistically signi®cant. In four (14%) patients of each group there was signi®cant proximal migration of the stones. The stones were completely fragmented in 17 of 23 (74%) patients in the lithoclast group and 19 of 22 (86%) in the EKL group. There was no fragmentation in one patient in each group. In the lithoclast and EKL groups, 20 of 23 (87%) and 17 of 22 (77%) were rendered stone-free, respectively (P>0.5). The equipment failed on two occasions in each group. Conclusion In this randomized trial there was no signi®cant difference in the stone-free rate, procedure duration, fragmentation time, proximal stone migration rate and equipment failure between these in situ ballistic lithotripters.

This system can exist as a stand-alone training aid after the problems have been addressed. The potential application of an in vivo system for routine transurethral prostate resection has great implications for training and quality control.

This endoluminal ultrasound system produces clear images of the ureteral and periureteral anatomy. The reusable aspect of the probe removes an important obstacle to its common use for evaluating a variety of upper urinary tract abnormalities.

In this paper, the authors assess whether endoluminal ultrasonography is helpful when carried out before retrograde endopyelotomy, and ask whether it can help to produce results comparable to laparoscopic pyeloplasty. They found that endopyelotomy was not as good in the presence of crossing vessels, despite using endoluminal ultrasonography, and they propose that laparoscopic pyeloplasty should be used in this situation. OBJECTIVE To present the results of endopyelotomy using endoluminal ultrasonography (EUS) to identify crossing vessels, as the success rates of endopyelotomy are generally lower than pyeloplasty, especially in patients with crossing vessels. PATIENTS AND METHODS Forty‐one consecutive patients who underwent EUS before a planned retrograde endopyelotomy were analysed retrospectively. EUS was used to direct the endopyelotomy incision for patients with crossing vessels. Treatment was considered successful if the patient was asymptomatic and unobstructed or improved on renography. The results were compared to those from 18 patients treated by laparoscopic pyeloplasty, some of whom had undergone EUS. RESULTS Crossing vessels were identified in 27 of the 41 patients (66%). Primary treatment consisted of endopyelotomy for 26 patients and laparoscopic pyeloplasty for 15. The overall success rate for 24 endopyelotomy patients with an adequate follow‐up (mean 19 months) was 71%, with more success in patients with no crossing vessels (11 of 13 (85%) vs six of 11 (55%)). Of the 18 patients treated by laparoscopic pyeloplasty (mean follow‐up 15.1 months) 17 were successful. CONCLUSION The results for endopyelotomy were disappointing in patients with crossing vessels, despite using EUS. The results suggest that patients with crossing vessels should be treated by laparoscopic pyeloplasty. More data are needed to compare endopyelotomy with laparoscopic pyeloplasty in patients with no crossing vessels.