A randomized trial comparing lithoclast with an electrokinetic lithotripter in the management of ureteric stones

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.

Comparing Two Different Ballistic Intracorporeal Lithotripters in the Management of Ureteral Stones

“…In fact, use of grasping forceps allowed the procedure to be equally effective, when complete fragmentation had not been achieved, even though it prolonged operating times in such cases. In our experience, as already noted by Menezes et al [11], the SLC handset is more comfortable, since it is lightweight and very easy to hold in one hand. We do not usually use the provided holder that attaches to the ureteroscope to prevent the probe from bending.…”

“…In a randomized trial, Menezes et al [11] found no significant differences in the stone-free rate, procedure duration, fragmentation time, proximal stone migration rate and equipment failure in these in situ ballistic lithotripters. In the same paper they made some practical recommendations for sterilizing the handset of both lithotripters and commented on their weight and shape, concluding that simplicity of use and ease of repair make the SLC an attractive choice.…”

Outcome analysis of holmium laser and pneumatic lithotripsy in the endoscopic management of lower ureteric calculus in pediatric patients: a prospective study

“…Advantage of pneumatic lithotripter when compared to other lithotriptors is its lower risk of perforating ureter and no thermal damage (13). Only concern with pneumatic lithotripter is stone migration, that ranges between 1.6% and 17.3% particularly with upper ureteral calculus (14, 15). …”

A comparison of efficacies of holmium YAG laser, and pneumatic lithotripsy in the endoscopic treatment of ureteral stones

“…[28] In a study performed by Santa-Cruz et al [29] on experimental animal models, the authors reported that after directly sending shock waves from a pneumatic lithotriptor on ureteral wall for 6 minutes, ureteral wall perforation did not occur.In the literature rates of stone migration with pneumatic lithotriptor range between 1.6, and 17.3%, which is more frequently seen with proximal ureteral stones. [6,30,31] Nowadays, ureteroscopy has become the first alternative in most centers with a success rate approaching to 100 percent. EAU indicated a success rate over 90% with PL in the endoscopic treatment of ureteral stones.…”