Tissue effects of intracorporeal lithotripsy techniques during percutaneous nephrolithotomy: comparison of pneumatic and ultrasonic lithotripters on rat bladder

Abstract

The objectives of this study were to determine the tissue effects of ultrasonic and pneumatic lithotripsy on the rat urothelium. The rats were divided into three groups. Groups I and II consisted of ten rats each that underwent intracorporeal lithotripsy (pneumatic and ultrasonic lithotripsy, respectively). Group III contained ten control rats and no lithotripsy method was used, they served as references for absence of injury. The light microscopy findings were evaluated as follows: squamous metaplasia, papillary projection, inflammation, increased stratification, and stone formation. In five (71.4%) animals of group II, bladders were edematous and hemorrhagic, macroscopically. Histologically, the bladder wall was normal in four rats of group I and in one of group II. There was a significant increase in inflammation (31.5%), squamous metaplasia (85.7%), papillary projection (71.4%), increased stratification (71.4%), and microscopic or macroscopic stone formation (85.7%) in the bladder wall of group II rats in comparison with group I and control group. In the rat model, we noted that ultrasonic devices have a potential risk for tissue injury. In turn, this was associated with a markedly increased deposition of CaOx stones in the kidney. When confronted with harder stones, pneumatic lithotripsy can be more effective while also minimizing tissue injury.

Comparison of efficacy of laser lithotripter with ultrasonic lithotripter in mini percutaneous nephrolithotomy

“…showed that ultrasonic probes may cause tissue injury in rat models (17). Furthermore, the overheating effect may lead to the breakage of the thin and fragile ultrasonic probe.…”

Comparison of Ultrasonic and Pneumatic Intracorporeal Lithotripsy Techniques during Percutaneous Nephrolithotomy

“…This technique offers safe, cheap, and effective clearance of calculi, and it is particularly useful for large and hard stones. Also, all stones can be destroyed regardless of their composition, but subsequent extraction of the stone fragments is required [10, 11]. According to the literature, the success rate of pneumatic lithotripsy appears to be higher than 84% [5, 10–12].…”

“…It fragments stones into small pieces and has the ability to aspirate these particles through the hollow bore of the transducer, which eliminates manual stone extraction [10, 11]. This technique was the standard method of lithotripsy for many years, with a fragmentation rate of 97% [10].…”

“…Nevertheless, overheating of the probe can cause tissue injury. In a rat model, Diri et al noted that ultrasonic devices have a potential risk for tissue injury [11]. They showed a significant increase in inflammation, papillary projection, stratification, and microscopic or macroscopic stone formation in the bladder wall of rats which was treated with ultrasonic lithotripsy.…”