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

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

Objective:

To analyse outcomes of holmium laser and pneumatic lithotripsy in treatment of lower ureteric calculus in pediatric patients.

Materials and methods:

Prospective study conducted between August 2013 and July 2015. Inclusion criteria were lower ureteric calculus with stone size ≤1.5cms. Exclusion criteria were other than lower ureteric calculus, stone size ≥1.5cms, congenital renal anomalies, previous ureteral stone surgery. Patients were divided into two groups. Group A underwent pneumatic and group B underwent laser lithotripsy procedure. Patient's baseline demographic and peri-operative data were recorded and analysed. Post operatively X-ray/ultrasound KUB (Kidney, ureter and bladder) was performed to assess stone free status.

Results:

A total of 76 patients who met the inclusion criteria to ureteroscopic intracorporeal lithotripsy were included. Group A and B included 38 patients in each. Mean age was 12.5±2.49 in Group A and 11.97±2.74 years in Group B respectively (p=0.38). Overall success rate was 94.73% in Group A and 100% in Group B, respectively (p=0.87).

Conclusion:

Holmium Laser lithotripsy is as efficacious as pneumatic lithotripsy and can be used safely for the endoscopic management of lower ureteric calculus in pediatric patients. However, holmium laser requires more expertise and it is a costly alternative.

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

OBJECTIVE

We aimed to compare the effectiveness of holmium YAG laser and pneumatic lithotripsy in the treatment of ureteral stones.

MATERIAL AND METHODS

A total of 216 patients who had established indications of ureteroscopy between November 2011 and June 2012 were included in this study. Patients' files were retrospectively reviewed by dividing cases as groups that underwent pneumatic (PL) or laser lithotripsy (LL) procedures. Age, sex, stone burden and localization, duration of follow-up, operative times were evaluated. Stone-free rates were evaluated by ureteroscopical examination, postoperative scout films and ultrasonography.

RESULTS

Group PL consisted of 109 and group LL of 107 patients. Median age was 43.93±15.94 years in Group PL and 46.15±14.54 years in Group LL. Male to female ratio, stone burden and localization were similar for both groups. Overall success rate was 89.9% in Group PL and 87.9% in Group LL, respectively (p<0.791). With the aid of additional procedures, success rate was 100% for both groups at the end of the first month. Groups were not different as for operative time, rate of insertion of an ureteral catheter and its removal time. Hospitalization period was apparently somewhat shorter in Group LL (p=0.00).

CONCLUSION

Pneumatic lithotripsy can be as efficacious as laser lithotripsy and be used safely in the endoscopic management of ureteral stone. In comparison of both methods, we detected no differences as to operative time, success of operation and the time to removal of the catheter, however, hospitalization period was shorter in Group LL.

Damage of stone baskets by endourologic lithotripters: a laboratory study of 5 lithotripters and 4 basket types

Background. In some cases, the ureteral stone is simultaneously stabilized by a stone basket when endourologic lithotripsy is performed. This stabilization can be either on purpose or by accident. By accident means that an impaction in the ureter occurs by an extraction of a stone with a basket. A stabilization on purpose means to avoid a retropulsion of the stone into the kidney during lithotripsy. At this part of the operation, stone baskets have been frequently damaged. This severing of wires can lead to ureteral trauma because of hook formation. Material and Methods. In a laboratory setting, the time and the pulse numbers were measured until breaking the wires from four different nitinol stone baskets by using five different lithotripsy devices. The endpoint was gross visibledamage to the wire and loss of electric conduction. Results. The Ho:YAG laser and the ultrasonic device were able to destroy almost all the wires. The ballistic devices and the electrohydraulic device were able to destroy thin wires. Conclusion. The operating surgeon should know the risk of damagefor every lithotripter. The Ho:YAG-laser and the ultrasonic device should be classified as dangerous for the basket wire with all adverse effects to the patient.

Use of NTrap® during Ureteroscopic Lithotripsy for Upper Ureteral Stones

Purpose

This study aimed to determine the value of the NTrap® (Cook Urological INC, USA), which was designed to block the upward movement of stones during ureteroscopic lithotripsy.

Materials and Methods

We reviewed the data of 144 patients who underwent ureteroscopic lithotripsy for an upper ureteral stone from June 2006 to May 2010. Sixty-eight patients who underwent ureteroscopic lithotripsy without the use of the NTrap® were assigned to Group I and 76 patients who underwent ureteroscopic lithotripsy with the NTrap® were assigned to Group II. The size of the stones, operation time, success rate, and pre- and postoperative complications were compared retrospectively between the two groups.

Results

The mean age of the patients (Group I: 35.8 years; Group II: 32.6 years) and the sex ratios were not significantly different between the two groups. The mean size of the stones was 6.9 mm and 7.4 mm, which also was not significantly different between the two groups. The mean operation time was 82.7 minutes and 78.7 minutes. The operation time was shorter in Group II, but the difference was not significant. The success rate of stone removal was 89.7% and 98.7% in Groups I and II, respectively; Group II showed a significantly higher success rate. Two cases of ureteral perforation and one case of ureteral avulsion occurred in Group I, and one case of ureteral perforation occurred in Group II.

Conclusions

NTrap®, which is an instrument used to assist during ureteroscopic lithotripsy, can be considered to be an effective tool that blocks the upward movement of the stone and aids in safe stone removal.

Use of LMA Stonebreaker as an intracorporeal lithotrite in the management of ureteral calculi

BACKGROUND AND PURPOSE

LMA Stonebreaker is a new type of ballistic intracorporeal lithotrite that does not need external electric power or access to compressed air. It is small and portable. This study aims to evaluate the efficacy, safety, and cost-effectiveness of this lithotrite in the management of ureteral calculi.

MATERIALS AND METHODS

A total of 110 patients with ureteral calculi necessitating intracorporeal lithotripsy were prospectively included in the study. The size of the stone, position of the stone, number of shocks needed to fragment the stone to effect complete clearance, and degree of retropulsion were documented in each case, and any evidence of urothelial trauma was noted.

RESULTS

All stones were fragmented, and all patients were rendered stone free. The mean number of shocks needed to fragment the stones was eight. The incidence of retropulsion was 6.36%. There was no evidence of urothelial trauma noted in any patient.

CONCLUSION

LMA Stonebreaker is a safe, effective, cost-effective, robust, and portable device for intracorporeal lithotripsy.

Removal of ureteral stones with extracorporeal shock wave lithotripsy and ureteroscopic procedures. What can we learn from the literature in terms of results and treatment efforts?

A literature review was made to obtain information on the treatment efforts required for a successful removal of ureteral stones when extracorporeal shock wave lithotripsy (ESWL) or ureteroscopic stone extraction or disintegration (URS) were used as primary procedures. Data were collected from 59 reports on ESWL and 23 on URS. The study thereby comprised 20,659 patients primarily treated with ESWL and 5,520 treated with URS. A treatment index (TI) was formulated from the total number of patients (N(TOT)), the number of stone free patients (N(SF)), the number of patients with retreatment (N(RE)), auxiliary procedures (N(AUX)) and general or regional anaesthesia (N(ANE)). The difference between the TI and the efficiency quotients normally used was the incorporation of the factor N(ANE) that reflected the need for general or regional anaesthesia. TI had the following form: TI = N(SF)/(N(TOT) + N(RE) + N(AUX) + N(ANE). When the groups of treated patients were considered in this way, TI was significantly higher for the patients treated with ESWL than for those treated with URS (P = 0.007). The median (range) for the groups of ESWL-treated patients was 0.50 (0.25-0.90) and for patients treated with URS 0.42 (0.26-0.94). For the combined groups of patients, the TI-values were 0.54 and 0.40, respectively. Although the average retreatment for URS was only 2.2% compared with 12.1 percent for ESWL, the need for general/regional anaesthesia was 94.3% and 28.3% in the two groups, respectively. The advantage of a lower rate of retreatment in patients primarily referred to URS was thus obviously counterbalanced by the much higher need for anaesthesia. For ureteral stones treated with ESWL in the author's department using Dornier HM3, MFL 5000, and Modulith SLX lithotripters, stone free rates of 96%, 97% an 95% were associated with TI-values of 0.61, 0.60 and 0.63, respectively. Both ESWL and URS are excellent procedures for the removal of stones from the ureter. In addition to the different degrees of invasiveness, the need for anaesthesia has to be considered in an objective comparison of the two methods.

Comparing two different ballistic intracorporeal lithotripters in the management of ureteral stones

INTRODUCTION

During the 1990s, two different in situ 'ballistic' lithotripters were introduced into clinical practice. The Swiss Lithoclast (SLC) was the first to be clinically tested. After a few years, a very similar device, the electrokinetic lithotripter (EKL), was described and has recently become available to us. In this paper we compare the clinical efficacy and features of these two ballistic lithotripters in the ureteroscopic treatment of ureteral stones.

MATERIALS AND METHODS

Thirty-eight patients with ureteral stones were randomized into two equal groups to undergo fragmentation using the SLC or the EKL via semirigid ureteroscope. In both groups the stones were in the mid- or lower ureter. The following parameters were evaluated: total procedure duration, complete fragmentation rate, time to complete fragmentation, proximal migration rate, complications and need for further procedures.

RESULTS

Although not statistically significant, a trend towards a higher fragmentation rate, a shorter time to fragmentation and a slightly higher proximal migration rate emerged in the SLC group. No difference was found in the stone-free rate in the two groups (94.7 vs. 89.4%). Only 2 cases of minor ureteric injury were observed in each group.

CONCLUSIONS

As previously described by others, the SLC and EKL are both attractive cost-effective options in the treatment of ureteral stones. Ten years after its introduction, the SLC still remains probably the best choice for most urologists.