Endourology/Urolithiasis
Comparison of Percutaneous Nephrolithotomy Using Pneumatic
Lithotripsy (Lithoclast
Ⓡ
) Alone or in Combination with Ultrasonic
Lithotripsy
C one Cho, Ji Hyeong Yu, Luck Hee Sung, Jae Yong Chung, Choong Hee Noh
Department of Urology, Inje University College of Medicine, Seoul, Korea
Purpo
se:
Percutaneous nephrolithotomy (PCNL) is the procedure of choice for treating
large renal stones. Pneumatic lithotripsy (Lithoclast
Ⓡ
) is effective regardless of the
stones’ composition, and ultrasonic lithotripsy allows the aspiration of small debris dur-
ing lithotripsy. We investigated the efficacy and safety of PCNL via Lithoclast
Ⓡ
alone
or combined with ultrasonic lithotripsy.
Materials and Methods:
Thirty-five (group A) and 39 (group B) patients underwent
Lithoclast
Ⓡ
PCNL and combination therapy, respectively, from May 2001 to March
2010, and the two groups were compared in terms of stone size, location, and composi-
tion; operative time; average number of treatments; hospital days; hemoglobin loss;
ancillary procedures; rate of device failure; and initial and total stone-free rates.
Results:
The two groups did not differ significantly in preoperative stone size, location,
or composition; the average number of treatments; or the initial and overall stone-free
rates. However, combination therapy was associated with a significantly lower oper-
ative time (181±50 vs. 221±65 min, respectively, p=0.004), number of hospital days
(11.6±3.8 vs. 14.2±4.4 days, respectively, p=0.009), and average hemoglobin loss
(1.12±0.61 vs. 1.39±1.02 g/dl, respectively, p=0.013). Transfusions were required in 6
patients (4 and 2 in each group, respectively), but there were no significant complica-
tions related to percutaneous access. There were 2 (5.7%) mechanical failures
(Lithoclast
Ⓡ
probe fracture) in the group A and 5 (12.8%) in the group B (2 cases of suc-
tion tube obstruction, 3 cases of overheating).
Conclusions:
The combination of ultrasonic lithotripter and Lithoclast
Ⓡ
is more effec-
tive than Lithoclast
Ⓡ
alone because it significantly decreases operative time, hemoglo-
bin loss, and the hospital stay. This may reflect the superior power of Lithoclast
Ⓡ
and
the ability to aspirate the debris during ultrasonic lithotripsy.
Key Words:
Kidney calculi; Lithotripsy; Percutaneous nephrolithotomy
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial
License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use,
distribution, and reproduction in any medium, provided the original work is properly cited.
Article History:
received
1 June, 2010
accepted
5 October, 2010
Corresponding Author:
Choong Hee Noh
Department of Urology, Inje University
College of Medicine, 761-7, Sanggye
7-dong, Nowon-gu, Seoul 139-707,
Korea
TEL: +82-2-950-1137
FAX: +82-2-933-6133
E-mail: choongnoh@yahoo.com
INTRODUCTION
Fernstrom and Johansson first removed a renal calculus
through a nephrostomy tract in 1976, and percutaneous
nephrolithotomy (PCNL) is now accepted as the procedure
of choice for those patients who have large renal stones (
＞
2
cm in diameter), infected stones, or lower calyceal stones
with obstruction or anatomical variations in the renal col-
lecting system as well as for those patients in whom prior
extracorporeal shock wave lithotripsy (ESWL) has failed
[1]. ESWL of larger stone masses results in many stone
fragments that rarely pass down the ureter spontaneously
without causing an obstruction.
In recent decades, endoscopic technology and operative
techniques have consistently advanced, which has in-
creased the success rate (
＞
90%) of PCNL and decreased