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      Comparison of Percutaneous Nephrolithotomy Using Pneumatic Lithotripsy (Lithoclast®) Alone or in Combination with Ultrasonic Lithotripsy

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          Abstract

          Purpose

          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 during 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 composition; 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 operative 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 complications 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 suction tube obstruction, 3 cases of overheating).

          Conclusions

          The combination of ultrasonic lithotripter and Lithoclast® is more effective than Lithoclast® alone because it significantly decreases operative time, hemoglobin loss, and the hospital stay. This may reflect the superior power of Lithoclast® and the ability to aspirate the debris during ultrasonic lithotripsy.

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          Most cited references 21

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          Percutaneous pyelolithotomy. A new extraction technique.

          Recurrent renal calculous disease is often troublesome to treat because of technical difficulties associated with reoperation. Attempts to dissolve the stones by irrigation with various solutions has not had much success. A new extraction technique has therefore been devised whereby the stones can be removed through a percutaneous nephrostomy umder radiological control. Three cases are described.
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            Influence of technique of percutaneous tract creation on incidence of renal hemorrhage.

             R Davidoff,  G Bellman (1997)
            Renal hemorrhage is one of the most common and worrisome complications of percutaneous renal surgery. We studied the incidence of renal hemorrhage and transfusion rates in patients undergoing balloon or Amplatz fascial dilation of the nephrostomy tract. Medical records of 143 patients who underwent 150 percutaneous renal procedures, including percutaneous nephrolithotomy, antegrade endopyelotomy and percutaneous treatment of stones in caliceal diverticula, were reviewed. The nephrostomy tract was dilated with balloon (50 patients) or Amplatz sequential (100) dilators. Perioperative decreases in hemoglobin level and blood transfusion rates were compared between the 2 groups. Of the 100 patients undergoing percutaneous renal Amplatz dilation 25 (25%) required a blood transfusion, compared to only 5 of 50 (10%) undergoing balloon dilation. The difference in the transfusion rates between the 2 groups was statistically significant (p = 0.048). Improvements in the technique of percutaneous renal surgery have decreased the morbidity associated with these procedures. In our study use of balloon tract dilators led to less renal hemorrhage and lower transfusion rates compared to Amplatz dilation. Additionally, balloon dilation appears to be more rapid and avoids renal movement away from the surgeon, which occasionally occurs during Amplatz dilation.
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              Prospective evaluation of safety and efficacy of the supracostal approach for percutaneous nephrolithotomy.

              To prospectively evaluate the safety and efficacy of the supracostal approach for percu-taneous nephrolithotomy (PCNL), as it is usually avoided because of concerns about potential chest complications. Between August 1998 and August 2001, 465 patients underwent PCNL. Supracostal access was obtained in 62 patients (63 renal units), comprising 13% of the procedures. The indications for a supracostal approach were staghorn, upper ureteric, superior calyceal stones and high-lying kidneys. The data were analysed for stone clearance, need for additional punctures and the complications associated with supracostal puncture. The supracostal was the only access in 63% of the PCNL procedures. Additional punctures were required mainly for staghorn stones (15 of 23). Overall, 90% of the patients were rendered stone-free or had clinically insignificant residuals with PCNL alone. In patients with staghorn stones, they were completely cleared in 84% of renal units. Significant chest complications developed in three (5%) patients, which required insertion of a chest tube. One (2%) patient developed haemothorax secondary to injury of the intercostal artery. All the patients recovered uneventfully. These results indicate that supracostal access provides high clearance rates with acceptable complications; it should not be avoided for fear of chest complications. A chest X-ray after surgery should be routine, to detect any complication.
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                Author and article information

                Journal
                Korean J Urol
                KJU
                Korean Journal of Urology
                The Korean Urological Association
                2005-6737
                2005-6745
                November 2010
                17 November 2010
                : 51
                : 11
                : 783-787
                Affiliations
                Department of Urology, Inje University College of Medicine, Seoul, Korea.
                Author notes
                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, choongnoh@ 123456yahoo.com
                Article
                10.4111/kju.2010.51.11.783
                2991577
                21165200
                Copyright © The Korean Urological Association, 2010

                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.

                Categories
                Original Article
                Endourology/Urolithiasis

                Urology

                percutaneous nephrolithotomy, kidney calculi, lithotripsy

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