title: Clinical efficacy of combined lithoclast and lithovac stone removal during ureteroscopy.
abstract: OBJECTIVE
  Pneumatic lithotripsy has proved to be an extremely safe, efficient and low cost intracorporeal fragmentation modality. Unfortunately proximal migration of fragments into inaccessible areas in the intrarenal collecting system is a potential limitation during ureteroscopic procedures. Moreover, the lack of an efficient mechanism of stone retrieval further limits the widespread application of this technique. The newly developed Lithovacdagger suction device was designed to be combined with pneumatic lithotripsy during ureteroscopic stone removal. We evaluated the effectiveness of this combination for overcoming these limitations.
  
  
  METHODS
  Between February and December 1998, 21 patients underwent pneumatic lithotripsy of ureteral calculi combined with use of the Lithovac suction probe. Stone area was 20 to 320 mm.2 (mean 84). Of the stones 71% and 29% were in the distal, and proximal and/or mid ureter, respectively. We used a 0.8 mm. pneumatic lithotripsy probe placed through a 4.8Fr Lithovac probe at a pulse frequency of 12 Hz. and pressure of 2 atmospheres.
  
  
  RESULTS
  Mean operative time was 42 minutes and the stone fragmentation rate was 100%. There were no complications in our series and no proximal migration of fragments. The overall stone-free rate was 95% at 3-month followup.
  
  
  CONCLUSIONS
  Using the Lithovac suction device greatly facilitates pneumatic lithotripsy during ureteroscopic stone removal. This combination not only prevents fragment migration, but also aids in maintaining a clear endoscopic field of view, allowing efficient, safe and effective stone fragmentation.
authors.affiliation: Comprehensive Kidney Stone Center, Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: F C
authors.initials: FC
authors.lastname: Delvecchio
authors.forename: R L
authors.initials: RL
authors.lastname: Kuo
authors.forename: G M
authors.initials: GM
authors.lastname: Preminger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008096:Lithotripsy / Q000379:methods; D008297:Male; D008875:Middle Aged; D013396:Suction; D014514:Ureteral Calculi / Q000628:therapy*; D018666:Ureteroscopy