Evaluation of fragmentation with single or multiple pulse setting of Lithoclast for renal calculi during percutaneous nephrolithotripsy and its impact on clearance.
OBJECTIVE
To evaluate the impact of single or multiple pulse settings of Lithoclast to fragment renal calculi, and its effect on fragment size and clearance.


METHODS
In a prospective study 153 patients, who had been treated over a period of 35 months for renal stone disease by percutaneous nephrolithotomy, were evaluated. In 69 cases the single and in 84 cases the multiple pulse modes were used to fragment the stone intracorporeally using the pneumatic lithoclast. The 2 groups were similar with regard to patient characteristics, stone location and size.


RESULTS
Most stones were staghorn. The lithoclast was effective with good fragmentation in all cases. The mean operating and fluoroscopy times in the single and multiple pulse mode were 124.1 and 5.8, and 141.2 and 7.4 min, respectively (both differences statistically significant, p < 0.001). Immediate postoperatively residual stone fragments were seen in 16 cases with the single and 35 cases with the multiple pulse mode setting (difference statistically significant, p < 0.05). Relook procedures were required in 14 cases with the single and 22 cases with the multiple pulse setting (difference not statistically significant). No specific complication was seen related to the use of either of the two modes. On follow-up 1 patient in the multiple pulse setting developed stone recurrence after 19 months.


CONCLUSIONS
The single pulse mode was associated with controlled fragmentation of the stone, formation of larger fragments which were easier to pick up, less stone scatter, shorter operating time and less exposure to fluoroscopy. The single pulse mode was also associated with statistically less chances of postoperative residual fragments.
Department of Urology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India. ahemal1@hfhs.org
A K
AK
Hemal
Apul
A
Goel
Monish
M
Aron
Amlesh
A
Seth
P N
PN
Dogra
N P
NP
Gupta
D000328:Adult; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000628:therapy*; D008096:Lithotripsy / Q000379:methods; D008297:Male; D009403:Nephrostomy, Percutaneous; D011446:Prospective Studies