title: Comparison of percutaneous nephrolithotomy using pneumatic lithotripsy (lithoclast®) alone or in combination with ultrasonic lithotripsy.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: Department of Urology, Inje University College of Medicine, Seoul, Korea.
authors.forename: C One
authors.initials: CO
authors.lastname: Cho
authors.forename: Ji Hyeong
authors.initials: JH
authors.lastname: Yu
authors.forename: Luck Hee
authors.initials: LH
authors.lastname: Sung
authors.forename: Jae Yong
authors.initials: JY
authors.lastname: Chung
authors.forename: Choong Hee
authors.initials: CH
authors.lastname: Noh