title: Histologic impact of dual-modality intracorporeal lithotripters to the renal pelvis.
abstract: OBJECTIVE
  To test the hypothesis that dual-modality intracorporeal lithotripters used during percutaneous nephrolithotomy create a degree of tissue trauma in the dual-modality mode (ballistic and ultrasonic) similar to that in the single-modality mode (ultrasonic).
  
  
  METHODS
  The lithotripter devices tested were the Cyberwand and Swiss LithoClast Select. The activated probes, in both single- and dual-modality modes, were applied directly to the renal pelvis of 11 fresh nephrectomy specimens. The treated tissue sites were then processed for light microscopy and reviewed by a single genitourinary pathologist.
  
  
  RESULTS
  Microscopic examination of the renal pelvis after 2 seconds of direct contact showed minimal denudation of the urothelium, with no changes noted in the subepithelial or muscle layers for the 2 devices evaluated. Direct contact for 4 seconds showed urothelial denudation and subepithelial changes (n = 13 of 23). Muscle injury was observed in some dual-modality specimens (n = 6 of 12). Increasing the contact time to 8 seconds resulted in fragmentation of the muscle layers more frequently with both settings (n = 15 of 22), except for when the Cyberwand was used at the small stone setting (n = 0 of 7).
  
  
  CONCLUSIONS
  In the ex vivo setting, minimal differences were noted in the degree of histologic trauma between the Cyberwand and Swiss LithoClast Select at 2 seconds. However, both dual-modality devices resulted in muscle damage at 4 and 8 seconds of contact time. Care should be taken during clinical procedures to avoid prolonged contact with the renal pelvis to minimize the potential for tissue trauma.
authors.affiliation: Department of Urology, Ohio State University Wexner Medical Center, Columbus, OH, USA.
authors.forename: Tariq A
authors.initials: TA
authors.lastname: Khemees
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Kenneson
authors.forename: Debra L
authors.initials: DL
authors.lastname: Zynger
authors.forename: Bodo E
authors.initials: BE
authors.lastname: Knudsen
mesh_terms: D006801:Humans; D007682:Kidney Pelvis / Q000473:pathology*; D008096:Lithotripsy / Q000009:adverse effects* / Q000295:instrumentation*; D009130:Muscle, Smooth / Q000473:pathology; D013997:Time Factors; D019459:Urothelium / Q000473:pathology*