KMID : 0358320100510110783
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Korean Journal of Urology 2010 Volume.51 No. 11 p.783 ~ p.787
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Comparison of Percutaneous Nephrolithotomy Using Pneumatic Lithotripsy (Lithoclast¢ç) Alone or in Combination with Ultrasonic Lithotripsy
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Cho C-One
Yu Ji-Hyeong Sung Luck-Hee Chung Jae-Yong Noh Choong-Hee
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Abstract
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Purpose Percutaneous nephrolithotomy (PCNL) is the procedure of choice for treating large renal stones. Pneumatic lithotripsy (Lithoclast¢ç) 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¢ç alone or combined with ultrasonic lithotripsy.
Materials and Methods Thirty-five (group A) and 39 (group B) patients underwent Lithoclast¢ç 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¡¾50 vs. 221¡¾65 min, respectively, p=0.004), number of hospital days (11.6¡¾3.8 vs. 14.2¡¾4.4 days, respectively, p=0.009), and average hemoglobin loss (1.12¡¾0.61 vs. 1.39¡¾1.02 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¢ç 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¢ç is more effective than Lithoclast¢ç alone because it significantly decreases operative time, hemoglobin loss, and the hospital stay. This may reflect the superior power of Lithoclast¢ç and the ability to aspirate the debris during ultrasonic lithotripsy.
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KEYWORD
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Kidney calculi, Lithotripsy, Percutaneous nephrolithotomy
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