Comparing Two Different Ballistic Intracorporeal Lithotripters in the Management of Ureteral Stones

Abstract

Introduction: During the 1990s, two different in situ ‘ballistic’ lithotripters were introduced into clinical practice. The Swiss Lithoclast (SLC) was the first to be clinically tested. After a few years, a very similar device, the electrokinetic lithotripter (EKL), was described and has recently become available to us. In this paper we compare the clinical efficacy and features of these two ballistic lithotripters in the ureteroscopic treatment of ureteral stones. Materials and Methods: Thirty-eight patients with ureteral stones were randomized into two equal groups to undergo fragmentation using the SLC or the EKL via semirigid ureteroscope. In both groups the stones were in the mid- or lower ureter. The following parameters were evaluated: total procedure duration, complete fragmentation rate, time to complete fragmentation, proximal migration rate, complications and need for further procedures. Results: Although not statistically significant, a trend towards a higher fragmentation rate, a shorter time to fragmentation and a slightly higher proximal migration rate emerged in the SLC group. No difference was found in the stone-free rate in the two groups (94.7 vs. 89.4%). Only 2 cases of minor ureteric injury were observed in each group. Conclusions: As previously described by others, the SLC and EKL are both attractive cost-effective options in the treatment of ureteral stones. Ten years after its introduction, the SLC still remains probably the best choice for most urologists.

A Comparison of Holmium YAG Laser and Electrokinetic Lithotripter in Pediatric Ureteral Stone Treatment

“…There was no significant difference in the stone-free rate, procedure duration, or proximal stone migration rate (8). However, in 38 adult patients with mid or lower ureter stones, lithoclast was reported to be more effective than EKL (11). The efficacy of the Ho: YAG lithotripter and a pneumatic lithotripter in treating 216 ureteral stones was reported to be the same as in a retrospective adult study.…”