Electrokinetic lithotripsy: safety, efficacy and limitations of a new form of ballistic lithotripsy

Abstract

Objective To investigate the safety and efficacy of electrokinetic lithotripsy (EKL), a ballistic lithotripter which uses high‐energy magnetic fields to propel an impactor to fragment calculi. Patients and methods The records and radiographs of 121 patients who underwent ureteroscopy using the EKL for stones in the upper (26), mid (28) or lower (67) ureter were reviewed retrospectively. Ureteroscopy was performed with an 8.5 F semi‐rigid ureteroscope, through which a 3 F EKL probe was passed. Results A total of 148 stones (mean stone size 11.5 mm, range 6–40) in 121 patients were treated using the EKL. One patient was lost to follow‐up. Of 148 stones, 147 (99.3%) were fragmented, including five that had resisted fragmentation with either pulsed‐dye laser or electrohydraulic lithotripsy. Despite this, only 45 of 56 patients (80%) with a single stone in the lower ureter were rendered stone‐free after a single ureteroscopic procedure. Seven patients in this group (12%) required shock‐wave lithotripsy for fragments that had been propelled into the kidney, while four patients (7%) required repeat ureteroscopy for retained ureteric fragments. Complications were limited to minor ureteric perforations in two patients, both of which were treated with a stent. Conclusion EKL is an inexpensive and reliable endoscopic method which fragments nearly all urinary calculi. Its limitations include the propulsion of fragments and the need to use an offset, semi‐rigid ureteroscope. We recommend the use of a basket or graspers to remove fragments of ≥4 mm after EKL.

Operative Failure during Ureteroscopic Pneumatic Lithotripsy: Factors Affecting Successful Outcome

“…Although there is a continuing search for an ideal alternative among the electrohydrolic, ultrasonographic, pulsed dye laser, and pneumatic ureteroscopic stone disintegration methods, pneumatic lithotripsy has been reported to be a reliable, costeffective alternative with its highly effective results with minimal morbidity [1] .…”

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

“…In our experience the SLC has already proven to be a simple, safe, reliable and economical method of endoscopic lithotripsy [5]. After a few years, a very similar device, the electrokinetic lithotripter (EKL), which uses electromagnetic energy to propel a rigid metal probe through a hollow cylinder to fragment calculi, was described [6] and has recently become available to us.…”

The need for additional equipment after ESWL in ureteroscopic lithotripsy

“…Daha küçük çaplı ve daha geniş çalışma kanallı endoskopik aletlerin geliştirilmesi, taş kırma yöntemlerinde ilerlemeler ve gelişmiş yardım-cı ekipmanlar sayesinde hem alt üriner sistemin primer taşları-nın tedavisinde hem de ESWL ile kırılamayan veya kırılsa da taşlardan tamamen arındırılamayan üreter taşlarının tedavisinde ÜRS seçkin bir tedavi alternatifi olmuştur. [1] Avrupa Üroloji Derneği'nin (AÜD) 2009 kılavuzuna göre 10 mm'den küçük taşlardaki ÜRS'nin taşsızlık oranları; alt üre-ter taşları için %96-98, orta üreter taşları için %81-96 ve üst üreter taşları için %73-85 olarak bildirilmiştir. Aynı klavuzda ESWL'deki taşsızlık oranları ise sırasıyla %80-91, %65-95 ve %85-93'tür.…”