Comparison of Percutaneous Nephrolithotomy Using Pneumatic Lithotripsy (Lithoclast (R)) Alone or in Combination with Ultrasonic Lithotripsy

Purpose: 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. Materials and 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.