Abu Dhabi, United Arab Emirates (UAE) (UroToday.com) Dr. Amy Krambeck, Professor of Urology at the University of Indiana, presented on lithotripsy and which modality is best for breaking stones during percutaneous nephrolithotomy (PCNL). The clearance of large renal stones during PCNL requires an energy source to break the stone. Options that are available include pneumatic, ultrasonic, and electrohydraulic lithotripsy and laser, with each having its own positive and negative attributes. Most modern lithotripters combine energy sources; however, there is no general consensus as to the single best modality for stone breakage.

Dr. Krambeck compared the newer lithotripters currently available including Cyberwand™ (Olympus, Tokyo, Japan), Swiss Lithoclast® Master/Select (EMS S.A., Switzerland/Boston Scientific, Marlborough, MA, USA), Shockpulse-SE™ (Olympus, Tokyo, Japan), Uretron (Richard Wolf, Vernon Hills, IL, USA), Stonebreaker (Cook Medical, Bloomington, IN, USA), and Swiss Lithoclast® Trilogy (ElectroMedical Systems/Boston Scientific). Specifically, the Trilogy is a single-probe device that delivers both ultrasonic and electromagnetic ballistic energy, as well as suction capability.

When compared to other devices the Trilogy was found to have superior stone clearance time, clearance rate, and required zero conversions to another device. Additionally, the stone-free rate was up to 84%. Other benefits include more reliability with less device malfunction. Dr. Krembeck shared her personal experience with this new device stating that the Triology is efficient at treating both hard and soft matrix stones. There is significantly less troubleshooting and is advocated by her nursing staff. Disadvantages include the 1200 gram weight of the device leading to low physician satisfaction.

At Indiana University they are currently performing a prospective trial comparing the Shockpulse versus the Triology. Initial data suggests superior reliability with the Trilogy and less need for secondary procedures due to a better stone-free rate. Additionally, for harder stones, the Trilogy device outperforms the Shockpulse. Dr. Krambeck concluded by stating for mini PCNL procedures fragmentation devices without extraction function is ideal and the laser is most commonly used. For standard PCNL a combination device is ideal.

Presented by: Amy Krambeck, MD, Professor of Urology, Department of Urology, University of Indiana, Bloomington, Indiana

Written by: Roshan M. Patel, MD, Department of Urology, University of California, Irvine, Medical Writer for UroToday.com, @rpatel26, at the 37th World Congress of Endourology (WCE) – October 29th-November 2nd, Abu Dhabi, United Arab Emirates