Intracorporeal lithotripsy: which modality is best?
ABSTRACT A large number of related articles published within the last year were reviewed. Different types of intracorporeal lithotripter devices were compared according to their advantages, disadvantages, efficacy, safety and clinical applications. General directions of future developments are discussed.
Ultrasound lithotripters employed through rigid endoscopes provide high fragmentation rates (97-100%) and stone free rate (94%). Clinical evaluation of a new combination ultrasound and pneumatic lithotripter reported an overall stone free rate of 80-89.7%. No major complications were observed. The holmium:YAG (Yttrium-Aluminum-Garnet) laser lithotripter is able to destroy all compositions of stone. The stone free rate for ureteral stones is close to 100%. Complications are rare and minimal. Newer wavelengths such as erbium:YAG are currently impractical. There are limited clinical data regarding frequency-doubled double-pulse neodymium:YAG laser lithotripsy.
Ultrasound lithotripsy is still the preferable modality applied through rigid endoscopes. A new combination of ultrasound and pneumatic impactor includes the advantages of each mode. The holmium:YAG laser lithotripter is the method of choice for flexible endoscopic procedures. Further development of new lithotripters with different energy sources and their combination is necessary.
Conference Proceeding: In-Vitro Under the Reproducible Conditions Investigation on Ho:YAG Laser Applications for Stone Fragmentation[show abstract] [hide abstract]
ABSTRACT: Laser assisted lithotripsy is an up-to-date clinical procedure for treatment of patients suffering from ureteral calculi. As different laser systems are clinically available, it is a prerequisite to test their potential for lithotripsy under reproducible experimental conditions. A new Ho:YAG-laser was tested with respect of its laser parameters (energy per pulse, repetition rate, pulse duration, fibre diameter) to laser power transmission through clinical optical fibres, artificial stone fragmentation, fibre burn back and stone repulsion. Laser energy transport through optical fibres resulted in a reduction of the in front of the stone available power in dependency to fibre core diameter and degree of bending. Short laser pulses results in a faster stone fragmentation compared to long laser pulse for both, soft stones and hard stones. Repulsion showed max. pendulum deviation at high energy per pulse, short pulse duration and large fibre core diameter and decrease with a reduction of the energy per pulse and fibre core diameter and elongation of the pulse duration.These investigation shows promising results for clinical application of the Ho:YAG-laser and may built the base for the urologist to choose the optimal laser parameter setting for laser assisted stone fragmentation.TIP TEKNOLOJiLERi ULUSAL KONGRESi (TIPTEkNO'12), Antalya, Turkey; 11/2012