Stone Fragmentation with Pneumatic Lithotripsy

2021 ◽  
pp. 164-168
Author(s):  
Michael Koch ◽  
Heinrich Iro
Keyword(s):  
Pneumatic Lithotripsy ◽  
Stone Fragmentation

Intracorporeal techniques of stone fragmentation

2017 ◽  
Author(s):  
Gastón M. Astroza ◽  
Michael E. Lipkin ◽  
Glenn M. Preminger
Keyword(s):  
Renal Calculi ◽  
Laser Lithotripsy ◽  
Ureteral Stones ◽  
Pneumatic Lithotripsy ◽  
Stone Fragmentation ◽  
Intracorporeal Lithotripsy ◽  
Ultrasonic Lithotripsy ◽  
Laser Fibres ◽  
Power Generation Systems ◽  
Percutaneous Nephrolithotripsy

The use of intracorporeal lithotripsy for the management of larger ureteral and intrarenal calculi has dramatically improved. Although the choice of intracorporeal fragmentation is frequently based on the location and composition of the stone to be treated, the experience of the clinician and availability of equipment often dictates this decision. Several different modalities of intracorporeal lithotripsy are currently available. Ultrasonic lithotripsy is mainly used for the fragmentation of large renal calculi during percutaneous nephrolithotripsy procedures. Ultrasound is used rarely via an ureteroscopic approach. Significant advances in laser fibres and power generation systems have propelled laser lithotripsy to the treatment of choice for fragmentation of most ureteral stones. Pneumatic lithotripsy consists of a pneumatically driven piston which will fragment stones by direct contact.

scholarly journals Comparison of pneumatic lithotripsy versus laser lithotripsy for upper ureteral calculi

2021 ◽  
Vol 8 (9) ◽  
pp. 2644
Author(s):  
Ershad Hussain Galeti ◽  
Saqib Shahab ◽  
Mriganka Deuri Bharali
Keyword(s):  
Yttrium Aluminum Garnet ◽  
Randomized Study ◽  
Laser Lithotripsy ◽  
Ureteral Calculi ◽  
Pneumatic Lithotripsy ◽  
Stone Fragmentation ◽  
Stone Free Rate ◽  
Mean Size ◽  
Second Procedure ◽  
Free Rate

Background: Several modalities are available for upper ureteric stone fragmentation. From them pneumatic and holmium: yttrium-aluminum-garnet lithotripsy has favourable outcomes. In this study we studied 50 patients who underwent ureteroscopic pneumatic lithotripsy or laser lithotripsy. This study aims to to compare the outcome of PL and LL in the management of upper ureteric calculi.Methods: This is a prospective, randomized study of 50 cases; 25 cases of TUL with pneumatic lithotripter and 25 cases of TUL with laser lithotripter over two years. The purpose of this study was to analyze the factors predicting the stone-free rate, assess the complications following PL and LL, and assess the need for a second procedure if retropulsion of calculi occurs.Results: Two groups were similar in age, gender, mean size of stones, retropulsion and complications. There was a statistical difference in terms of stone free rate in favour of LL group (p≤0.05) and mean operative time in favor of the PL group (p≤ 0.05). Conclusions: In conclusion, we found that both the PL and LL approaches were effective and safe for upper ureteric calculi, but the LL method had advantages, especially in stone free rate, over the PL treatment. Another advantage of the LL method was safe stone fragmentation in upper ureteral calculi due to lower retropulsion rate in contrast with the PL method.

scholarly journals Outcome of Lower Ureteric Stone Fragmentation by Laser in Comparison with Pneumatic Lithotripsy

2020 ◽  
Vol 23 (2) ◽  
pp. 169-175
Author(s):  
SA Anowar Ul Quadir ◽  
Khan Nazrul Islam ◽  
Md Mostafizur Rahman ◽  
Md Shafiqul Alam Chowdhury ◽  
SM Mahbub Alam
Keyword(s):  
Laser Lithotripsy ◽  
Medical College Hospital ◽  
Ureteric Stone ◽  
College Hospital ◽  
Operation Theatre ◽  
Medical College ◽  
Pneumatic Lithotripsy ◽  
Stone Fragmentation ◽  
Group A ◽  
Group B

Background: Several different modalities are available for ureteral stone fragmentation. From them pneumatic and holmium: yttrium-aluminum-garnet (Ho: YAG) lithotripsy have supportive outcomes. Aims: To see the outcome of lower ureteric stone fragmentation by laser in comparison with pneumatic lithotripsy. Methods: The prospective clinical study was conducted during the period from July 2012 to June 2014 in Dhaka Medical College Hospital. From the patient admitted in Dhaka medical college hospital a total of 60 patient were selected using purposive sampling methods. Selected patients were numbered chronologically and odd number group as group A (laser lithotripsy) and even number group B (pneumatic lithtripsy). Cystoscopy followed by ureterescopy with the help of guide wire was done and stone fragmentation done by either laser lithotripsy (done in general operation theatre in Dhaka Medical College Hospital) or pneumatic lithotripsy (done in Urology operation theatre in Dhaka Medical College Hospital). Collected data were processed and analyzed using computer software SPSS (statistical package for social science), version-18. Un-pair t-test, chisquare test and Fishers Exact probability test were used to analyze the data. The findings of the study showed age and sex are almost identically distributed in both groups. Results: The mean age of group A and group- B were 35.63±11.66 and 38.90±11.21 years respectively. A male predominance was observed in both groups with 70% male in group- A and 53.3% in group-B. Stone size was also observed identically in both groups. 43% of stone are larger than 10mm in group- A and 47% stone are larger than 10mm. None of other baseline variable found very between groups. Immediate stone clearance was much higher in group-A (96.7%) then that in group- B (80%). Although both the groups demonstrated 100% clearance after 1 month. Immediate complications were higher in group B then those of group- A. Ureteral perforation in group B was found 6.7% as opposed to none in group-A. Fever in group A (6.7%) was observed to be more than 3 times higher than in group- B (23.3%). Comparison of complications after 1 and 3 months shows some differences (higher in group-B) but that is not significant. Ureteral stricture developed in 3 patients in group- B compared to nil in group- A. More than 90% of patients of group-A were released from the hospital within 3 days after operation, in contrast about 40% in group-B left the hospital within 3 days. Conclusion: So, laser lithotripsy is better option for the management of lower ureteric stone by using semi rigid ureteroscope, in term of stone migration, rate of stone fragmentation and clearance, operation time, hospital stay and complication. Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.169-175

Endoscopic Salivary Stone Fragmentation with Pneumatic Lithotripsy in a Simulation Model

2016 ◽  
Vol 154 (3) ◽  
pp. 454-459 ◽  
Author(s):  
Henry T. Hoffman ◽  
Rohan R. Walvekar ◽  
Chad R. Tracy ◽  
Jack Kolenda ◽  
Nitin Pagedar
Keyword(s):  
Simulation Model ◽  
Pneumatic Lithotripsy ◽  
Stone Fragmentation

scholarly journals The outcome of pneumatic lithotripsy for the management of ureteric calculi

1970 ◽  
Vol 6 (3) ◽  
pp. 355-360
Author(s):  
B Shrestha ◽  
DV Karki ◽  
JL Baidya
Keyword(s):  
Hospital Stay ◽  
Good Alternative ◽  
Shockwave Lithotripsy ◽  
Pneumatic Lithotripsy ◽  
Stone Fragmentation ◽  
Ureteric Calculi ◽  
Operative Complications ◽  
The Mean ◽  
One Year ◽  
Post Operative Complications

Background: Various methods have been adopted for the removal of ureteric calculi around the world. Ureteroscopic pneumatic lithotripsy has been used to treat ureteric calculi for more than a decade. Owing to its low price and high degree of effectiveness, it has become the most popular ureteroscopic device amongst many others. Moreover, ureteroscopy has become the method of choice for the quickest way of rendering patients stone-free. Objectives: To determine successful stone fragmentation by ureteroscopic pneumatic lithotripsy in the management of ureteric calculi as well as intra-operative and post-operative complications related to it. Study design: A prospective and descriptive study. The study was conducted in Section of Urology, Department of Surgery, B&B Teaching Hospital, Kathmandu University. The data was collected from April 2005 to April 2006. Materials and methods: Ninety-two consecutive patients having ninety-five ureteric stones were treated with intracorporeal pneumatic lithotripsy over a period of one year. The size, side, number and site of stones along with the results of preoperative routine investigations were noted in the patients. The pneumatic lithotripter was introduced through a 10 or 8 Fr rigid ureteroscope (Karl Storz) to break the stone/s. Successful stone fragmentation, lithotripsy time, intra-operative and post-operative complications and duration of hospital stay were recorded. Results: Complete stone fragmentation was achieved in about 80 % of cases. The mean lithotripsy time was 17.66 minutes. About 76% of patients were stone-free at one week follow-up after the procedure, 92% by the end of eight weeks while 100% stone-free status was achieved by the end of 12 weeks. The mean hospital stay was 1.82 days and complications (both significant and minor) occurred in 51 % of cases. However, majority of them were minor and successfully managed. Conclusion: Intra-operative pneumatic lithotripsy is a minimally invasive, effective and rapid procedure for the management of ureteric calculi. Though it can give rise to considerable complications, they are mainly minor. Moreover, both complications and failure rates can be reduced if patients with ureteric calculi are properly selected. It seems to be a good alternative in patients where extracorporeal shockwave lithotripsy is unsuccessful or not indicated and in patients who need early stone removal. Key words: SIRS- Systemic Inflammatory Response Syndrome, ESWL- Extra corporeal shockwave lithotripsy, JJ stent: Double J stent, URS: Ureterorenoscope, Steinstrasse. doi: 10.3126/kumj.v6i3.1711 Kathmandu University Medical Journal (2008), Vol. 6, No. 3, Issue 23, 355-360    

scholarly journals A Comparative Study between Holmium Laser, Pneumatic Lithotripsy and Shock Pulse in Terms of Efficacy and Safety in Percutaneous Nephrolithotomy (PCNL) : A Prospective Randomised Study.

2020 ◽  
Vol 3 (1) ◽  
pp. e1-e8
Author(s):  
Rajeev T P ◽  
Sarbartha Kumar Pratihar ◽  
Debanga Sarma ◽  
Saumar Jyoti Baruah ◽  
Sasanka Kumar Barua ◽  
...  
Keyword(s):  
Success Rate ◽  
Holmium Laser ◽  
Shock Pulse ◽  
Efficacy And Safety ◽  
Stone Clearance ◽  
Pneumatic Lithotripsy ◽  
Stone Fragmentation ◽  
Stone Free Rate ◽  
Significant Difference ◽  
Free Rate

Background and ObjectivesPercutaneous nephrolithotomy (PCNL) occupies an essential place in the treatment of upper urinary tract calculi. PCNL also accomplishes higher stone-free rates and requires fewer auxiliary procedures than shock wave lithotripsy (SWL) and ureterorenoscopy (URS) for renal stones between 1–2 cm. There are different intracorporeal lithotripter devices available. This study aims to compare the efficacy and safety of holmium laser, pneumatic lithotripsy and Shock Pulse in PCNL. Materials and MethodsA prospective randomized study was performed in Gauhati Medical College & Hospital, Guwahati, Assam, India, between October 2016 to November 2018. Patients of renal calculi and upper ureteric calculi less than or equal to 2.5cms and functioning kidney on the ipsilateral side were included. 300 patients were randomized according to a random number generator. In the holmium laser, pneumatic and Shock Pulse groups’ number of patients was 96, 102, 102 respectively. Stone disintegration time (SDT), stone-free rate, failure rate, success rate, irrigant used, mean hematocrit drop were evaluated. Statistical analysis was done to compare and predict any significant difference. ResultsPatients were divided into groups depending on the lithotripter used: group A (n=96), group B (n=102), group C (n=102) were holmium laser, pneumatic lithotripsy, and Shock Pulse respectively. No significant difference in stone location (p=0.785),Hounsfield unit (p=0.115),complication rates between the groups. Stone free rate in laser, pneumatic lithotripter, and Shock Pulse were 81.25%, 67.65%, 82.35% (highest in Shock Pulse and lowest in the Pneumatic group) and failure rate were 6.25%, 14.7%, 5.89% respectively. A significant difference was found in terms of stone-free, success rate, clinically insignificant residual fragments(CIRF)and failure rates between the groups(p<0.001). Irrigant requirement (litre/mm3) between the groups is statistically significant (p<0.001) with the highest in Shock Pulse and lowest in the Pneumatic group. Mean hematocrit drop: 4.19%, 4.20%, 5.46% in Laser, Pneumatic and Shock Pulse respectively. No significant difference between Laser and Pneumatic group (p=0.907), but in Shock Pulse group it is significantly higher. (p< 0.001) ConclusionEfficacy of energy sources used in PCNL for stone fragmentation vary in terms of stone clearance, failure rates, SDT, irrigant requirement and mean hematocrit drop. In our study, we found stone clearance signifi-cantly higher in Shock Pulse than Pneumatic and Laser groups. Stone fragmentation volume per unit time highest in Shock Pulse and lowest in Laser. Irrigant requirement highest in Shock Pulse group and compa-rable between Laser and Pneumatic group. The higher irrigant requirement in the Shock Pulse group may be the cause for higher hematocrit drop in this group. Complications between the groups are comparable.  

scholarly journals Outcome of Stone Fragmentation with Pneumatic and Ultrasonic Lithotripter During Percutaneous Nephrolithotomy

2020 ◽  
Vol 23 (2) ◽  
pp. 129-135
Author(s):  
Shariful Islam Khan ◽  
Md Nurul Hooda ◽  
Md Safiul Alam Babul ◽  
Mohammad Habibur Rahman ◽  
Anup Roy Chowdhury ◽  
...  
Keyword(s):  
Statistical Analysis ◽  
Percutaneous Nephrolithotomy ◽  
P Value ◽  
Pneumatic Lithotripsy ◽  
Stone Fragmentation ◽  
Study Results ◽  
Wide Range ◽  
Ultrasonic Lithotripsy ◽  
Group A ◽  
Group B

Background of the study: Percutaneous nephrolithotomy (PCNL) is the gold standard treatment for kidney stones larger than 2 cm. PCNL has replaced open surgical removal of large or complex calculi at the most institutions. The success of PCNL is related to the ability to achieve an optimum access tract and proper fragmentation. A wide range of lithotripsy techniques are currently available. One of these is ultrasonic lithotripsy, in which the stones are fragmented and sucked out simultaneously. This technique induces minimal tissue injury and could be considered as a standard modality for PCNL. The pneumatic lithotripter uses pneumatic ballast, which crushes the stones without producing any thermal effects. Because this mechanical energy passes along the metal wire to the stone, the probe works like a chisel on the stone surface. This modality destroys all stones, regardless of their composition. There were very few studies had been done in this context in our country, so I had decided to do this study to compare the outcome of stone fragmentation with pneumatic and ultrasonic lithotripter during percutaneous nephrolithotomy. Objective: To compare the outcome of stone fragmentation with pneumatic and ultrasonic lithotripter during percutaneous nephrolithotomy. Materials & Methods: This Prospective Interventional Study (Quasi Experimental Trial) was performed in Department of Urology, National Institute of Kidney Diseases and Urology, Sher-E- Bangla Nagar, Dhaka during the period from December 2014 to May 2016. A total of 60 subjects will be selected with renal calculi (as per inclusion & exclusion criteria), among these, half of the patients will be group A (using pneumatic lithotripsy) & rest of the patients will be group B (using ultrasonic lithotripsy). The study subjects were underwent PCNL under general anesthesia, half of which used pneumatic lithotripter and rest used ultrasonic lithotripter for stone fragmentation. Above mentioned outcome variables were assessed both per-operative and post-operatively. Data were collected, processed & analyzed. Statistical analysis of relevant variables was done by unpaired Student’s T test and Chi Square test. P value Â0.05 was considered significant. Results: Total 60 patients were selected for study according to the selection criteria. Of the 60 subjects, 30 patients, those who were done PCNL by pneumatic lithotripsy were labeled as Group A and 30 patients, those who were done PCNL by ultrasonic lithotripsy, were labeled with Group B. Distribution of respondents in terms of different parameters is shown in tabulated form and statistical analysis was done in both groups to see statistical significance, p value less than 0.05 was considered significant. The mean stone fragmentation time was 27.23±4.78 (18-38) min in PCNL by pneumatic lithotripsy and those were 23.80±5.30 (13-34) min in by ultrasonic lithotripsy which is statistically significant. Other variables of interest which includes stone clearance rate, post operative haematuria and post operative hospital stay, were not statistically significant. Conclusion: Comparing the findings of the present study, results indicate that stone fragmentation time is lesser in ultrasonic lithotripsy than pneumatic lithotripsy in PCNL which decreases the overall operative time. Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.129-135

A Novel Approach for the Treatment of Sialolithiasis that Preserves Salivary Duct Anatomy

2021 ◽  
pp. 000348942110189
Author(s):  
Gani Atilla Şengör ◽  
Ahmet Mert Bilgili
Keyword(s):  
Salivary Gland ◽  
Success Rate ◽  
Cost Effective ◽  
Complete Removal ◽  
Level Of Evidence ◽  
Invasive Approach ◽  
Pneumatic Lithotripsy ◽  
Novel Approach ◽  
Surgical Methods ◽  
Salivary Gland Stones

Objective: The sialendoscopy era in the treatment of salivary gland stones has reduced the use of classical surgical methods. However, the miniature ducts and tools may cause difficulties in removing large sialoliths. Therefore, invasive combined oral surgeries or gland resection may be considered. We searched for the most suitable method in order to stay in line with the minimally invasive approach that preserves the ductus anatomy, and that can reduce the surgical fears of patients. Materials and Methods: The study included 84 cases (23 parotid and 61 submandibular) in whom stones were fragmented by pneumatic lithotripsy and removed between January 2015 and January 2020. The parotid cases comprised 7 females and 16 males, and the submandibular cases comprised 25 females and 36 males. Intraductal lithotripsy was performed using pneumatic lithotripter. This study has fourth level of evidence. Results: Based on total number of cases (n = 84), success rate was 67/84 (79.7%) immediately after sialendoscopy, and overall success rate was 77/84 (91.6%). Based on number of stones treated (n = 111), our immediate success rate was 94/111 (84.6%), and overall success rate was 104/111 (93.7%). The success criteria were complete removal of the stone and fragments in a single sialendoscopy procedure and resolution of symptoms. Conclusions: We successfully treated salivary gland stones, including L3b stones, in our patient cohort with sialendoscopy combined with pneumatic lithotripsy. The lithotripsy method that we have adapted seems to be more useful and cost-effective compared to its alternatives. We were also able to preserve the ductus anatomy and relieve patients’ concerns. Level of Evidence: Level IV

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