Research Information System
Turk Uroloji Dergisi, vol.33, no.3, pp.302-307, 2007 (Scopus)
Introduction: Although the use of ultrasonic (UL) or pneumatic lithotrites (PL) has proved to be very safe and efficient in percutaneous nephrolithotomy (PCNL), they both still have some disadvantages. In order to test the hypothesis that their combination may reduce these disadvantages, the efficiency of the combined PL/UL use and PL alone were compared in this prospective study. Materials and Methods: A total number of 85 patients with kidney stones who would undergo PCNL were randomized into two groups. In Group-1 (n=44) and Group-2 (n=41), PL alone and PL/UL combination were used for stone disintegration, respectively. Results were evaluated three months after the operation with noncontrast computerized tomography. Results: Mean stone area was 729.1±372.8 mm2 for Group-1 and 652.1±280.7 mm2 for Group-2 (p>0.05). Of the stones, 27 (31.8%), 33 (38.8%) and 25 (29.4%) were found to be solitary, multiple and staghorn respectively. Stone-free rates in Group-1 and Group-2 were %52.3 and %70.7, respectively (p>0.05). Together with clinically insignificant (<4 mm) residual stones, overall success rate was %81.8 for Group-1 and %78 for Group-2 (p>0.05). Compared to Group-1, Group-2 had less number of clinically insignificant (<4 mm) residual stones (p=0.005). Total operation time and stone disintegration time were shorter in Group-2 (p<0.05 for both). In Group-1 and Group-2 stone clearance in one minute was found 17.4 and 26.6 mm2 respectively (p<0.001). In both group, complication rates were similar and the best results were obtained in stones of solitary in number, of pelvic in localization, of calcium-oxalate-monohydrate or uric acid in composition. Conclusion: Although stone-free, overall success and complication rates are similar, the combination PL/UL is capable of disintegrating and extracting stone material at a more rapid rate than PL alone. At the same time, using combined device also prevents leaving very small residual stones. During PCNL, combined PL/UL use should be preferred over PL use alone.