Urolithiasis update: clinical experience with the Swiss LithoClast

This article describes the authors' first experience using the EMS Swiss LithoClast pneumatic lithotriptor in the management of middle and distal ureteral calculi. Also presented is a review of the literature comparing different modalities of intracorporeal lithotripsy. A retrospective analysis was performed on 11 patients treated with the Swiss LithoClast using the Circon ACMI MR6 Rigid Mini-ureteroscope (7 patients with distal calculi and 4 patients with midureteral calculi). The lithotriptor successfully fragmented 91% of the calculi, independent of stone composition. Complete failure of fragmentation was only encountered in one patient, and this was secondary to the lithotriptor's inherent ballistic force causing retrograde passage of the calculus. One patient had postoperative radiographic evidence of stone fragments along the ureteral stent. There was no intraoperative morbidity or long-term complications encountered with use of the pneumatic lithotriptor. Additionally, patients' overall satisfaction was 91% with respect to the procedure itself and relief of preoperative pain. The only significant postoperative complaint was ureteral stent discomfort in one patient. The authors conclude that the EMS Swiss LithoClast pneumatic lithotriptor is a safe and effective tool in the management of middle and distal ureteral calculi. However, as noted with one patient, there is always a risk of stone push from the ballistic force of the lithotriptor.