Comparison of a single center, academic surgeon real-world experience with three percutaneous nephrolithotomy...

We compared a single surgeon, single-institution experience with the Wolf Ultrasonic Model #2167.05 (Richard Wolf Medical Instruments Co., Vernon Hills, IL, USA), Lithoclast Ultra (Boston Scientific, Natick, MA, USA), and CyberWand (Gyrus/ACMI, Southborough, MA, USA) lithotripters for percutaneous nephrolithotomy (PCNL). We assessed each lithotripter's performance and durability.

We conducted a retrospective chart review on 70 sequential PCNLs. Treatments were split into three cohorts based on the type of lithotripter used, Wolf (August 2003 to February 2004), Lithoclast (March 2004 to November 2008), or CyberWand (December 2008 to October 2009). Operative time, repeat PCNL procedures, lithotripter efficacy, patient body mass index (BMI), and stone-free rates (defined as < 4 mm fragment on postoperative day one noncontrast CT scan) were compared.

Sixty-one patients underwent 70 PCNLs using the Wolf (12), Lithoclast (39) or CyberWand (19). The CyberWand cohort had higher rates of obesity (74% versus 53% for Lithoclast and 45% for Wolf) and staghorn calculi (68% versus 39% for Lithoclast and 36% for Wolf). Operative time were 151 minutes (75-384, Wolf), 190 (55-360, Lithoclast) and 200 (81-387, CyberWand) cohorts. Stone-free rates were 50% (Wolf), 49% (Lithoclast) and 37% (CyberWand). PCNL was repeated within 45 days following 6 (50%) Wolf, 7 (18%) Lithoclast and 1 (5%) CyberWand procedures. Lithotripter malfunction complicated 1 Wolf (8%), 5 (13%) Lithoclast and no CyberWand PCNLs. Intraoperative complications occurred during 1 (8%) Wolf, 9 (23%) Lithoclast, and 2 (11%) CyberWand cases.

Despite treating larger stones in more obese patients, the CyberWand lithotripter had a lower malfunction and need for repeat PCNL rates. These findings suggest that the CyberWand may be a more durable lithotripter. However, the overall efficacy of each lithotripter in performing PCNL was similar.