Randomized Controlled Trial Comparing Three Different Modalities of Lithotrites for Intracorporeal Lithotripsy in...

Area of Science:

• Urology
• Nephrology
• Surgical Technology

Background:

• Percutaneous nephrolithotomy (PCNL) is a common procedure for kidney stone removal.
• Intracorporeal lithotripters are crucial for fragmenting stones during PCNL.
• Comparing different lithotripter models is essential for optimizing treatment outcomes.

Purpose of the Study:

• To compare the efficiency and complication rates of three intracorporeal lithotripter models during PCNL.
• Evaluate stone fragmentation and removal times across different devices.
• Assess the safety and efficacy of Cyberwand, Lithoclast Select, and StoneBreaker.

Main Methods:

• Prospective, randomized controlled trial involving 201 patients across nine North American centers (2009-2016).
• Patients were randomized to Cyberwand (dual-probe ultrasonic), Lithoclast Select (pneumatic-ultrasonic), or StoneBreaker (pneumatic with ultrasonic assist).
• Stone clearance rate, complications, and stone-free rates were primary and secondary outcome measures.

Main Results:

• Mean stone surface area was smaller in the StoneBreaker group.
• Unadjusted stone clearance rate was slowest with StoneBreaker.
• After adjusting for stone size, no significant difference in stone clearance rate was observed among the three lithotripter groups (p=0.249).

Conclusions:

• The Cyberwand, Lithoclast Select, and StoneBreaker lithotripters exhibit similar adjusted stone clearance rates in PCNL for stones larger than 2 cm.
• The safety and efficacy of these three lithotripter devices are comparable.
• These findings support the interchangeable use of these lithotripters in PCNL procedures.