Dual-energy single-probe lithotripsy versus laser lithotripsy in percutaneous nephrolithotomy: A systematic review...

Advances in laser technology have rendered laser lithotripsy an attractive option for lithotripsy during percutaneous nephrolithotomy (PCNL). However, limitations such as lower ablation rates and significant stone retropulsion have been noted, particularly in larger or harder stones. Trilogy is an emerging lithotrite that combines electromagnetic ballistic and ultrasonic energy with integrated suction in a single probe. This design offers theoretical advantages in stone fragmentation speed and debris clearance. This systematic review and meta-analysis aims to evaluate the safety and efficacy of Trilogy vs laser lithotripsy in PCNL.

A comprehensive literature search was conducted in PubMed, Scopus, Web of Science, and the Cochrane Library. Studies that compared the efficacy and safety of the Trilogy lithotripsy system to laser-based lithotripsy in adult patients undergoing percutaneous nephrolithotomy were included.

Four studies including 260 patients were included. Trilogy lithotripsy demonstrated a statistically significant higher stone-free rate (RR = 1.24, 95% CI: 1.06-1.44; p = 0.005) and higher lithotripsy rate (MD = 33.23 mm³/min, 95% CI: 13.55-52.91; p = 0.0009) compared to laser-based lithotripsy. No statistically significant difference was found between Trilogy and laser lithotripsy regarding operative time (MD = 3.75 minutes, 95% CI: -5.39 to 12.88; p = 0.42) and risk of perioperative complications (RR = 1.44, 95% CI: 0.53-3.91; p = 0.47).

Despite technological advances in laser lithotripsy, dual energy lithotripsy probes with suction provide more efficient stone disintegration and superior stone-free rates in PCNL compared to laser lithotripsy without compromising safety or operative time. The combination of ultrasonic, ballistic, and suction capabilities in dual energy probes facilitates stone fragmentation and simultaneous fragment removal while reducing stone retropulsion and lowering the intra-renal pressure, contributing to improved visibility and lower risk of infectious complications.