Modes of intracorporeal lithotripsy: ultrasound versus electrohydraulic lithotripsy versus laser lithotripsy

It seems apparent, from the previous discussion, that no form of intracorporeal lithotripsy represents the perfect treatment modality for all upper urinary-tract calculi. In fact, the role of endoscopic techniques for treatment for upper-tract calculi must be carefully considered given the success of SWL. However, not all stones are amenable to extracorporeal treatment. Therefore, ureteroscopy, with the various forms of intracorporeal lithotripsy, represents an alternative means for successfully treating patients without having to resort to surgical intervention. Ultrasonic lithotripsy is probably the least preferable of the three forms of treatment, primarily because it must be carried out with rigid endoscopic equipment. In the future, if flexible or semirigid devices can be developed, ultrasonic lithotripsy may become a more useful option for the treatment of ureteral calculi. Laser lithotripsy and EHL seem to be equally well suited for use with flexible, actively deflectable ureteroscopes. The relative risks and benefits of these two modalities make their use a matter of clinician's choice. The greater risk of ureteral injury may make EHL somewhat less attractive to endoscopists. However, this must be balanced with the increased cost of the laser lithotripter. It has become apparent that a direct comparison of these three types of intracorporeal lithotripsy is difficult because of the lack of standardized data and the scarcity of randomized comparative trials. Despite this, it appears that all three forms of intracorporeal lithotripsy play an integral part in the treatment of upper-tract urinary calculus disease. Certainly, one of the more exciting areas in the field of endourology will be the continued emergence and development of new technologies and devices for these purposes.