Comparison of Percutaneous Nephrolithotomy Using Pneumatic Lithotripsy (Lithoclast®) Alone or in Combination with Ultrasonic Lithotripsy
조시완, 유지형, 성락희, 정재용, 노충희,
소속 상세정보
조시완 ( Cho C-One )
인제대학교 의과대학 비뇨기과학교실
유지형 ( Yu Ji-Hyeong )
인제대학교 의과대학 비뇨기과학교실
성락희 ( Sung Luck-Hee )
인제대학교 의과대학 비뇨기과학교실
정재용 ( Chung Jae-Yong )
인제대학교 의과대학 비뇨기과학교실
노충희 ( Noh Choong-Hee )
인제대학교 의과대학 비뇨기과학교실
KMID : 0358320100510110783
Abstract
Purpose Percutaneous nephrolithotomy (PCNL) is the procedure of choice for treating large renal stones. Pneumatic lithotripsy (Lithoclast®) is effective regardless of the stones’ composition, and ultrasonic lithotripsy allows the aspiration of small debris during lithotripsy. We investigated the efficacy and safety of PCNL via Lithoclast® alone or combined with ultrasonic lithotripsy.
Materials and Methods Thirty-five (group A) and 39 (group B) patients underwent Lithoclast® PCNL and combination therapy, respectively, from May 2001 to March 2010, and the two groups were compared in terms of stone size, location, and composition; operative time; average number of treatments; hospital days; hemoglobin loss; ancillary procedures; rate of device failure; and initial and total stone-free rates.
Results The two groups did not differ significantly in preoperative stone size, location, or composition; the average number of treatments; or the initial and overall stone-free rates. However, combination therapy was associated with a significantly lower operative time (181±50 vs. 221±65 min, respectively, p=0.004), number of hospital days (11.6±3.8 vs. 14.2±4.4 days, respectively, p=0.009), and average hemoglobin loss (1.12±0.61 vs. 1.39±1.02 g/dl, respectively, p=0.013). Transfusions were required in 6 patients (4 and 2 in each group, respectively), but there were no significant complications related to percutaneous access. There were 2 (5.7%) mechanical failures (Lithoclast® probe fracture) in the group A and 5 (12.8%) in the group B (2 cases of suction tube obstruction, 3 cases of overheating).
Conclusions The combination of ultrasonic lithotripter and Lithoclast® is more effective than Lithoclast® alone because it significantly decreases operative time, hemoglobin loss, and the hospital stay. This may reflect the superior power of Lithoclast® and the ability to aspirate the debris during ultrasonic lithotripsy.
키워드
Kidney calculi; Lithotripsy; Percutaneous nephrolithotomy
원문 및 링크아웃 정보
등재저널 정보