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COMPARISON OF PNEUMATIC AND NANOPULSE METHODS OF CONTACT LITHOTRIPSY

V. A. Bashlachyov, N. B. Kryuchkov
Municipal Health Care Institution, City Hospital of Mezhdurechensk, Kemerovo Region, Russia

The South of the Kuznetsk Basin is an endemic zone of urolithiasis, which accounts for the high percentage of patients with this pathology in the Urology Department of Mezhdurechensk. It compels the Department to actively apply some new treatment technologies aimed at improving the quality of medical care and the department's economic performance.
The purpose of this study is to compare the efficiency of two lithotripsy methods - pneumatic and nanopulse.
The Urology Department of Mezhdurechensk has performed contact lithotripsy (CLT) since 2003. Medical equipment includes ureteroscopes 8 and 10 Sr. manufactured by Karl Storz, together with a set of forceps and loops; a Karl Storz lithotripter; a video camera for endoscopy manufactured by EFA-M; a light source (490-S, Karl Storz) and a xenon light source (0101, EFA-M); and a monitor (EFA-M). In 2007 the Department purchased a Urolit nanopulse lithotripter. There were 188 CLTs performed during the period under consideration (from 2003 to 2009). The procedures are conducted under different types of anaesthesia: mostly (in 85% of cases) under spinal anaesthesia, in other cases under endotracheal anaesthesia and combined methods.
The diagnosis was confirmed by urinary tract ultrasound scans, excretory urography and, in a number of patients, by spiral computed tomography. Interventions have been conducted mainly for stones in the lower third of the ureter (69.7%), less often in the middle third (23.9%) and the upper third (6.4%). The procedure generally resulted either in the placement of a stent (51%) or catheterisation of the ureter (21%).

Method

Number of procedures

Average time of procedure (minutes)

Post-operative bed-days

Complication rate

Mechanical

112

71.2

6.6

6 (7.1%)

Nanopulse

76

46.3

4.9

4 (5.2%)

The most frequent complication is development of pyelonephritis in the post-operative period. In one case, perforation of the ureter occurred during stent placement, which required lumbotomy. The comparison shows that nanopulse lithotripsy has made it possible to reduce the time of the procedure and post-operative bed-days, as well as the number of complications.
By analysing this working experience, a comparative description can be summarized in a table:

Method

Nanopulse

Mechanical

Advantages

1. Reduction of procedure time.
2. Reduction of post-operative bed-days.
3. Fine adjustment of pulse energy.
4. Applicability for flexible ureteroscopes.

1. High reliability of the equipment manufactured by Karl Storz.

Disadvantages

1. Limited wear resistance of the probe.
2. Risk of damage to ureteroscope optics in case of improper application of the fragmentation technique.

1. Longer procedure and anaesthesia time.
2. Higher risk of stone migration to upper sections.
3. Use of a compressor in an operating room (noise, vibration).
Conclusion: It can be concluded that nanopulse lithotripsy is a more efficient method for treatment of urolithiasis as compared with mechanical lithotripsy; it offers the possibility of reducing the procedure time, complication rate and post-operative bed-days.


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