Comparison of Lithotripsy Methods During Mini-PNL: is There a Role for Ballistic Lithotripsy in the Era of High-power Lasers

Overview

Journal BMC Urol

Publisher Biomed Central

Specialty Urology

Date 2024 Mar 8

PMID 38454412

Authors

Muhammed Arif Ibis

Ahmet Furkan Ozsoy

Mehmet Fatih Ozkaya

Emre Erdem

Serhat Erkmen

Ahmet Doruk Guler

Mehmet Ilker Gokce

Affiliations

Soon will be listed here.

Abstract

Background: For renal stones > 20 mm, percutaneous nephrolithotomy (PNL) offers the best stone clearance rates with acceptable complication rates. This study aimed to compare the efficiency of high-power holmium YAG laser and ballistic lithotripsy during mini-PNL.

Methods: Data from 880 patients who underwent mini-PNL for renal stones was investigated retrospectively. The study utilized propensity score matching to create two groups: laser lithotripsy (n = 440) and ballistic lithotripsy (n = 440). The groups were matched based on stone size, Guy's stone score, and stone density. The main objectives of the study were to assess the stone-free rate (SFR), duration of surgery, and complication rates.

Results: The average age of the population was 51.4 ± 7.1 years, with a mean stone size of 28.6 ± 8.3 mm and a mean stone density of 1205 ± 159 HU. There were no significant differences between the groups. The SFRs of the laser lithotripsy and ballistic lithotripsy were 92.5% and 90.2%, respectively (p = 0.23). The laser lithotripsy group had a notably shorter surgery time (40.1 ± 6.3 min) compared to the ballistic lithotripsy group (55.6 ± 9.9 min) (p = 0.03). Complication rates were similar (p = 0.67).

Conclusions: Our study shows that a high-power holmium YAG laser provides quicker operation time compared to ballistic lithotripsy. However, ballistic lithotripsy is still an effective and safe option for stone fragmentation during mini-PNL. In places where a high-power holmium YAG laser is not available, ballistic lithotripters are still a safe, effective, and affordable option for mini-PNL.

References

Liu Y, Zhu W, Zeng G . Percutaneous nephrolithotomy with suction: is this the future?. Curr Opin Urol. 2021; 31(2):95-101. DOI: 10.1097/MOU.0000000000000854. View

Scoffone C, Cracco C, Cossu M, Grande S, Poggio M, Scarpa R . Endoscopic combined intrarenal surgery in Galdakao-modified supine Valdivia position: a new standard for percutaneous nephrolithotomy?. Eur Urol. 2008; 54(6):1393-403. DOI: 10.1016/j.eururo.2008.07.073. View

Zhao Z, Sun H, Wu X, Cai C, Liu Y, Zeng G . Evaluation of day-care versus inpatient mini-percutaneous nephrolithotomy: a propensity score-matching study. Urolithiasis. 2019; 48(3):209-215. DOI: 10.1007/s00240-019-01160-y. View

Nagele U, Schilling D, Anastasiadis A, Walcher U, Sievert K, Merseburger A . [Minimally invasive percutaneous nephrolitholapaxy (MIP)]. Urologe A. 2008; 47(9):1066, 1068-73. DOI: 10.1007/s00120-008-1814-2. View

Turk C, Petrik A, Sarica K, Seitz C, Skolarikos A, Straub M . EAU Guidelines on Interventional Treatment for Urolithiasis. Eur Urol. 2015; 69(3):475-82. DOI: 10.1016/j.eururo.2015.07.041. View

Tangal S, Sanci A, Baklaci U, Babayigit M, Karaburun M, Kubilay E . What is the optimum lithotripsy method for high density stones during mini-PNL? Laser, ballistic or combination of both. Lasers Med Sci. 2020; 35(8):1765-1768. DOI: 10.1007/s10103-020-02971-x. View

Garcia Rojo E, Traxer O, Vallejo Arzayus D, Castellani D, Ferreti S, Gatti C . Comparison of Low-Power High-Power Holmium Lasers in Pediatric Retrograde Intrarenal Surgery Outcomes. J Endourol. 2023; 37(5):509-515. DOI: 10.1089/end.2022.0778. View

Bader M, Gratzke C, Seitz M, Sharma R, Stief C, Desai M . The "all-seeing needle": initial results of an optical puncture system confirming access in percutaneous nephrolithotomy. Eur Urol. 2011; 59(6):1054-9. DOI: 10.1016/j.eururo.2011.03.026. View

Pietropaolo A, Massella V, Ripa F, Sinha M, Somani B . Ureteroscopy and lasertripsy with pop dusting using high power holmium laser for large urinary stones > 15 mm: 6.5-year prospective outcomes from a high-volume stone center. World J Urol. 2023; 41(7):1935-1941. DOI: 10.1007/s00345-023-04438-4. View

10.

Mager R, Balzereit C, Gust K, Husch T, Herrmann T, Nagele U . The hydrodynamic basis of the vacuum cleaner effect in continuous-flow PCNL instruments: an empiric approach and mathematical model. World J Urol. 2015; 34(5):717-24. DOI: 10.1007/s00345-015-1682-5. View

11.

Lahme S, Bichler K, Strohmaier W, Gotz T . Minimally invasive PCNL in patients with renal pelvic and calyceal stones. Eur Urol. 2002; 40(6):619-24. DOI: 10.1159/000049847. View

12.

Keskin E, Bozkurt M, Sahin M, Ozdemir H, Sevik C, Canat H . Effect of preoperative single-dose methylprednisolone administration on early postoperative pain following retrograde intrarenal surgery. Int Urol Nephrol. 2023; 56(4):1253-1258. DOI: 10.1007/s11255-023-03875-9. View

13.

Haupt G, van Ophoven A, Pannek J, Herde T, Senge T . In vitro comparison of two ballistic systems for endoscopic stone disintegration. J Endourol. 1996; 10(5):417-20. DOI: 10.1089/end.1996.10.417. View

14.

Lahme S . Miniaturisation of PCNL. Urolithiasis. 2017; 46(1):99-106. DOI: 10.1007/s00240-017-1029-3. View

15.

Axelsson T, Cracco C, Desai M, Hasan M, Knoll T, Montanari E . Consultation on kidney stones, Copenhagen 2019: lithotripsy in percutaneous nephrolithotomy. World J Urol. 2020; 39(6):1663-1670. PMC: 8217030. DOI: 10.1007/s00345-020-03383-w. View

16.

Zeng G, Wan S, Zhao Z, Zhu J, Tuerxun A, Song C . Super-mini percutaneous nephrolithotomy (SMP): a new concept in technique and instrumentation. BJU Int. 2015; 117(4):655-61. DOI: 10.1111/bju.13242. View

17.

Ibis M, Gokce M, Babayigit M, Yitgin Y, Karagoz M, Boyuk A . Could retrograde intrarenal surgery be a safe and effective alternative to mini-percutaneous nephrolithotomy ın the management of relatively large (20-30 mm) stones? A critical evaluation. Int Urol Nephrol. 2022; 54(9):2141-2148. DOI: 10.1007/s11255-022-03255-9. View

18.

Tokatli Z, Ibis M, Sarica K . Robot-Assisted Mini-Endoscopic Combined Intrarenal Surgery for Complex and Multiple Calculi: What Are the Real Advantages?. J Laparoendosc Adv Surg Tech A. 2022; 32(8):890-895. DOI: 10.1089/lap.2022.0124. View

19.

Antoniou V, Pietropaolo A, Somani B . Lithotripsy devices for percutaneous nephrolithotomy (PNL) - new developments. Curr Opin Urol. 2022; 32(4):405-410. DOI: 10.1097/MOU.0000000000000996. View

20.

Desai J, Solanki R . Ultra-mini percutaneous nephrolithotomy (UMP): one more armamentarium. BJU Int. 2013; 112(7):1046-9. DOI: 10.1111/bju.12193. View