Pneumatic lithotripsy applied through deflected working channel of miniureteroscope: Results in 143 patients

Although extracorporeal shockwave lithotripsy (SWL) is a successful treatme nt for ureteral calculi, introduction of miniureteroscopes has advanced end oscopic management, We combined the use of a semirigid ureteroscope with a pneumatic lithotripter (Swiss Lithoclast(TM)) for the treatment of ureteral calculi, From January 1992 to August 1994, 143 patients (87 male, 56 femal e; mean age 48.7 years; age range 22-74 years) with urolithiasis underwent endoscopic Lithotripsy with the Swiss Lithoclast under general anesthesia, The 0.8 mm probe was inserted through the deflected working channel (3.4F) of the MiCro.6L(TM) ureteroscope (tip diameter 6.9F), The calculi were in t he distal (N = 96; 67.1%), mid (N = 34; 23.8%), and proximal part (N 13; 9. 1%) of the ureter, The mean stone size was 6.8 mm (range 5-26 mm), Of the 1 37 patients whose stones we could access adequately, 70 (51.1%) were stone free immediately after the procedure, and another 31 (22.6%) had residual f ragments <3 mm that passed spontaneously. The remaining 36 patients underwe nt another 50 procedures; 30 SWL sessions in 26 patients (19%), 17 further endoscopic lithotripsies in 14 (10.2%), and open surgery in 3, Application of the Swiss Lithoclast through semirigid miniureteroscopes is highly effec tive for endoscopic lithotripsy, regardless of stone composition. Deflectio n of the probe up to 30 degrees did not impair the disintegration rate, Bec ause of the high migration rate of mid and proximal ureteral stones, the Sw iss Lithoclast is not recommended in these cases as a primary procedure. Lo w capital cost and simple and safe handling are the device's major advantag es over laser lithotripsy.