Clinical efficacy of combined lithoclast and lithovac stone removal duringureteroscopy

Purpose: Pneumatic lithotripsy has proved to be an extremely safe, efficien t and low cost intracorporeal fragmentation modality. Unfortunately proxima l migration of fragments into inaccessible areas in the intrarenal collecti ng system is a potential limitation during ureteroscopic procedures. Moreov er, the lack of an efficient mechanism of stone retrieval further limits th e widespread application of this technique. The newly developed Lithovac da gger suction device was designed to be combined with pneumatic lithotripsy during ureteroscopic stone removal. We evaluated the effectiveness of this combination for overcoming these limitations. Materials and Methods: Between February and December 1998, 21 patients unde rwent pneumatic lithotripsy of ureteral calculi combined with use of the Li thovac suction probe. Stone area was 20 to 320 mm.(2) (mean 84). Of the sto nes 71% and 29% were in the distal, and proximal and/or mid meter, respecti vely. We used a 0.8 mm. pneumatic lithotripsy probe placed through a 4.8Fr Lithovac probe at a pulse frequency of 12 Hz. and pressure of 2 atmospheres . Results: Mean operative time was 42 minutes and the stone fragmentation rat e was 100%. There were no complications in our series and no proximal migra tion of fragments. The overall stone-free rate was 95% at 3-month followup. Conclusions: Using the Lithovac suction device greatly facilitates pneumati c lithotripsy during ureteroscopic stone removal. This combination not only prevents fragment migration, but also aids in maintaining a clear endoscop ic field of view, allowing efficient, safe and effective stone fragmentatio n.