eMedicine Specialties > Urology > Stones

Intracorporeal Lithotripsy: Follow-up

Author: Michael Grasso, MD, Chairman, Department of Urology, Saint Vincent's Medical Center; Professor and Vice Chairman, Department of Urology, New York Medical College
Coauthor(s): Andrew Ira Fishman, MD, Staff Physician, Department of Urology, Saint Vincent Catholic Medical Center; Keith T Tracy, MD, Staff Physician, Department of Urology, New York Medical College, Westchester Medical Center
Contributor Information and Disclosures

Updated: Jul 2, 2008

Outcome and Prognosis

The endpoint of endoscopic lithotripsy has changed based on new technology. Stone extraction was once commonly used; today, however, devices such as the holmium laser allow the surgeon to safely convert the stone burden to fine particulate debris. This debris is partially irrigated from the collecting system during the procedure or allowed to pass over time.

  • Studies indicate that holmium:YAG lithotripsy is associated with shorter operative time and postoperative hospitalization period than lithoclast lithotripsy for ureteral stones. Data also suggest that holmium:YAG lithotripsy is safe and more effective than lithoclast lithotripsy, with significantly better immediate stone-free rates.
  • The holmium:YAG laser lithotripter can fragment and destroy all compositions of stone. The stone-free rate for ureteral stones approaches 100%. The overall success rate for ureteroscopic treatment of renal stones varies from 75-92%. Complications are rare and minimal when used with the current technique.
Ultrasonic lithotriptors used only through rigid endoscopes provide high fragmentation rates (97-100%) and stone-free rates (94%). Limitations are based primarily on failure of endoscopic access, since this class of lithotrite cannot be deflected significantly and is thus not complementary with semirigid or actively deflectable flexible ureteroscopes.

Future and Controversies

Traditional open surgical lithotomy procedures have been replaced by extracorporeal, intracorporeal, and percutaneous lithotripsy. Extracorporeal lithotripsy is the least invasive method for eliminating stones, but it has a relatively high failure rate with large stones, obstructing stones, cystine stones, and other complex stones. Intracorporeal lithotripsy is minimally invasive and yields high success rates with most ureteral stones and renal stones. The holmium:YAG laser is currently the most effective and widely used laser available today.  Current studies are investigating newer lasers and devices to continually improve the efficiency, cost, and visualization of stone fragmentation via an endoscopic approach.

Controversy still exists about the preferred endoscopic approach, percutaneously through the kidney versus ureteroscopically. The preferred approach is the one that, in the hands of the operator, offers the greatest chance of rendering the patient stone-free with the least morbidity and expense. Therefore, for most urologists, the preferred approach is strongly influenced by the number, size, location, and probable composition of the stone(s) and by the body habitus of the patient.

 


More on Intracorporeal Lithotripsy

Overview: Intracorporeal Lithotripsy
Workup: Intracorporeal Lithotripsy
Treatment: Intracorporeal Lithotripsy
Follow-up: Intracorporeal Lithotripsy
Multimedia: Intracorporeal Lithotripsy
References
Further Reading
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References

  1. Johnson DE, Cromeens DM, Price RE. Use of the holmium:YAG laser in urology. Lasers Surg Med. 1992;12(4):353-63. [Medline].

  2. Matsuoka K, Iida S, Nakanami M, et al. Holmium: yttrium-aluminum-garnet laser for endoscopic lithotripsy. Urology. Jun 1995;45(6):947-52. [Medline].

  3. Dubosq F, Pasqui F, Girard F, et al. Endoscopic lithotripsy and the FREDDY laser: initial experience. J Endourol. May 2006;20(5):296-9. [Medline].

  4. Kang HW, Lee H, Teichman JM, et al. Comparison of erbium:YAG versus holmium:YAG lithotripsy. J Urol. 2006;175 (Suppl 4):574.

  5. Marks AJ, Teichman JM. Lasers in clinical urology: state of the art and new horizons. World J Urol. Jun 2007;25(3):227-33. [Medline].

  6. Auge BK, Sekula JJ, Springhart WP, et al. In vitro comparison of fragmentation efficiency of flexible pneumatic lithotripsy using 2 flexible ureteroscopes. J Urol. Sep 2004;172(3):967-70. [Medline].

  7. Beaghler M, Poon M, Ruckle H, et al. Complications employing the holmium:YAG laser. J Endourol. Dec 1998;12(6):533-5. [Medline].

  8. Beiko DT, Denstedt JD. Advances in ureterorenoscopy. Urol Clin North Am. Aug 2007;34(3):397-408. [Medline].

  9. Bierkens AF, Hendrikx AJ, De La Rosette JJ, et al. Treatment of mid- and lower ureteric calculi: extracorporeal shock-wave lithotripsy vs laser ureteroscopy. A comparison of costs, morbidity and effectiveness. Br J Urol. Jan 1998;81(1):31-5. [Medline].

  10. Busby JE, Low RK. Ureteroscopic treatment of renal calculi. Urol Clin North Am. Feb 2004;31(1):89-98. [Medline].

  11. Chaussy C, Fuchs G, Kahn R, et al. Transurethral ultrasonic ureterolithotripsy using a solid-wire probe. Urology. May 1987;29(5):531-2. [Medline].

  12. Denstedt JD, Clayman RV. Electrohydraulic lithotripsy of renal and ureteral calculi. J Urol. Jan 1990;143(1):13-7. [Medline].

  13. Denstedt JD, Eberwein PM, Singh RR. The Swiss Lithoclast: a new device for intracorporeal lithotripsy. J Urol. Sep 1992;148(3 Pt 2):1088-90. [Medline].

  14. Dretler SP, Watson G, Parrish JA, et al. Pulsed dye laser fragmentation of ureteral calculi: initial clinical experience. J Urol. Mar 1987;137(3):386-9. [Medline].

  15. Elbahnasy AM, Shalhav AL, Hoenig DM, et al. Lower caliceal stone clearance after shock wave lithotripsy or ureteroscopy: the impact of lower pole radiographic anatomy. J Urol. Mar 1998;159(3):676-82. [Medline].

  16. Erhard MJ, Bagley DH. Urologic applications of the holmium laser: preliminary experience. J Endourol. Oct 1995;9(5):383-6. [Medline].

  17. Fabrizio MD, Behari A, Bagley DH. Ureteroscopic management of intrarenal calculi. J Urol. Apr 1998;159(4):1139-43. [Medline].

  18. Goodfriend R. Disintegration of ureteral calculi by ultrasound. Urology. Mar 1973;1(3):260-3. [Medline].

  19. Grasso M. Experience with the holmium laser as an endoscopic lithotrite. Urology. Aug 1996;48(2):199-206. [Medline].

  20. Grasso M. Ureteropyeloscopic treatment of ureteral and intrarenal calculi. Urol Clin North Am. Nov 2000;27(4):623-31. [Medline].

  21. Grasso M, Beaghler M, Loisides P. The case for primary endoscopic management of upper urinary tract calculi: II. Cost and outcome assessment of 112 primary ureteral calculi. Urology. Mar 1995;45(3):372-6. [Medline].

  22. Grasso M, Conlin M, Bagley D. Retrograde ureteropyeloscopic treatment of 2 cm. or greater upper urinary tract and minor Staghorn calculi. J Urol. Aug 1998;160(2):346-51. [Medline].

  23. Grasso M, Ficazzola M. Retrograde ureteropyeloscopy for lower pole caliceal calculi. J Urol. Dec 1999;162(6):1904-8. [Medline].

  24. Grasso M, Loisides P, Beaghler M, et al. The case for primary endoscopic management of upper urinary tract calculi: I. A critical review of 121 extracorporeal shock-wave lithotripsy failures. Urology. Mar 1995;45(3):363-71. [Medline].

  25. Hofbauer J, Hobarth K, Marberger M. Lithoclast: new and inexpensive mode of intracorporeal lithotripsy. J Endourol. 1992;6:429.

  26. Jeon SS, Hyun JH, Lee KS. A comparison of holmium:YAG laser with Lithoclast lithotripsy in ureteral calculi fragmentation. Int J Urol. Jun 2005;12(6):544-7. [Medline].

  27. Knudsen BE, Glickman RD, Stallman KJ, et al. Performance and safety of holmium: YAG laser optical fibers. J Endourol. Nov 2005;19(9):1092-7. [Medline].

  28. Leveillee RJ, Lobik L. Intracorporeal lithotripsy: which modality is best?. Curr Opin Urol. May 2003;13(3):249-53. [Medline].

  29. Raney AM. Electrohydraulic lithotripsy: experimental study and case reports with the stone disintegrator. J Urol. Mar 1975;113(3):345-7. [Medline].

  30. Weizer AZ, Springhart WP, Ekeruo WO, et al. Ureteroscopic management of renal calculi in anomalous kidneys. Urology. Feb 2005;65(2):265-9. [Medline].

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Further Reading

For additional information on stone disease, see Medscape’s Stone Disease Resource Center.

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Keywords

intracorporeal lithotripsy, endoscopic lithotripsy, stone removal, stone fragmenting, calculus removal, kidney stone, urinary tract calculi, ultrasonic lithotripsy, US lithotripsy, electrohydraulic lithotripsy, EHL lithotripsy, laser lithotripsy, endoscopic stone removal, urinary tract endoscopy, urologic endoscopy, ureteroscopic lithotripsy, ureteral stones, mechanical lithotripsy, ballistic lithotripsy, renal stones, Lithoclast, FREDDY laser, holmium:YAG laser, erbium:YAG laser, thulium:YAG laser, retrograde ureteroscopic lithotripsy, percutaneous nephrostolithotomy, pulsed-dye laser lithotripsy, Ho:YAG laser lithotripsy, Nd:YAG laser lithotripsy

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Contributor Information and Disclosures

Author

Michael Grasso, MD, Chairman, Department of Urology, Saint Vincent's Medical Center; Professor and Vice Chairman, Department of Urology, New York Medical College
Michael Grasso, MD is a member of the following medical societies: American Medical Association, American Urological Association, California Medical Association, and Endourological Society
Disclosure: Nothing to disclose.

Coauthor(s)

Andrew Ira Fishman, MD, Staff Physician, Department of Urology, Saint Vincent Catholic Medical Center
Andrew Ira Fishman, MD is a member of the following medical societies: American Medical Association and American Urological Association
Disclosure: Nothing to disclose.

Keith T Tracy, MD, Staff Physician, Department of Urology, New York Medical College, Westchester Medical Center
Keith T Tracy, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, and American Urological Association
Disclosure: Nothing to disclose.

Medical Editor

Erik T Goluboff, MD, Assistant Professor, Program Director, Department of Urology, Columbia-Presbyterian Medical Center, Columbia University
Erik T Goluboff, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, American Urological Association, Medical Society of the State of New York, New York Academy of Medicine, Phi Beta Kappa, and Society for Basic Urologic Research
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

CME Editor

J Stuart Wolf, Jr, MD, FACS, David A Bloom Professor of Urology, Director, Division of Minimally Invasive Urology, Department of Urology, University of Michigan Medical Center
J Stuart Wolf, Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, and Society of University Urologists
Disclosure: Terumo Corporation Consulting fee Consulting; Omeros Corporation Consulting fee Consulting

Chief Editor

Stephen W Leslie, MD, FACS, Founder and Medical Director, Lorain Kidney Stone Research Center; Clinical Assistant Professor, Department of Urology, University of Toledo
Stephen W Leslie, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, National Kidney Foundation, and Ohio State Medical Association
Disclosure: Nothing to disclose.

 
 
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