Comparison of Percutaneous Nephrolithotomy Using Pneumatic Lithotripsy (Lithoclast(R)) Alone or in Combination with Ultrasonic Lithotripsy

PURPOSE: Percutaneous nephrolithotomy (PCNL) is the procedure of choice for treating large renal stones. Pneumatic lithotripsy (Lithoclast(R)) is effective regardless of the stones' composition, and ultrasonic lithotripsy allows the aspiration of small debris during lithotripsy. We investigated the efficacy and safety of PCNL via Lithoclast(R) alone or combined with ultrasonic lithotripsy. MATERIALS AND METHODS: Thirty-five (group A) and 39 (group B) patients underwent Lithoclast(R) PCNL and combination therapy, respectively, from May 2001 to March 2010, and the two groups were compared in terms of stone size, location, and composition; operative time; average number of treatments; hospital days; hemoglobin loss; ancillary procedures; rate of device failure; and initial and total stone-free rates. RESULTS: The two groups did not differ significantly in preoperative stone size, location, or composition; the average number of treatments; or the initial and overall stone-free rates. However, combination therapy was associated with a significantly lower operative time (181+/-50 vs. 221+/-65 min, respectively, p=0.004), number of hospital days (11.6+/-3.8 vs. 14.2+/-4.4 days, respectively, p=0.009), and average hemoglobin loss (1.12+/-0.61 vs. 1.39+/-1.02 g/dl, respectively, p=0.013). Transfusions were required in 6 patients (4 and 2 in each group, respectively), but there were no significant complications related to percutaneous access. There were 2 (5.7%) mechanical failures (Lithoclast(R) probe fracture) in the group A and 5 (12.8%) in the group B (2 cases of suction tube obstruction, 3 cases of overheating). CONCLUSIONS: The combination of ultrasonic lithotripter and Lithoclast(R) is more effective than Lithoclast(R) alone because it significantly decreases operative time, hemoglobin loss, and the hospital stay. This may reflect the superior power of Lithoclast(R) and the ability to aspirate the debris during ultrasonic lithotripsy.

Staghorn Stones Combined with Transitional Cell Carcinoma of the Renal Pelvis

Longstanding, unrecognized staghorn stones remain a major cause of morbidity in the form of pain, infection, and functional impairment of the affected kidney. Squamous cell carcinoma of the upper urinary tract is associated with stone disease and chronic infection, but the association with transitional cell carcinoma (TCC) has not been proven. We report a case of a 73-year-old man presenting with right flank pain with episodes of total gross hematuria for 1 year. An abdominopelvic computed tomography scan showed decreased parenchymal enhancement and staghorn stones in the right renal pelvis and multiple tiny calyceal stones with severe hydronephrosis. The patient underwent a simple nephrectomy. Histopathologic analysis revealed staghorn stones combined with high-grade papillary TCC of the renal pelvis. The tumor was extended into the peripelvic fat and renal parenchyme (pT3NoMo).