ABSTRACT
OBJECTIVES: Our results in the treatment of distal ureteral calculus with pulsed dye lasertripsy (Pulsolith) and the EKL-Compact (Olympus) electrokinetic lithotriptor are analyzed. METHODS: The time interval compared was 12 months for both cases; lasertripsy was utilized in 57 and electrokinetic energy in 61 cases. All patients underwent IVP or radiological and/or US evaluation of the urinary tree to determine the size and location of the calculus, and a complete routine presurgical assessment. Epidural anesthesia was administered in all patients, as well as prophylactic antibiotics. The approach and endoscopic technique using the 7.9-9.8 FR ureteroscopes (Olympus), stone removal with long forceps and ureteral dilatation with the Uromat hydraulic pump are described. All but 9 patients had a 5 FR catheter indwelling for 24 hours to avoid the postureteroscopy colic pain caused by perilithiasic ureteral edema. RESULTS: Our success rate was 93% for both modalities of stone fragmentation. Fragmentation with ultrasound was required in 4 cases of failed lasertripsy and 3 cases of failed lithotripsy with electrokinetic energy. There were 7 cases with mucosal laceration from ureteroscope insertion and punctate mechanical perforation of the ureteral mucosa produced by the laser fiber. There were no complications with the use of EKL-C except for small areas of petechiae. CONCLUSION: Analysis of our results for both treatment modalities, as well as their advantages and disadvantages, showed stone fragmentation with the EKL-C to be the treatment of choice. We have utilized this system in our unit since December 1994 because of its efficacy. Furthermore, it is easy to use, to transport inside and outside the hospital, easy to assemble and low-cost.
