ABSTRACT
BACKGROUND AND PURPOSE: Percutaneous nephrolithotripsy (PCNL) is the treatment of choice for patients with large renal stones. The StoneBreaker™ (SB) is a novel handheld pneumatic lithotriptor, powered by a compressed carbon dioxide cartridge. The purpose of this study was to compare the efficiency of the SB to a standard pneumatic lithotriptor, the Swiss LithoClast(®) (LC). PATIENTS AND METHODS: From January 2008 to December 2009, patients undergoing PCNL were randomized to either the SB or the Swiss LC. Primary outcomes included time to fragment the stone, retrieve the fragments, and remove debris using ultrasonic lithotripsy. Secondary end points were stone-free rate, lithotriptor setup time, ease of use, operator fatigue, endoscopic visualization, damage to mucosa, and device-related complications. RESULTS: Of the initial 115 patients recruited, 77 were enrolled and 38 were excluded. The SB had significantly faster stone fragmentation time, total lithotripsy time, and setup time than the Swiss LC (P ≤ 0.05). A significant difference was also noted in the ease of use and operator fatigue in favor of the SB. There were no device-related complications. CONCLUSION: The SB pneumatic lithotriptor is easier to set up and use, and it provides faster stone fragmentation than the Swiss LC.
Subject(s)
Kidney Calculi/surgery , Lithotripsy/instrumentation , Female , Humans , Kidney Calculi/pathology , Male , Middle Aged , Time FactorsABSTRACT
A respective review was performed of 18 patients presenting with spermatic cord sarcomas over a 28 year period to determine factors predictive of local recurrence and disease-specific survival. Factors assessed at predictors of local recurrence included tumor grade, histology, positive surgical margins, and inadequate excision, defined as scrotal violation or excisional biopsy. In addition to these factors, local recurrence and the presence of hematogenous metastasis were evaluated as predictors of disease-specific survival. Nine patients were originally treated with radical orchiectomy; 2 underwent trans-scrotal orchiectomy; 6 had an excisional biopsy; and 1 had scrotal exploration followed by radical orchiectomy. The presence of positive surgical margins was a significant predictor of early local recurrence on univariate analysis. Local recurrence and the presence of hematogenous metastasis were significant predictors of disease-specific survival on univariate analysis. This emphasizes the importance of radical orchiectomy with local excision in the management of spermatic cord sarcomas.
