Editorial comment

Mechanical intracorporeal lithotripsy devices such as ultrasound and the pneumatically driven Swiss Lithoclast have been the primary units used during percutaneous nephrolithotripsy during the past decade. In general terms, ultrasound lithotripsy is somewhat less efficient for very hard stones, yet does have the unique advantage of simultaneous evacuation of stone fragments. The Lithoclast, on the other hand, rapidly fragments the hardest stones but has the disadvantage of the surgeon then tediously removing the resultant fragments with grasping forceps. There have been strong proponents of both modalities, largely based, one would suspect, on experience and personal preference rather than any form of scientific comparison either in vitro or by way of clinical trials. For those privileged to have both devices, as in our own unit, it was commonplace to connect, activate, and use both to make use of the combined advantages of each. Although neither have a disposable component, the process of using both was cumbersome for nursing personnel and for the surgeon who was faced with multiple exchanges and the introduction of different probes throughout the procedure. The new combined unit presented in this report provides the advantages of both in a single probe and device. The authors convincingly demonstrate an increased efficiency of stone fragmentation with the combined device. Although use of the combination unit is preferable in most situations, the surgeon still has the option of using either the ultrasound or pneumatic component alone if desired, by simply using the appropriate foot pedal. Efficient conduct of any surgical procedure is important, but especially so during percutaneous nephrolithotomy with the potential for significant fluid shifts, bleeding, or hypothermia. Having had the opportunity to use the new combined unit in more than 50 cases, I believe the efficiency described by these authors in vitro is likely to be translated into a similar advantage during clinical percutaneous stone surgery.