Trial Comparing Three Different Devices for Kidney Stone Removal During Percutaneous Surgery

Randomized Controlled Trial Comparing Three Different Modalities of Newer Lithotrites For Intracorporeal Lithotripsy

The investigators plan to compare three different devices that are used to break up large kidney stones during surgery for removal to see if one is faster or more efficient than the others.

Large kidney stones can be removed by a surgical procedure where a small puncture is made through the back into the kidney (percutaneous nephrolithotomy or PNL) but the stones usually need to be broken into smaller pieces before they can be removed through the small surgical incision. There are a number of FDA approved devices commercially available used to break up the stones including pneumatic, ultrasonic, and a combination of the two. Each technology has advantages and disadvantages. In the last few years there have been new, improved versions of these devices introduced. These improved versions have addressed previous issues of probes clogging or breaking and cumbersome handpiece design. These include the Cyberwand (Cybersonics, Erie, PA), a dual probe ultrasonic device, Swiss Lithoclast Select (EMS, Switzerland) combining the pneumatic and ultrasonic modalities, and a novel device by LMA (Gland, Switzerland) called the StoneBreakerTM, a portable pneumatic device powered by CO2 cartridges. We propose to compare each of these devices in a randomized study to see if one is better than another at removing kidney stones quickly and efficiently.

Lithoclast Select will be used to breakup and remove kidney stone. Duration will be timed and documented.

The dual probe Cyberwand device will be used to fragment and remove the kidney stone. Duration will be timed and documented.

Dual probe lithotrite Cyberwand will be used to remove kidney stone. Duration will be timed and documented.

Lithoclast Select will be used to break up and remove the kidney stone. Duration will be timed and documented

Clearance rate was calculated by dividing the surface area of the targeted stone (mm2) by the total clearance time (min)

collected intraoperatively from the time stone breakage begins to end of stone removal with a stone extraction basket

Participants requiring a nephrostomy tube to be placed at the end of the initial stone removal procedure

Number of participants in which another stone breakage device was used in addition to the study-assigned lithotrite

Inclusion Criteria: Scheduled to undergo percutaneous nephrolithotomy for at least one kidney stone measuring 2 cm or greater Stone easily visible/measurable on plain abdominal imaging (KUB) or CT scan preoperatively Age 18 years or older Able to give informed consent Exclusion Criteria: Size of single largest stone less than 2 cm Pregnancy Active urinary tract infection Extracorporeal shockwave lithotripsy within the last three months Complex stone anticipating multiple access sites Stones that are not clearly able to be measured on KUB or CT scan Inability to give informed consent Age less than 18 years