Comparison of the Nanopulse Lithotripter to the Holmium Laser: Stone Fragmentation Efficiency and Impact on Flexible Ureteroscope Deflection and Flow

作者：Kaplan Adam G^*; Chen Tony T; Sankin Georgy; Yang Chen; Dale Joanne A; Simmons W Neal; Zhong Pei; Preminger Glenn M; Lipkin Michael Eric

来源：Journal of Endourology, 2016, 30(11): 1150-1154.

DOI：10.1089/end.2016.0228

• holmium laser
• instrumentation
• lithotripsy
• nanoelectric pulse
• nanopulse
• ureteroscopy

Introduction: The Nanopulse Lithotripter (NPL; Lithotech Medical, Israel) is a novel intracorporeal device that uses a nanosecond duration electrical discharge through a reusable flexible coaxial probe to endoscopically fragment urinary stones. This device was compared with a holmium laser lithotripsy (HoL) with regard to stone fragmentation efficiency (SFE) and its impact on flexible ureteroscope (URS) deflection and flow of irrigation.
Methods: Using a custom bench model, a 6mm BegoStone cylindrical phantom (mixture 5: 2) was confined under 0.9% saline atop sequential mesh sieves. The SFE of two NPL probe sizes (2.0F, 3.6F) and two HoL fibers (200, 365 mu m) was evaluated using concordant settings of 1 J and 5 Hz. URS deflection and irrigation flow with NPL probes in the working channel were tested in five new fourth generation flexible URS and compared with other adjunct endourologic instruments.
Results: The 2.0F NPL showed improved SFE compared with the 200 lm laser (86 mg/min vs 52 mg/min, p = 0.014) as did the 3.6F NPL vs the 365 lm laser (173 mg/min vs 80 mg/min, p = 0.05). The NPL created more 1 to 2mm fragments; the laser created more dust. URS deflection reduced by 3.75 degrees with the 2.0 NPL probe. URS irrigation flow reduced from 36.5 to 6.3 mL/min with the 2.0F NPL probe.
Conclusion: NPL shows improved SFE compared with HoL. Flow with the 2.0F probe is akin to a stone basket. NPL offers an effective alternative to HoL.

• 出版日期2016-11