Intracorporeal Lithotripsy: Electrohydraulic, Pneumatic, and Ultrasonic

Abstract

The evolution of ureteroscopy using electrohydraulic lithotripsy (EHL), pneumatic lithotripsy (PL), and ultrasonic lithotripsy (USL) for the treatment of ureteral stones offered a much less invasive alternative to contemporary open ureterolithotomy, and a was major advancement for the fledgling field of endourology. As new energy sources became widely available, studies examining the safety, efficacy, and cost sought to determine the one best modality to treat ureteral stones. EHL, while efficient and safe for treatment of bladder stones proved to be too powerful to use for the treatment of most stones within the ureter. USL and PL were safer and often times more efficient than EHL, but the breadth of their applicability was somewhat limited by the rigid nature of their probes. The advent of shock wave lithotripsy and laser lithotripsy, and their subsequent widespread affordability and availability, eclipsed other energy sources as the first-line treatment for ureteral stones. Contemporaneous and modern clinical studies however prove that the traditional lithotrites, including EHL, PL, and USL, still have utility and can be especially effective when cost constraints dictate equipment choice.