Efficacy and safety of the EMS Swiss LithoClast® Trilogy for PCNL: results of the European multicentre prospective study on behalf of European Section of UroTechnology.

PURPOSE: PCNL requires a lithotrite to efficiently break stones, and some devices include active suction to remove the fragments. We set out to determine the efficacy and safety of the Swiss LithoClast® Trilogy, in a prospective European multicentre evaluation and compared it to published stone clearance rates for Trilogy based on surface area (68.9 mm2/min) and using the 3D calculated stone volume (526.7 mm3/min). METHODS: Ten European centres participated in this prospective non-randomized study of Trilogy for PCNL. Objective measures of stone clearance rate, device malfunction, complications and stone-free rates were assessed. Each surgeon subjectively evaluated ergonomic and device effectiveness, on a 1-10 scale (10 = extremely ergonomic/effective) and compared to their usual lithotrite on a 1-10 scale (10 = extremely effective). RESULTS: One hundred and fifty seven PCNLs using Trilogy were included (53% male, 47% female; mean age 55 years, range 13-84 years). Mean stone clearance rate was 65.55 mm2/min or 945 mm3/min based on calculated 3D volume. Stone-free rate on fluoroscopy screening at the end of the procedure was 83%. Feedback for suction effectiveness was 9.0 with 9.1 for combination and 9.0 for overall effectiveness compared to lithotrite used previously. Ergonomic score was 8.1, the least satisfactory element. Complications included 13 (8.2%) Clavien-Dindo Grade II and 2 (1.3%) Grade III. Probe breakage was seen in 9 (5.7%), none required using a different lithotrite. CONCLUSIONS: We have demonstrated that Trilogy is highly effective at stone removal. From a user perspective, the device was perceived by surgeons to be highly effective overall and compared to the most commonly used previous lithotrite, with an excellent safety profile.

Gustative sensitivity to glucose improvement in diabetics after sulphonylurea.

Sensitivity of the gustatory receptor to glucose has been studied in 20 diabetic patients given tolbutamid and glibenclamid as treatment or examined in the tolbutamid tolerance test (TTT). Tolbutamid and glibenclamid treatment significantly improves the diabetic taste for glucose, both for detection threshold (DT) (p less than 0.01) and recognition threshold (RT) (p less than 0.001). Also in TTT there is a significant improvement of taste reception: DT falls at 2 h (p less than 0.05), RT falls more slowly at 3 h (p less than 0.05). There is no direct correlation between perception for sweet and glycemia and insulinemia increase in TTT. Our results suggest that glucose receptivity is dependent on a receptor glucose-insulin complex, and tolbutamid (and glibenclamid) besides its capacity to stimulate insulin secretion has even a peripheral action, at this receptor level.