Comparative Evaluation Between One Ultrasonic and Two Single-Probe Dual-Energy Lithotripters: In Vitro and In Vivo Experiment in a Porcine Model.

Objective: To investigate the efficiency of three advanced lithotripters during the treatment of artificial stones (hard and soft) in an experimental in vitro and in vivo setting. Materials and Methods: An experimental configuration was created to treat artificial stones, made from BegoStone Plus in a weight ratio of 15:3 or 15:6 powder to water, replicating hard and soft urinary stones, respectively. Experimental data of three lithotripters, the Lithoclast Master, the Lithoclast Trilogy, and the ShockPulse-SE, were assessed. Experiments aimed at comparing the stone clearance times (SCTs) of the devices as well as different probe diameters, probe disposability, and hardness of the stones. The in vivo experiment was performed in a porcine model after the approval from the State Services. Before in vivo lithotripsy, stones had been placed through percutaneous access established by using the Bull's eye technique. The SCT between the Lithoclast Trilogy and the ShockPulse-SE was compared. Results: All the devices were statistically more efficient in the treatment of soft stones in both in vitro (p < 0.001) and in vivo settings (p < 0.008). The use of larger-diameter probes resulted in shorter SCT (p < 0.007). The disposable probes of the ShockPulse-SE showed higher performance than the multiple-use probes (p < 0.05). In the direct comparison between the devices, the Lithoclast Trilogy was found to be the fastest during all the in vitro (p < 0.001) and in vivo (p < 0.008) trials. Conclusion: Modern dual-energy lithotripters proved to possess high performance in the treatment of stones. Faster SCTs were observed by using the larger-diameter and disposable probes. The Lithoclast Trilogy was superior in terms of SCT over all the experimental settings compared with other lithotripters.