Purpose: The Lithoclast Ultra (Boston Scientific Corporation, Natick, MA) enables the simultaneous application of ultrasonic and pneumatic modalities for the fragmentation and removal of stones during percutaneous nephrolithotomy (PCNL). We evaluated the effectiveness of this unit using a hands-free in vitro testing system. Materials and Methods: An in vitro test system was used to assess the efficiency of stone penetration when the Lithoclast Ultra was operated at different settings of ultrasonic power and pneumatic frequency. The pneumatic and ultrasonic handpieces were assembled, the probes were inserted into an irrigation sheath (Cook Urological, Spencer, IN), and the complete unit was mounted upright (probe tip up). A gypsum artificial stone (mean length 12.8 ± 0.6 mm; mean diameter 7.6 ± 0.1 mm) was centered on the probe tip. A weight (63.4 g) was placed atop the stone to provide a constant force. Pneumatic frequency settings of 12, 8, 4, and 1 Hz were tested in conjunction with ultrasonic power settings of 100%, 70%, and 40%. The times required for complete stone penetration were assessed for each combination of settings. Differences in mean stone penetration times were compared using ANOVA. Results: The combination of 12 Hz and 100% produced the fastest mean stone penetration time (8.9 ± 1.1 seconds). Stone penetration times decreased significantly with increases in pneumatic frequency (P < 0.001) as well as with increases in ultrasonic power (P = 0.001). When analyzing the effect of each modality on the total improvement in penetration time, increasing the pneumatic frequency accounted for approximately 80% of the performance improvement. The stone penetration times were better than those of the most efficient ultrasonic device previously evaluated using this test system. Conclusions: The Lithoclast Ultra exhibited excellent stone penetration efficiency when evaluated with a hands-free in vitro test system. Increases in either pneumatic frequency or ultrasonic power significantly improve penetration times, with the pneumatic modality contributing the majority of the effect.
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