Intracorporeal lithotripsy of salivary stones: in vitro comparison of different methods.

PURPOSE: Intracorporeal lithotripsy is a gland-preserving treatment option for sialolithiasis. Laser lithotripsy (LL) and pneumatic lithotripsy (PL) are the only two methods currently approved, the latter being no longer available. Electrokinetic lithotripsy (EKL) is a promising alternative used for the treatment of ureteral stones. The aim of this study is to compare efficacy and therapeutical safety of EKL with LL and PL.

METHODS

StoneBreaker® (PL), Lithotron EL 27 Compact (EKL) and Ho:YAG laser Auriga (LL) were assessed using in vitro setups with human salivary stones, casted and tumbled stones. Efficacy was measured by the number of impulses and time taken until fragmentation. Parameters for therapeutical safety were number of impulses until perforation, propulsion, duct widening, number of tears and tear length.

RESULTS

Efficacy of EKL was higher than LL but lower than PL. The fragmentation of casted stones took 01:50 ± 00:28 min with PL, 02:49 ± 00:37 min with EKL and 05:12 ± 00:58 min with LL (Mann-Whitney-U test p < 0.01). LL caused the lowest propulsion (0.0 ± 0 cm, n = 20); the highest propulsion was observed for PL (3.5 ± 0.7 cm, n = 20). In the gelatin setup, LL induced the most extensive damage (damage index: 5.9 ± 2.9, n = 15). LL was the fastest to cause perforation in the parotid duct (1 ± 0 impulses until perforation, n = 10).

CONCLUSION

Efficacy and safety of EKL are between those of LL and PL. Therefore, clinical testing of EKL seems to be justified.