Shock pulse & trilogy

• 02 Sep 2021 10:25:04 PM
• |Endo Urology

Advances in PCNL revolves around 3 things – reduction in size of sheath, incorporating suction & energy sources. Sheath size is reduced from conventional to microperc (4.85F). Suction can be incorporated on 2 ways – on sheath & on energy sources. When we were resident that time, Ultrasonic lithotripsy was the only way to break the stones. It was powerful energy with excellent suction but too high maintenance cost. Hence  when lithoclast came it, Ultrasonic just disappeared even though it had some fantastic features. As sheath size decreased, laser became mainstay. Even lasers have changed from Nd Yag to holmium to MOSES to pulse width modifier, & now thulium. However recently some more energy sources are introduced mostly for large bulk stones. Those are shock pulse & trilogy.

We were lucky to use both. Shock pulse is combination of ultrasonic & ballistic manufactured by Olympus. While trilogy is combination of Ultrasonic with electromagnetic manufactured by Swiss EMS. In principle both are same with minor differences. Both work very effectively & extremely useful for large bulk stones. Both have wide range of probe sizes which can be used for miniperc, slender as well as for conventional PCNL. Trilogy has some benefit as all 4 components like suction, impact, ultrasonic & frequency can be adjusted by touch panel. However disadvantage from Indian perspective is disposable (single use) probe. I am attaching a publication which compares trilogy & shock pulse. Authors concluded not to have much difference between both energy sources. Our experience is also the same.

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