Stone Fragmentation and Extraction

  • András HoznekEmail author
  • Michael N’Tege Kimuli
  • Cesare Marco Scoffone


Once an adequate percutaneous tract is created, the next step is to clear the stone. The fragmentation and extraction strategies should be tailored according to stone (hardness, location, size, and burden) and instrument (chosen size of the Amplatz sheath, diameter of the working channel of the endoscope in use) factors. Such strategies are similar in both prone and supine position, in spite of the fact that the slightly downward inclination of the Amplatz sheath in the supine position favors fragments’ spontaneous evacuation. Various tips and tricks, like the variety of laser settings with their different effects or the vacuum-cleaner effect, are described.


Calcium Oxalate Stone Fragment Calcium Oxalate Monohydrate Calcium Oxalate Dihydrate Staghorn Stone 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Hemal AK, Goel A, Aron M et al (2003) Evaluation of fragmentation with single or multiple pulse setting of Lithoclast for renal calculi during percutaneous nephrolithotripsy and its impact on clearance. Urol Int 70:265–268PubMedCrossRefGoogle Scholar
  2. 2.
    Nerli RB, Koura AC, Prabha V et al (2008) Use of LMA Stonebreaker as an intracorporeal lithotrite in the management of ureteral calculi. J Endourol 22:641–644PubMedCrossRefGoogle Scholar
  3. 3.
    Chew BH, Arsovska O, Lange D et al (2011) The Canadian StoneBreaker trial: a randomized, multicenter trial comparing the LMA StoneBreaker and the Swiss LithoClast(R) during percutaneous nephrolithotripsy. J Endourol 25:1415–1419PubMedCrossRefGoogle Scholar
  4. 4.
    Alken P (2010) PNL for staghorn stones. In: Rane AM, Desai M, Keeley FX (eds) Top tips in endourology. Euromed Communications, Passfield, pp 20–24Google Scholar
  5. 5.
    Clayman RV (2000) Nephroscopy sheath characteristics and intrarenal pressure: human kidney model. J Urol 163:1616PubMedGoogle Scholar
  6. 6.
    Lahme S, Bichler KH, Strohmaier WL, Gotz T (2001) Minimally invasive PCNL in patients with renal pelvic and calyceal stones. Eur Urol 40:619–624PubMedCrossRefGoogle Scholar
  7. 7.
    Lahme S, Zimmermanns V, Hochmuth A, Janitzki V (2008) Minimally invasive PCNL (mini-perc). Alternative treatment modality or replacement of conventional PCNL? Urologe A 47:563–568PubMedCrossRefGoogle Scholar
  8. 8.
    Nagele U, Schilling D, Sievert KD (2008) Management of lower-pole stones of 0.8 to 1.5 cm maximal diameter by the minimally invasive percutaneous approach. J Endourol 22:1851–1853, discussion 7PubMedCrossRefGoogle Scholar
  9. 9.
    Hoffman N, Lukasewycz SJ, Canales B et al (2004) Percutaneous renal stone extraction: in vitro study of retrieval devices. J Urol 172:559–561PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag France 2014

Authors and Affiliations

  • András Hoznek
    • 1
    Email author
  • Michael N’Tege Kimuli
    • 2
  • Cesare Marco Scoffone
    • 3
  1. 1.Department of UrologyCHU Henri MondorCréteil CedexFrance
  2. 2.Pyrah Department of UrologySt James’s University HospitalLeedsUK
  3. 3.Department of UrologyCottolengo HospitalTorinoItaly

Personalised recommendations