1 3 World J Urol DOI 10.1007/s00345-017-2057-x TOPIC PAPER Stone technology: intracorporeal lithotripters Kymora B. Scotland 1 · Tadeusz Kroczak 2 · Kenneth T. Pace 2 · Ben H. Chew 1 Received: 23 February 2017 / Accepted: 31 May 2017 © Springer-Verlag GmbH Germany 2017 Introduction Intracorporeal lithotripsy provides a minimally invasive means of stone management. Unlike extracorporeal shock wave lithotripsy (ESWL), contemporary intracorporeal lithotripters are used under direct visualization, allowing for real-time confirmation of stone treatment. Use of the various modalities of intracorporeal lithotripters has now all but eclipsed open surgical methods of treating urinary calculi. Indeed, intracorporeal lithotripsy is now recom- mended by both the AUA and EAU as the preferred treat- ment option for percutaneous nephrolithotomy and is increasingly used and recommended for the management of ureteral and bladder calculi [1, 2]. This review aims to provide an overview of the various types of intracorporeal lithotripters. This will include a discussion of the mechan- ics of each instrument and/or a comparison of their uses and effectiveness of action. One way of classifying these lithotripters is by mechanism of action. They can be cat- egorized into mechanical, ultrasonic, combination, electro- hydraulic, and laser lithotripters. Mechanical lithotripters Mechanical lithotripters include ballistic lithotripters as well as the manually operated bladder calculus fragmenters which were the first lithotripters to be developed. The his- tory of lithotripsy began in the early 1800s with physicians attempting intravesical means of treating stones. Franz von Gruithuisen developed the first model of a function- ing lithotrite, the Steinbohrer or stone drill in 1813. It was designed to drill holes into bladder calculi [3]. The term lithotrite was coined by Jean Civiale who developed the Abstract Purpose Intracorporeal lithotripsy is becoming the most commonly used surgical method of stone treatment in Urol- ogy. The five major types of intracorporeal lithotripters are ultrasonic, ballistic, and combination lithotripters as well as laser and electrohydraulic lithotripters. The advantages and disadvantages of choosing each of these treatment modali- ties are reviewed. Methods Extensive review of literature was performed to identify the types of intracorporeal lithotripters. An inves- tigation was undertaken of the early development of each modality of intracorporeal lithotripsy and/or the mechanism of action. Challenges of each technique were identified and presented. Finally, a determination was made of how these lithotripters compare on the basis of effectiveness of action and cost based on information provided in primary litera- ture as well as previous reviews of these modalities. Results Contemporary lithotripters have found widespread use in the management of urinary lithiasis. Holmium laser lithotripsy has become one of the most commonly used tools for intracorporeal lithotripsy. Conclusion There is a wide variety of intracorporeal lithotripters which can be chosen based on the characteris- tics of each modality and the requirements of the urologist. Keywords Nephrolithiasis · Lithotripsy · Lithotrites · Percutaneous nephrolithotomy * Ben H. Chew ben.chew@ubc.ca 1 University of British Columbia, Level 6 - 2775 Laurel St., Vancouver, BC, V5Z 1M9, Canada 2 University of Toronto, Ontario, Canada