1837 SHOCKWAVE LITHOTRIPSY: IS ITS CURRENT EFFICACY OVERESTIMATED? AN INVESTIGATION OF SUCCESS AND RETREATMENT FOR BOTH FIRST- AND FOURTH-GENERATION LITHOTRIPTERS

Abstract

You have accessJournal of UrologyStone Disease: New Technology/SWL, Ureteroscopic or Percutaneous Stone Removal1 Apr 20111837 SHOCKWAVE LITHOTRIPSY: IS ITS CURRENT EFFICACY OVERESTIMATED? AN INVESTIGATION OF SUCCESS AND RETREATMENT FOR BOTH FIRST- AND FOURTH-GENERATION LITHOTRIPTERS Brian Benway, Timur Roytman, Robert Figenshau, Sam Bhayani, and Alana Desai Brian BenwayBrian Benway St. Louis, MO More articles by this author , Timur RoytmanTimur Roytman St. Louis, MO More articles by this author , Robert FigenshauRobert Figenshau St. Louis, MO More articles by this author , Sam BhayaniSam Bhayani St. Louis, MO More articles by this author , and Alana DesaiAlana Desai St. Louis, MO More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1856AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Shockwave lithotripsy (SWL) is one accepted modality for the treatment of renal and ureteral calculi, with reported success rates historically on par with ureteroscopic intervention. However, at our institution, we have witnessed what we believe to be a sharp decrease in efficacy of SWL for stones <1.5cm. We therefore sought to evaluate contemporary outcomes of SWL performed with both first- and fourth-generation lithotripters from January 2007 through January 2009. METHODS An interim analysis of patients undergoing SWL between 2007 and 2009 was performed. Only patients with follow-up at our institution were included. Of the 53 patients who met inclusion criteria, 26 patients were treated with the first-generation Dornier HM3 lithotripter, and 27 were treated using the fourth-generation Storz Modulith F2. Outcomes, including stone clearance, postoperative complications, and retreatments were evaluated. RESULTS The two patient populations were equivalent across all measured demographic parameters, including age, BMI, comorbidity, stone size, and composition. Mean stone size for the HM3 group was 12.1mm, and 11.5 for the F2 cohort (p=0.7). Stone composition was predominantly calcium oxalate monohydrate. Skin-to-stone distance for HM3 and F2 was 12.5 and 11.4cm, respectively (p=0.3). Success, as determined by residual fragment size <2 mm was 47% for the HM3 and 39% for the F2; this difference was not statistically significant (p=0.6). 27% of HM3 and 19% of F2 patients required emergent evaluation or re-admission. Retreatment was required in 50% and 52% of patients treated with the HM3 and F2, respectively (p=0.5). CONCLUSIONS In our sampling analysis, SWL in the modern era appears to be associated with a marked decrease in efficacy over historically-reported outcomes, with half of patients now requiring retreatment. Even more surprisingly, this decline appears to be independent of lithotripter generation, suggesting perhaps that changes in patient characteristics and stone composition, and not technology may be to blame. Further study is critically needed. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e736 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Brian Benway St. Louis, MO More articles by this author Timur Roytman St. Louis, MO More articles by this author Robert Figenshau St. Louis, MO More articles by this author Sam Bhayani St. Louis, MO More articles by this author Alana Desai St. Louis, MO More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...