1842 SHOCKWAVE LITHOTRIPSY STONE-FREE RATES REMAIN POOR DESPITE DEVELOPMENT OF NEW GENERATION ELECTROHYDRAULIC LITHOTRIPTERS

Abstract

You have accessJournal of UrologyStone Disease: New Technology/SWL, Ureteroscopic or Percutaneous Stone Removal III1 Apr 20121842 SHOCKWAVE LITHOTRIPSY STONE-FREE RATES REMAIN POOR DESPITE DEVELOPMENT OF NEW GENERATION ELECTROHYDRAULIC LITHOTRIPTERS Vincent Harisaran, Jessica Dai, Sammy Elsamra, Simone Thavaseelan, George Haleblian, and Gyan Pareek Vincent HarisaranVincent Harisaran Providence, RI More articles by this author , Jessica DaiJessica Dai Providence, RI More articles by this author , Sammy ElsamraSammy Elsamra Providence, RI More articles by this author , Simone ThavaseelanSimone Thavaseelan Providence, RI More articles by this author , George HaleblianGeorge Haleblian Providence, RI More articles by this author , and Gyan PareekGyan Pareek Providence, RI More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1930AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Evidence supports that the newer generation lithotripters are not as effective as the original Dornier HM3™. Herein, we perform a critical analysis of 2 electrohydraulic lithotripters(LithoGold™ & Medispec™ E3000) utilized at our institution for the treament of urinary calculi. METHODS A total of 149 stones were treated over a 14-month period (2/2010 to 4/2011). Of these, 77 patients were treated by the LithoGold™ lithotripter (focal zone of 20 x 101 mm, penetration depth of 165mm) and 72 were treated with the Medispec E3000 (focal zone 13 x 60mm, penetration depth 135-170mm). Along with demographic data and stone characteristics, treatment outcomes were recorded for each patient. Specific endpoints included stone-free rates (SFR) defined by fragments less than 4mm on follow up imaging. Fisher's Exact test was used for analysis. RESULTS Outcomes were analyzed for 69 patients in the LithoGold group and 40 in the Medispec group. Average patient age was 53.5 (51 men, 18 women) and 55.3 (24 men, 16 women) years for the LithoGold and Medispec respectively. Average stone size was 6.7mm x 7mm and 6.6mm x 6.9mm in the LithoGold and Medispec groups respectively (P>0.05). Average shocks delivered per patient was 2660 (Lithogold) and 2453 (Medispec) (P>0.05). Stone location (LithoGold, Medispec) distribution was upper pole (7, 5), mid pole (8, 8), lower pole (20, 15), renal pelvis (20, 2), proximal ureter (9, 5), mid ureter (3, 1), and distal ureter (2,4). Overall SFR on follow-up imaging in the LithoGold group was 50%. By location, SFR revealed upper pole 71%, mid pole 86%, lower pole 20%, renal pelvis 40%, proximal ureter 33%, mid ureter 33%, and distal ureter 50%. In the Medispec group, overall SFR was 65%. By location, SFR revealed: upper pole 60%, mid pole 75%, lower pole 73%, renal pelvis 50%, proximal ureter 40%, mid ureter 100%, and distal ureter 50%. Overall SFR was NOT significant (p=0.065) between the 2 lithotripters, but there was a trend toward more overall success using the Medispec. CONCLUSIONS Despite theoretical technological advancement of newer generation electrohydraulic lithotripters, overall SFR remain poor. LithoGold™ demonstrated adequate SFR for upper and mid pole stones (71% and 86% respectively), but overall SFR were 50%. The Medispec™ demonstrated adequate SFR for lower pole stones (73%), with overall SFR of 65%. SFR for new generation lithotripters are overall poor and careful consideration for other endourological management is critical when counseling patients. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e745 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Vincent Harisaran Providence, RI More articles by this author Jessica Dai Providence, RI More articles by this author Sammy Elsamra Providence, RI More articles by this author Simone Thavaseelan Providence, RI More articles by this author George Haleblian Providence, RI More articles by this author Gyan Pareek Providence, RI More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...