1896 SHOCKWAVE LITHOTRIPSY: COMPARATIVE ANALYSIS OF SAFETY AND EFFICACY BETWEEN FIRST- AND FOURTH-GENERATION LITHOTRIPTERS

Abstract

You have accessJournal of UrologyStone Disease: SWL, Ureteroscopic or Percutaneous Stone Removal IV1 Apr 20101896 SHOCKWAVE LITHOTRIPSY: COMPARATIVE ANALYSIS OF SAFETY AND EFFICACY BETWEEN FIRST- AND FOURTH-GENERATION LITHOTRIPTERS Brian Benway, Ramakrishna Venkatesh, Cathy Chen, Nitin Das, Timur Roytman, Sam Bhayani, Robert Figenshau, and Alana Desai Brian BenwayBrian Benway Saint Louis, MO More articles by this author , Ramakrishna VenkateshRamakrishna Venkatesh Lexington, KY More articles by this author , Cathy ChenCathy Chen Saint Louis, MO More articles by this author , Nitin DasNitin Das Saint Louis, MO More articles by this author , Timur RoytmanTimur Roytman Saint Louis, MO More articles by this author , Sam BhayaniSam Bhayani Saint Louis, MO More articles by this author , Robert FigenshauRobert Figenshau Saint Louis, MO More articles by this author , and Alana DesaiAlana Desai Saint Louis, MO More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1850AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Shockwave lithotripsy (SWL) has undergone significant evolution since its introduction in the 1980's. The Dornier HM3, the first lithotripter widely available in the United States, has been phased out at most centers in favor of later-generation systems. However, there remains a paucity of information regarding the comparative efficacy fourth-generation systems. We sought to compare the efficacy and complication rates of the Storz Modulith SLX-F2 lithotripter with the unmodified Dornier HM3 for the treatment of renal and ureteral stones. METHODS A retrospective chart review was performed, evaluating the records of 125 consecutive patients who underwent SWL at our institution for renal or ureteral stones 2 cm or less in diameter. Imaging studies obtained at 1 and 3 months post-SWL were reviewed to assess for stone-free status using two separate endpoints for analysis; we utilized residual fragment sizes of both <2mm and <4mm as independent measures of treatment success. Imaging modalities included plain radiograph in 106 patients, computed tomography in 16, and ultrasonography in 1. RESULTS Mean stone size was 10 mm and was equivalent for both groups. For renal calculi, using residual fragment size <2 mm, the success rate at 1 and 3 months for the HM3 was 42.6% and 61.5%, respectively. Using residual fragment size <4 mm, the success rates were 63% and 71.8%. For ureteral calculi success rates for the HM3 at 1 and 3 months were 58.8% and 80%, respectively using a residual fragment size of <2 mm, and 70.6% and 93.3% using a residual fragment size of <4 mm. For the Modulith, success for renal calculi at 1 and 3 months were 31.9% and 65.6%, respectively, using residual fragments <2 mm as the definition of success, and 44.7% and 65.6% when using residual fragment size of <4mm. For ureteral stones, success at 1 and 3 months was 42.8% and 57.1%, respectively using residual fragment size <2 mm, and 57.1% and 57.1% using residual fragment size <4 mm. At 3 months, for renal calculi, there was no significant difference in success rates between the HM3 and the Modulith for the 2 and 4 mm cutoffs (p=0.7 and 0.6), nor was there a difference between the two lithotripters for the treatment of ureteral calculi (p=0.3 and 0.8). Complication rates were equivalent between the two groups. CONCLUSIONS The efficacy of both first- and fourth-generation lithotripters appears to be similar, regardless of the size cutoff for residual fragments used to define success. Likewise, there is no difference in the rate of complications with newer lithotripters compared to first-generation equipment. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e737 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Brian Benway Saint Louis, MO More articles by this author Ramakrishna Venkatesh Lexington, KY More articles by this author Cathy Chen Saint Louis, MO More articles by this author Nitin Das Saint Louis, MO More articles by this author Timur Roytman Saint Louis, MO More articles by this author Sam Bhayani Saint Louis, MO More articles by this author Robert Figenshau Saint Louis, MO More articles by this author Alana Desai Saint Louis, MO More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...