The Modulith SL 20* was designed as a third generation lithotriptor with outstanding disintegrative efficacy in vitro, and equipped with a combined flouroscopic and ultrasound localization system integrated in a multifunctional table. Its introduction to clinical extracorporeal shock wave lithotripsy took place in 3 phases. In phase 1 (49 patients) only in line ultrasound localization was possible. The many caliceal stones were adequately disintegrated with restricted generator voltage. In phase 2 (81 patients) flouroscopic localization with the virtual focus of an adapted x-ray C-arm unit enabled in situ lithotripsy of ureteral stones in 33 percent of all patients. Phase 3 (549 patients) was characterized by additionally increasing the generator voltage to 20 energy resulted in the possibility for successful disintegration of stones in the entire upper urinary tract (including the complete ureter), decreased treatment time (52 to 39 minutes) and an improved efficiency quotient (0.45 to 0.67). During phase 3 auxiliary measures were performed before lithotripsy in 24 percent of the cases. After 1.8 percent of the treatments minor or moderate perirenal fluid collection or bleeding was detected by routine followup sonography. A 91 percent stone-free rate was achieved with only 9.3 percent curative auxiliary measures after extracorporeal shock wave lithotripsy, including a 23 percent retreatment rate. Thus, the Modulith device had a high efficacy quotient compared with other lithotriptors. *Storz Medical, Kreuzlingen, Germany.
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