Electromagnetic Lithotripter Research Articles

Long-term experiences with high-energy shock wave therapy in the management chronic phase Peyronie’s disease using two different electromagnetic lithotripters

BackgroundExtracorporeal shock wave lithotripsy represents one option for the non-surgical management of Peyronie’s disease. Despite promising results, several questions are still pending. We want to present the long-term results of a retrospective study using high-energy extracorporeal shock wave lithotripsy.Material and methodsWe evaluated retrospectively 110 patients treated between 1996 and 2020 at the Department of Urology, SLK Kliniken Heilbronn for chronic phase Peyronie’s disease using two electromagnetic lithotripters (Siemens Lithostar Plus Overhead Module, Siemens Lithoskop) applying high-energy shock waves under local anesthesia and sonographic or fluoroscopic control. A standardized questionnaire focused on the change in pain, curvature, sexual function and the need of penile surgery.ResultsIn 85 of the 110 patients (mean age 54 years) we had sufficient data for evaluation. The median follow-up was 228 (6–288) months. There were no significant complications. Pain reduction was achieved in all patients, 65 (76%) patients were free of pain. Improvement of penile curvature was achieved in 43 patients (51%) ranging from 25% improvement (deflected angle < 30°) to 95% (angle 30–60°). 59 patients (69%) reported problems with sexual intercourse, 40 of those (68%) reported improvement. Only 9 (10.5%) patients underwent surgical correction. We did not observe any significant differences between both electromagnetic devices with stable long-term results.ConclusionsHigh-energy shock wave therapy delivered by two standard electromagnetic lithotripters is safe and efficient providing stable long-term results. In cases with significant plaque formation, the concept of high-energy ESWT should be considered in future studies.

Biceps brachii long head calcific tendinitis can be treated quickly and effectively with radial shockwave therapy: a case report

Calcific tendinitis, which mostly involves the supraspinatus and rotator cuff tendons, may very rarely involve the long head of the biceps brachii (LHBB). Arthroscopy is the first choice in cases of calcific tendinitis accompanied by a rotator cuff tear but in cases where the rotator cuff is intact, there are different treatment methods, such as non-steroidal anti-inflammatory drugs (NSAID), steroid injection, Extracorporeal Shock Wave Therapy (ESWT), and Radial Shock Wave Therapy (RSWT). A 28-year-old male presented at the outpatient clinic with right shoulder pain which had been ongoing for 6 months. The patient, who was a licensed table tennis player and amateur bodybuilder, had no systemic diseases. After clinical and radiological evaluation, ultrasonography showed calcification at the level of the greater tuberculum of the right humerus. The patient was diagnosed with calcific tendinitis of the bicipital tendon. Magnetic resonance imaging (MRI) was then performed to investigate any rotator cuff pathology or glenohumeral joint pathology. No additional pathology was observed. The patient was managed with the standard RSWT protocol of four sessions. 0.25 mJ/mm2 3 bar 2000 beats administered with an electromagnetic lithotriptor. Before RSWT, the VAS score was 9 over 10 and Constant score was 37, and after the first session of RSWT, the VAS score of the patient had decreased to 6. After the 4th session, treatment was terminated as the patient was completely pain-free. At the 1-year follow-up examination, the patient was still pain-free during daily activities and sports activities, and had full range of motion. In this case report, RSWT is presented as an effective treatment option for LHBB calcific tendinitis. RSWT may be a priority option over ultrasound-guided or arthroscopic barbotage in patients without tendon rupture.

Optimal Shock Wave Frequency and Energy, Important Factors for Renal Stone Fragmentation in ESWL: A Prospective Randomized Trial

Background: Kidney stones are crystalline structures with high prevalence rate across the globe. Different treatment method are used to treat renal stones among which extracorporeal shock wave lithotripsy (ESWL) shows promising results for stone free rate among non-invasive treatment modalities. Different factors govern effectiveness of lithotripsy among which shock wave frequency and energy had always been in debate as they have direct effect on responsiveness of ESWL. Objective: Comparison of different energy and shock wave frequency levels in terms of effectiveness in stone fragmentation. Study Design: Prospective randomized study. Settings: Department of Urology, DHQ Hospital/Faisalabad Medical University, Faisalabad Pakistan. Duration: April 2018 to September 2020 (2.5 Years). Methods: 120 patients enrolled using non probable consecutive sampling according to inclusion and exclusion criteria. Patients subjected to four sessions of ESWL using electromagnetic lithotripter and stones observed for fragmentation. Patients divided into four groups i.e. A, B, C and D depending upon frequency and energy of shock waves applied.(Group-A: Frequency 60 shocks/min Energy 50)(Group B: Frequency 90 shocks/min Energy 50)(Group C: Frequency 60 shocks/min Energy 65)( Group D: Frequency 90 shocks/min Energy 65). Each group further divided into subgroups 1 and 2 according to age as subgroup I patients having age 15-35 years and subgroup II having age 36-55 years. Statistical analysis done and P &lt; 0.05 was taken as statistically significant. Results: 120 patients enrolled from age 15-55 years with mean age 37.191 + 11.09. Results showed that response of ESWL is statistically significant when frequency is low however both energy levels have equal response for effectiveness. Conclusion: We conclude that ESWL is an effective treatment method for renal stones when frequency of shock waves is less and combining it with low levels of energy shows with promising stone fragmentation rate with minimal side effects.

Can we predict the ancillary treatments after extracorporeal shockwave lithotripsy for renal and upper ureteral stones?

To quantify the predictors for the ancillary treatments after extracorporeal shock wave lithotripsy (SWL) for renal and upper ureteral stones. From January 2014 to January 2017, patients undergoing SWL using an electromagnetic lithotripter machine (Compact Delta; Dornier MedTech GmbH, Wessling, Germany) for renal and upper ureteral stones ≤ 20 mm were retrospectively reviewed. All patients underwent CT urography prior to SWL. The cohort was subdivided into three groups according to stone attenuation values in Hounsfield Units (HU). Group I; HU < 500 (n = 20), group II; HU 500-1000 (n = 51) and group III; HU ≥ 1000 (n = 180). The parameters included for multivariate analysis were stone size, location, multiplicity, stone attenuation value, number of shocks and stone clearance rate by 3 months. The ancillary treatments were ureteroscopy (URS), ureteral stenting and hospital readmission for pain or fever. A total of 251 patients were included in the study. The overall SWL success rate was 92.4%. Mean stone size was 10.9 ± 2.1, 11.6 ± 3 and 11.4 ± 3.6 mm and mean stone attenuation values were 364 ± 125, 811 ± 154 and 1285 ± 171 HU for groups I, II and III respectively. The stone clearance rates by 3 months were 96%, 92% and 88.4% for groups I, II and III respectively. On subgroup analysis, group III required ancillary treatments in 70% of patients whereas group I, II, did not require any ancillary treatments. On multivariate analysis, stone multiplicity, stone location (lower calyceal stones) and HU were independent significant predictors for the need for ancillary treatments after SWL (p values < 0.05). Patients with stone attenuation value (HU) > 1000, multiple stones and/or lower calyceal stones have higher risk to necessitate ancillary treatments after SWL. These patients would likely benefit from upfront endoscopic lithotripsy for treating symptomatic renal or upper ureteral stones.

Are Newer Extracorporeal Shock Wave Lithotripsy Models Truly Improving Pancreatolithiasis Lithotripsy Performance? A Japanese Single-Center Study Using Endoscopic Adjunctive Treatment.

Many Japanese institutions use electromagnetic extracorporeal shock wave lithotripsy (ESWL) systems for treating pancreatic duct stones. However, there are no reports on direct comparisons between recent electromagnetic lithotripters. This study aimed to verify whether the new electromagnetic lithotripter can improve the efficiency of pancreatic stone fragmentation, and to clarify the role of combined endoscopic treatment on the clearance of pancreatic duct stones. We retrospectively identified 208 patients with pancreatolithiasis who underwent endoscopic adjunctive treatment after pancreatic ESWL at a single Japanese center over a 17-year period. We evaluated the outcome data of this procedure performed with SLX-F2 (last 2 years; group A) and Lithostar/Lithoskop (first 15 years; group B), as well as additional endoscopic treatments for pancreatolithiasis. We also performed logistic regression analysis to detect various factors associated with the procedure. For pancreatic head stones, ESWL disintegration was achieved in 93.7% of group A patients and 69.0% of group B patients (p=0.004), and adjunctive endoscopic treatment removed stones in 96.8% of group A patients and 73.0% of group B patients (p=0.003). Multivariate analysis revealed that lithotripter type (odds ratio, 6.99; 95% confidence interval, 1.56 to 31.33; p<0.01) and main pancreatic duct stricture (odds ratio, 2.87; 95% confidence interval, 1.27 to 6.45; p<0.01) were significant factors for ESWL fragmentation. The SLX F2 showed high performance in fragmenting the pancreatic duct stones. In addition, endoscopic adjunctive treatment improved the overall success rate of the procedure. The improved ESWL lithotripter has many advantages for patients undergoing pancreatic lithotripsy treatment.

Effect of targeting and generator type on efficacy of extracorporeal shock wave lithotripsy.

Analysis of the effect of technical factors, i.e. the type of stone targeting and shock wave generator, on ESWL efficacy. Evaluation of secondary outcomes to determine an optimal strategy for performing the procedure. In the period from 01/2016 to 07/2021, we analyzed data from patients indicated for ESWL for nephrolithiasis and proximal or distal ureterolithiasis. This was a tricenter retrospective study to evaluate stone-free rates (SFR) while taking into account the number of ESWL sessions in four selected groups of patients with comparable characteristics. A patient is considered stone-free in the absence of residual lithiasis or with an asymptomatic residue of up to 2 mm. The real-time ultrasound-guided (USG) arm consisted of a group of 120 patients on the electromagnetic STORZ SLK lithotripter in the period from 02/2017 to 02/2020. A total of three comparison arms with x-ray guidance were created: A: 68 patients between 01/2016 and 03/2017 on the Medilit 7 electrohydraulic lithotripter. B: 72 patients from 04/2017 to 10/2017 on the Sonolith i-sys electroconductive lithotripter (EDAP). C: 120 patients from 03/2018 to 07/2021 on the STORZ SLK electromagnetic lithotripter. By comparing the US and x-ray guidance using the STORZ SLK lithotripter, the effect of targeting when using an identical device (electromagnetic generator) was evaluated. By comparing the arms A, B, and C, the efficacy in different types of generators - electromagnetic, electroconductive, electrohydraulic - was assessed when the same type of targeting (fluoroscopy) was used. The secondary parameters that were monitored included: the rate of use of auxiliary techniques in stone management; radiation exposure for the patient and/or operator; analgesic consumption; and the time required to perform the procedure. When US versus x-ray guidance was compared in an electromagnetic lithotripter, SFRs of 90% vs. 85% (P=0.329), i.e. statistically comparable results, were obtained. By comparing electromagnetic, electroconductive, and electrohydraulic generators with fluoroscopy, SFRs of 85%, 88.9%, and 88.2% were obtained, respectively (P=0.727). When the degree of need for intraoperative analgesic administration was assessed, the electromagnetic generator was found to have a significantly lower consumption (20.8% vs. 30.6% vs. 48.5%) (P=0.0005). Values less than 1095 HU and 108.5 mm were shown to be optimal cut-off values for stone density and skin-to-stone distance, respectively. Based on our comparative analysis, the noninferiority of US stone targeting was demonstrated compared to fluoroscopic targeting. No significant differences in ESWL efficacy were found using electrohydraulic, electroconductive or electromagnetic shock wave generators. With the electromagnetic lithotripter, there was a significantly lower analgesic consumption than with the electrohydraulic type.

A clinical observational study of effectiveness of a solid coupling medium in extracorporeal shock wave lithotripsy

This study aimed to investigate clinical effectiveness of stone disintegration by using isolation coupling pad (“icPad”) as coupling medium to reduce trapped air pockets during extracorporeal shock wave lithotripsy (ESWL). Patients underwent ESWL between Oct. 2017 and May 2018 were enrolled in this clinical observational study. An electromagnetic lithotripter (Dornier MedTech Europe GmbH Co., Germany) was used in this study. Patients were divided into icPad group P1, P2 and semi-gel group C by different coupling medium. The energy level and total number of shock wave (SW) for group P1 and C was set at level 2 and 3000 and group P2 at level 3 and 2500. The successful stone disintegration rate (SSDR) was determined to evaluate the treatment outcome. All patients were evaluated by KUB film and ultrasonography after 90 days. Complications during ESWL were recorded. A total of 300 patients satisfied the inclusion criteria. There were no significant differences in characteristics of patients and stone among three groups. The corresponding SSDRs for patients in group P1, P2 and C was 73.0%, 73.2% and 55.3%, respectively. The SSDR in group P1 was statistically higher than Group C. Comparing to semi-liquid gel, coupling medium using by icPad could achieve better treatment outcome of stone disintegration in ESWL.

Shock Wave Lithotripsy in Pediatric Stone Disease: A 15-Year Single-Center Experience with 2 Types of Lithotripters

Introduction and Objectives: We report our experience with pediatric shock wave lithotripsy (SWL) using two types of lithotripters: Dornier HM3 (HM3) and Dornier Lithotripter SII (DLS). Study Design: We retrospectively reviewed the charts of children who underwent SWL between 2002 and 2016. Patients were divided into two groups based on the type of the lithotripter: during 2002–2009, we used the electrohydraulic HM3 lithotripter which was replaced in 2009 with the DLS electromagnetic lithotripter. Clinical and perioperative parameters were compared. Results: Our cohort included 107 children who underwent SWL. Average age was 11.5 ± 5.1 years. Average stone size was 10.6 ± 4.9 mm. HM3 was used in 38% of children and DLS2 in 62% (n = 41 and 66, respectively). There were no significant differences in age, gender, stone size, or location between the groups. The total SFR did not differ statistically between HM3 and DLS (83% vs. 74%, p = 0.35). SFR after one SWL was higher with the HM3 (78% vs. 62%, p = 0.093). Re-treatment rate was 22% and 17% (HM3 vs. DLS, p = 0.61). Complication rates were low, with renal colic being the most common (HM3 10%, DLS 20%, NS). Conclusions: SWL in the pediatric population using the DLS showed good results with low complication rates that are equivalent to the gold standard HM3.

Is there a place for extracorporeal shockwave lithotripsy (ESWL) in the endoscopic era?

This retrospective study aimed to evaluate whether there was still a place for ESWL therapy in the endourological era. From 1988 to 2018, ESWL therapy was performed with 3 successive types of lithotripters in our hospital. From 1988 to 1998, the electrohydraulic lithotripter NS-15 was used, and the electromagnetic lithotripter HK-V was put to use in 1999. Since 2010, the electromagnetic lithotripter HK-Vm has been used. Over the 30-year period, 16,969 urolithiasis patients underwent ESWL therapy, including 124 paediatric cases and 178 special cases. The stone clearance rate (SCR) and postoperative complications in the 3 lithotripter groups were recorded and analysed. The SCR was estimated by ultrasonography or plain X-ray, while the complications were recorded by the modified Clavien grading system. The primary stone clearance rate (pSCR) of ureteral and renal stones was significantly improved in the HK-Vm group compared with the NS-15 and HK-V groups. The final stone clearance rate (fSCR) of lower calyx stones was considerably higher in the HK-Vm group (55.9%) than in the NS-15 (41.1%) and HK-V (44.1%) groups. Most complications were grade I and II, while the incidence of grade III and above complications was less than 3%. Additionally, the fSCR in paediatric and special cases ranged from 66.5% to 83.5%, with no record of severe complications. As our data showed, ESWL was effective and safe for most urolithiasis patients, including paediatric patients and special cases. Therefore, ESWL is still the major treatment option in the current endourological era.

Treatment of Moderate-sized Kidney Stone with Third-generation Electromagnetic Shock Wave Lithotripter

BACKGROUND: The extracorporeal shock wave lithotripsy (ESWL) is a non-invasive method in the treatment of urinary tract stones and its discovery has led to a complete change in the therapeutic strategy for urolithiasis. Due to the low morbidity and excellent fragmentation of the stones, ESWL has proven to be an effective and non-invasive method in the treatment of renal stones.&#x0D; AIM: The aim of this retrospective study is to evaluate the efficacy and safety of the ESWL as a monotherapy in the treatment of moderate size kidney stones with stone area (SA) of 100–300 mm².&#x0D; MATERIALS AND METHODS: We made a retrospective study of 98 patients with moderate size kidney stones with SA of 100–300 mm², divided into two subgroups, into a group with a SA of 100–200 mm² and with 200–300 mm², treated with ESWL in the period of November 2018–December 2019. The patients were treated with a third-generation electromagnetic lithotripter (Lithoskop®, Siemens Medical Systems, Erlangen, Germany), with a source of electromagnetic shocks (Pulso™) and dual ultrasonographic/fluoroscopic system for detection of the stones. The stone location, size, maximum energy used, localization technique, number of shock waves, sessions, re-treatment rate, and additional procedures were reviewed. All the patients before the intervention had a complete laboratory and radiological examinations. Postoperatively, patients were monitored on the 1st, 30th, and 90th post-operative days.&#x0D; RESULTS: Ninety-eight patients with solitary kidney stone with a SA of 100–300 mm² were treated with ESWL. The study included 58 men (59.18%) and 44 women (40.81%). The average length and width of the stone were 15.47 ± 2.68 mm and 12.99 ± 2.83 mm, respectively. The average surface area of the stones in our series was 203.78 ± 72.85 mm². The mean number of treatments for the entire series of patients was 1.82 ± 0.91. The mean number of shock waves for the total series of patients was 3899.11 ± 40. The mean energy used for the overall patient series was 110106.17 ± 21489.61 mJ. The total re-treatment rate was 47.95%. The entire rate of additional procedures was 19.38%. The overall success rate (SR) in our study was 77.55%. The efficiency quotient for the upper-middle and lower calyx was 55.57, 57.15, and 30.81, respectively.&#x0D; CONCLUSION: ESWL is a safe and effective method in the treatment of renal stones, and we recommend as the first method in the treatment of moderate size kidney stone with a surface area of 100–300 mm². The treatment of each patient should be individualized and take into account all favored and non-favored factors that influence the decision to choose extracorporeal lithotripsy as a method of treatment of medium-sized stones.

Comparing 60 versus 120 shocks per minute for shock-wave lithotripsy of solitary renal calculi: A controlled randomized study

Objective: This study aimed to compare the difference in outcome of shock-wave lithotripsy (SWL) using a slow rate of 60 shocks per minute versus a rapid rate of 120 shocks per minute generated by an electromagnetic lithotripter for renal calculi. Methods: From May 2017 to June 2019, 156 patients ( Mage=38.7 years) with single radio-opaque renal stones smaller than 20 mm were included and randomly divided into two groups: group A, 78 patients who received 60 shocks per minute; and group B, 78 patients who received 120 shocks per minute. Patients were radiologically reviewed at 3 months for an outcome. Results: There was no statistically significant difference between mean stone area treated ( p=0.222) or additional analgesic use in the form of patient-controlled analgesia (PCA; alfentanil; p=0.82). A successful outcome was defined by fragments smaller than 4 mm or stone-free status. In group A, 60% of patients had a successful outcome compared with 61.4% in group B ( p=0.869) following a single treatment. Post-treatment complications were similar in both groups at 12% for group A and 10.7% for group B ( p=0.797). Conclusions: There was no statistically significant difference between the delivery of 60 and 120 shocks per minute during SWL for the treatment of solitary renal stones with a mean stone area of 62 mm2 regarding the outcome, complications or PCA use when using a Dornier Compact Delta II lithotripter.

UP24 - Comparison between piezoelectric and electromagnetic lithotripter: Initial and prospective experience on a single center series

UP24 - Comparison between piezoelectric and electromagnetic lithotripter: Initial and prospective experience on a single center series

Dual-frequency setting for urinary stone fragmentation during shock wave lithotripsy: an in vitro study.

Extracorporeal shock wave lithotripsy (SWL) is less invasive compared to the other invasive modalities of stone treatment that are gaining popularity. Hence, methods to improve the efficacy of SWL are desirable. We studied the effectiveness of dual frequency on the efficacy of stone fragmentation, but minimizing treatment time. A phantom 10mm spherical BegoStone was fragmented in vitro in a kidney model using an electromagnetic lithotripter (Storz MODULITH®SLX-F2). A total of 78 stones were fragmented each with 3000 shocks at 60Hz or 120Hz or a dual frequency (DF) of 60-120Hz. For the DF setting, the first 1000 shocks were delivered at 60Hz and the next 2000 at 120Hz. Total weight and number of significant fragments of > 3mm (TWSF and TNSF, respectively) and also > 2mm was measured. Results: The mean TWSF was 0.1, 0.16, and 0.08g for 60Hz, 120Hz, and DF 60-120Hz, respectively. The TWSF of DF 60-120Hz was significantly lower than that of 120Hz (p = 0.02), but same as the 60Hz (p = 0.32). The mean TNSF of > 3mm was 2.6, 3.0, and 2.0 for 60Hz, 120Hz, and DF 60-120Hz, respectively, without significant differences between each setting. However, increasing trend of TWSF, TW2mm and TN2mm was seen in the order of DF, 60Hz and 120Hz (p = 0.019, p = 0.004 and 0.017, respectively). Treatment time for 60Hz, 120Hz, and DF 60-120Hz was 50, 25, and 34min, respectively. Dual-frequency setting produced effective stone fragmentation compared to the recommended 60Hz, while decreasing treatment time. DF variation is one other factor that may be tailored for effective stone comminution and needs clinical evaluation.

Quantitative factors of unenhanced CT for predicting fragmenting efficacy of extracorporeal shock wave lithotripsy on pancreatic duct stones

To find potential predictors at unenhanced computed tomography (CT) to evaluate the stone clearance rate (SCR) of pancreatic duct stones (PDS) by extracorporeal shock wave lithotripsy (ESWL). A total of 106 consecutive patients with multiple stones of maximal transverse length (MTL) 0.3-3.6 cm in pancreatic head region were enrolled. Unenhanced CT was performed both before and after ESWL therapy. All patients underwent ESWL therapy using an electromagnetic lithotripter, and were divided into three groups with threshold values of >90%, 50-90% and <50% of SCR. Factors including sex, age, MTL, mean stone density (MSD), standard deviation of stone density (SDSD), variation coefficient of stone density (VCSD), attenuation density (AD), pancreatic duct diameter (PDD), skin-to-stone distance (SSD), and number of ESWL sessions were analysed, and their impact on SCR was evaluated by univariate and multivariate analyses. The diagnostic threshold of the independent predicting index was further calculated, and its relationship with SCR and ESWL was analysed by drawing a trend line. The only significant predictor of SCR by ESWL was MSD (p<0.05). More courses of ESWL therapy are required in PDS patients with an MSD higher than the cut-off value of 375.4 HU (mean, 2.6 versus 1.8), but with a relatively lower SCR (mean, 43.96 versus 88.68%) . MSD on pre-treatment unenhanced CT is an independent predictor for SCR of PDS patients treated with ESWL. Using a cut-off value of 375.4 HU, patients with low MSD are good candidates for ESWL therapy.

Comparison of the Efficacy of Ultra-Mini PCNL, Flexible Ureteroscopy, and Shock Wave Lithotripsy on the Treatment of 1–2 cm Lower Pole Renal Calculi

Objective: To compare the efficacy of new percutaneous technique (“ultra-mini PCNL”, UMP), shock wave lithotripsy (SWL) and flexible ureteroscopy (FURS) on the treatment of 1–2 cm lower pole kidney stones, and to determine the advantages and disadvantages of each method. Materials and Methods: This prospective study was based on data collected from the files of patients between March 2015 and March 2017. This study recruited a total of 180 patients with single radio-opaque lower caliceal calculi of 1–2 cm. All patients were randomly divided into 3 groups: group A was treated with UMP, group B was treated with FURS by using holmium laser and group C was treated with SWL by using the electromagnetic lithotripter. The average age, sex, size of the stone, the time of operation, the rate of no stone, the time of hospitalization, the rate of retreatment, the cost and the complications of the 3 groups were compared. The success of the operation was defined as no residual stone or < 0.3 cm on computed tomography at 3 months postoperatively. Results: The stone burdens of the groups were equivalent. The re-treatment rate in group C was significantly higher than that in group A and B (30 vs. 1.6%, 5%). The average operating time in group B (93.35 ± 21.64 min) was statistically significantly longer than that in group A and C (68.58 ± 15.82 min, 46.33 ± 5.81 min). Although the time of hospitalization of group A (5.32 ± 1.20 day) was longer than that of group B (3.22 ± 0.52 day) and C (1.08 ± 0.28 day; p < 0.05). The stone-free rate (SFR) in UMP, FURS, SWL were 98, 92, and 73% respectively; the highest SFR was in the UMP group (p < 0.05). The complication rates were evaluated by using the Clavien grading system, which were determined to be 16.67% in UMP, 6.67% in SWL and 8.33% in FURS. In particular, the complications of GI and GII were more common in group A (p < 0.05). Conclusions: UMP, FURS, and SWL are all safe and effective in the treatment of 1–2 cm lower pole kidney stones. UMP and FURS had a better SFR than SWL, but the time of hospitalization in UMP group was longer and there were more complications in the UMP group. In addition, the operation time of FURS is longer as compared to UMP and SWL, and there is a higher rate of postoperative fever. The invasiveness and cost of SWL were lower than that of UMP and FURS, but the re-treatment rate was higher.

Efficacy of electromagnetic lithotriptor in the treatment of renal and upper ureteral stones

Introduction: The innovation of outpatient extracorporeal shock wave lithotripsy (ESWL) has created a revolution in the treatment of urinary tract stones. Objectives: The aim of this study was to evaluate the success rate of electromagnetic lithotriptor, in the treatment of renal and upper ureteral stones. Patients and Methods: In this study, 84 patients aged over 10 years, with renal and upper ureteral stones less than 20 mm, were considered for ESWL. Patients were randomly assigned into two groups. In all patients, using ultrasound and fluoroscopy, stone was localized and using an electromagnetic machine by standard method, ESWL was performed with electromagnetic waves. ESWL started with 12 kV and was increased to18 kV, up to a maximum of 3500 shock waves. Two weeks later a kidney, ureter, and bladder (KUB) X-ray and ultrasonography was conducted and the success rate of lithotripsy according to the crushing of stones and decrease in stone size was measured and recorded. Results: In this study, 61.9% of patients were male. The mean age of patients was 46.62 ± 13.12 years. The mean size of stones in both groups was 13.4 ± 2.5 mm. Around 56.3% of patients had opaque stones and 43.8% had non-opaque stones. A total of 63.5% of patients received up to 3000 shock waves and 37.5% of patients received more than 3000 shock waves. Complete efficacy and clearance of renal and ureteral stones was observed in 54.8% and 59.1% of cases, respectively (P&gt;0.05). Conclusion: This study showed a similarity in the success and efficacy of electromagnetic lithotriptor in the treatment of renal and upper ureteral stones. Additionally, the success rate of opaque and non-opaque stones have no significant differences, while stone size and proportion of shock waves will not increase the efficacy of the electromagnetic lithotriptor in crushing the stones.

Extracorporeal shock wave lithotripsy (ESWL): Our first experience with Siemens electromagnetic lithotripter

Extracorporeal shock wave lithotripsy (ESWL): Our first experience with Siemens electromagnetic lithotripter

Comparison of Electrohydraulic and Electromagnetic Shock Wave Lithotripsy for Upper Urinary Tract Stones in Elderly Patients

Summary Backgrounds In this study we compared the clinical outcomes of elderly patients with upper urinary tract stones who underwent extracorporeal shock wave lithotripsy (ESWL) with two different machines, an electrohydraulic (EH) and an electromagnetic (EM) lithotripter. Methods A retrospective review of medical records was performed of 238 patients (EH 168, EM 70) aged 65 years or older with upper urinary tract stones who underwent ESWL at two branches of the same institution between 2007 and 2015. The demographic data, stone parameters, stone-free rate, retreatment rate, and complication rate in both groups were analyzed. Results There was no significant difference between the EH and EM groups in terms of stone free rate (43.5% vs. 34.3%, p > 0.05) regardless of stone site or size. EM group had a higher retreatment rate than EH group (31.5% vs. 50.0%, p = 0.007). Complication rates were similar (22.0% vs. 27.1%, p > 0.05). The most common complication was flank pain. Two EH group patients had subcapsular renal hematomas. Conclusions Our study showed that elderly patients with upper urinary tract stones undergoing ESWL with EH and EM machines had comparable stone free rates and complication rates, but a higher retreatment rate was seen with EM machines.

Acoustic removal of cavitation nuclei to enhance stone comminution in shockwave lithotripsy

Cavitation bubbles are formed by shockwaves as part of the normal SWL procedure and can assist in fragmentation when they collapse against a stone. However, following collapse, the bubble cloud leaves behind a large population of residual micron sized bubble “nuclei” that can interfere with subsequent shockwaves. This often manifests as more efficient fragmentation at lower shockwave repetition rates where there is sufficient time for nuclei to dissolve. This study will show how the application of low amplitude, unfocused ultrasound bursts can be used to stimulate bubbles to coalescence or dispersion from the shockwave path by the primary and secondary Bjerknes forces. Applying these bursts in between shockwaves reduces the bubble nuclei shielding effect allowing more energy to reach the stone and increasing efficacy. Our results will show this technique is effective at reducing the number of shocks required for stone comminution on a clinical electromagnetic lithotripter with a simple supplemental transducer to generate the low amplitude field.

Lower calyceal and renal pelvic stones in preschool children: A comparative study of mini-percutaneous nephrolithotomy versus extracorporeal shockwave lithotripsy.

To compare outcomes of the mini-percutaneous nephrolithotripsy technique and extracorporeal shockwave lithotripsy for lower calyceal and renal pelvic stones in preschool children. From January 2010 to December 2014, single renal pelvic or lower calyceal calculi 10-25 mm in size in children (age ≤6 years) treated by either extracorporeal shockwave lithotripsy (64 patients) or the mini-percutaneous nephrolithotripsy technique (54 patients) were included. Extracorporeal shockwave lithotripsy was carried out by using a Dornier electromagnetic lithotripter. The mini-percutaneous nephrolithotripsy technique was through 14-Fr renal access using a 9.5-Fr semirigid ureteroscope with holmium:yttrium aluminium garnet lithotripsy. The two study groups were compared using Mann-Whitney, χ(2) -test or Fisher's exact test. Stone parameters were similar in the mini-percutaneous nephrolithotripsy technique and extracorporeal shockwave lithotripsy groups in all patients, and in the pelvic (39 Miniperc, 52 extracorporeal shockwave lithotripsy) and lower calyceal (15 Miniperc, 12 extracorporeal shockwave lithotripsy) subgroups. Stone-free rates in the mini-percutaneous nephrolithotripsy technique and extracorporeal shockwave lithotripsy groups were 88.9% versus 43.8% (P < 0.001) and 94.4% versus 81.2% (P = 0.032) after first and last sessions, respectively. In the renal pelvis, they were 87.2% versus 50% (P < 0.001) and 94.9% versus 84.6% (P = 0.179), whereas in the lower calyx, they were 93.3% versus 16.7% (P < 0.001) and 93.3% versus 66.7% (P = 0.139) after first and last sessions, respectively. Retreatment rates in the mini-percutaneous nephrolithotripsy technique versus extracorporeal shockwave lithotripsy were 7.4% versus 50% (P < 0.001), 7.7% versus 46.2% (P < 0.001), and 6.7% versus 66.7% (P = 0.003) in all patients, renal pelvic and lower calyceal stones, respectively. No significant difference was found in complications (P = 0.521). Auxiliary procedures were required in 9.4% and 1.9% of children in the extracorporeal shockwave lithotripsy and mini-percutaneous nephrolithotripsy technique groups, respectively. The mini-percutaneous nephrolithotripsy technique has significantly higher stone-free rates than extracorporeal shockwave lithotripsy for renal pelvic and lower calyceal stones (10-25 mm), with a lower retreatment rate and without a significant increase in complications.