Modified Dornier HM3 Research Articles

A Prospective Randomised Trial Comparing the Modified HM3 with the MODULITH® SLX-F2 Lithotripter

BackgroundThe relative efficacy of first- versus last-generation lithotripters is unknown. ObjectivesTo compare the clinical effectiveness and complications of the modified Dornier HM3 lithotripter (Dornier MedTech, Wessling, Germany) to the MODULITH® SLX-F2 lithotripter (Storz Medical AG, Tägerwilen, Switzerland) for extracorporeal shock wave lithotripsy (ESWL). Design, setting and participantsWe conducted a prospective, randomised, single-institution trial that included elective and emergency patients. InterventionsShock wave treatments were performed under anaesthesia. MeasurementsStone disintegration, residual fragments, collecting system dilatation, colic pain, and possible kidney haematoma were evaluated 1 d and 3 mo after ESWL. Complications, ESWL retreatments, and adjuvant procedures were documented. Results and limitationsPatients treated with the HM3 lithotripter (n=405) required fewer shock waves and shorter fluoroscopy times than patients treated with the MODULITH® SLX-F2 lithotripter (n=415). For solitary kidney stones, the HM3 lithotripter produced a slightly higher stone-free rate (p=0.06) on day 1; stone-free rates were not significantly different at 3 mo (HM3: 74% vs MODULITH® SLX-F2: 67%; p=0.36). For solitary ureteral stones, the stone-free rate was higher at 3 mo with the HM3 lithotripter (HM3: 90% vs MODULITH® SLX-F2: 81%; p=0.05). For solitary lower calyx stones, stone-free rates were equal at 3 mo (63%). In patients with multiple stones, the HM3 lithotripter’s stone-free rate was higher at 3 mo (HM3: 64% vs MODULITH® SLX-F2: 44%; p=0.003). Overall, HM3 lithotripter led to fewer secondary treatments (HM3: 11% vs MODULITH® SLX-F2: 19%; p=0.001) and fewer kidney haematomas (HM3: 1% vs. MODULITH® SLX-F2: 3%; p=0.02). ConclusionsThe modified HM3 lithotripter required fewer shock waves and shorter fluoroscopy times, showed higher stone-free rates for solitary ureteral stones and multiple stones, and led to fewer kidney haematomas and fewer secondary treatments than the MODULITH® SLX-F2 lithotripter. In patients with a solitary kidney and solitary lower calyx stones, results were comparable for both lithotripters.

EFFICACY AND COST-EFFECTIVENESS OF EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY FOR SOLITARY LOWER POLE RENAL CALCULI

Purpose We determined the efficacy of extracorporeal shock wave lithotripsy monotherapy and compared its cost-effectiveness with percutaneous nephrolithotomy for the management of lower pole renal calculi. Materials and Methods The efficacy (stone-free rates at 3-months posttreatment) of shock wave lithotripsy with the modified Dornier HM3 * * Dornier Medical Systems, Inc., Marietta, Georgia. machine was determined retrospectively in 114 patients with solitary lower pole renal calculi. Using cost data available from patient billing charges and efficacy data from the literature, the cost-effectiveness for percutaneous nephrolithotomy and shock wave lithotripsy as primary therapy was evaluated. To make this cost-effectiveness comparison, we developed a decision analysis model in which a patient in whom primary therapy failed was rendered stone-free with a secondary percutaneous nephrolithotomy procedure. Results The stone-free rates of solitary lower pole stones with a size range of less than 10, 11 to 20 and greater than 20 mm. were 76, 74 and 33%, respectively, with a single shock wave lithotripsy treatment. Based on average treatment costs for shock wave lithotripsy and percutaneous nephrolithotomy, the model results show that for stone sizes less than 2 cm. primary lithotripsy therapy followed by nephrolithotomy for failed cases is the least costly approach. For stone sizes greater than 2 cm. primary percutaneous nephrolithotomy may be more cost-effective. Conclusions Whereas shock wave lithotripsy with the Dornier HM3 should be considered the initial treatment choice for most lower pole stones less than 2 cm., primary percutaneous nephrolithotomy should be considered for stones larger than 2 cm.

A Prospective Trial Comparing the Efficacy and Complications of the Modified Dornier HM3 and MFL 5000 Lithotriptors for Solitary Renal Calculi

A Prospective Trial Comparing the Efficacy and Complications of the Modified Dornier HM3 and MFL 5000 Lithotriptors for Solitary Renal Calculi

A Prospective Trial Comparing the Efficacy and Complications of the Modified Dornier HM3 and MFL 5000 Lithotriptors for Solitary Renal Calculi

A prospective randomized study of 198 patients was conducted to compare the efficacy of the modified Dornier HM3 lithotriptor to the MFL 5000 lithotriptor. Entrance criteria included solitary stones at any location within the upper collecting system that had not previously been treated with lithotripsy. Following lithotripsy the patients were evaluated by a blinded radiologist with a plain abdominal film, tomograms and renal ultrasound at 1, 4 and 12 weeks. Patients were classified at 12 weeks after lithotripsy as failing treatment if any stone fragments were imaged. Of the patients 170 were available for complete 3-month followup. No statistical or clinical difference in stone-free rates was apparent for calculi in the ureter or renal pelvis in either group. Of patients with lower caliceal stones 80 percent had no residual fragments visualized at 12 weeks when treated with the modified HM3 device versus 56 percent with the MFL 5000 lithotriptor (p = 0.05). Treatment time on the MFL 5000 unit was significantly prolonged compared with the modified HM3 device (0.7 hours versus 0.4 hours, respectively) resulting in fewer patients being treated in a given day (p less than 0.001). No statistical difference in complication rates could be found between the 2 machines. Steinstrasse were noted in 10 percent of the patients treated with the modified HM3 device and 6 percent of the MFL 5000 group. Subcapsular hematomas were noted in 4 percent of the MFL 5000 treatment arm compared to 1 percent in the modified HM3 group. Overall, the MFL 5000 lithotriptor was believed to offer no significant clinical advantage over the modified HM3 device in terms of lithotripsy efficacy, although the multifunctional table did offer more versatility for stone treatment. For a busy lithotripsy center, the modified HM3 lithotriptor is still the most efficacious.

Long-Term Follow-Up of Blood Pressure After Extracorporeal Shock Wave Lithotripsy

Thirty-five men and 33 women, mean age 45 years (range 15-67) treated with extracorporeal shock wave lithotripsy (SWL) for renal stones by a modified Dornier HM3 lithotripter, were followed in a 24- to 36-month prospective study to assess the risk of hypertension. No significant increase in the mean diastolic blood pressure was observed. No correlation was found between the hypertension incidence and the number of shock waves applied, the kilovoltage, urinary N-acetylglucosaminidase variations, or initial blood pressure. Among the normotensive group, three new cases of hypertension (diastolic pressure of ≥100 mm Hg) were observed (6%), which was not significantly greater than expected. Nevertheless, we believe that long-term surveillance is essential after SWL.

Changes in Renal Function after Extracorporeal Shock Wave Lithotripsy in Patients with Solitary Functioning Kidneys: Long-Term Follow-Up

Nine of twelve consecutive patients with a solitary functioning kidney treated for renal stone by extracorporeal shock wave lithotripsy (SWL) with the modified Dornier HM3 lithotripter were evaluated before and 20 months (range 12-24 months) after treatment by detailed renal cortical and tubular function tests. Urinary excretion of the renal tubular enzymes N-acetyl-β-glucosaminidase (NAG), alkaline phosphatase (ALP), and kallikrein and of albumin and β2-microglobulin was unchanged. Clearances of creatinine (CCr), inulin (CIN) and para-aminohippuric acid (CPAH) and filtration fraction (FF) were constant, as were serum levels of creatinine, urea, and β2-microglobulin. In seven of the nine patients, however, CIN was decreased at follow-up by a mean of 15% (range 5% to 54%), and CPAH was decreased by a mean of 30% (range 3% to 58%) in six of the nine patients. Plasma renin activity (PRA) and serum aldosterone were stable, and no patient developed new-onset hypertension.

Acute Changes in Renal Function Following Extracorporeal Shock Wave Lithotripsy in Patients with a Solitary Functioning Kidney

Twelve consecutive patients with a solitary functioning kidney were treated for renal stone by extracorporeal shock wave lithotripsy (ESWL*) with the modified Dornier HM3 lithotriptor and studied for 3 days after treatment. Urinary excretion of electrolytes, N-acetyl-ß-glucosaminidase (NAG), alkaline phosphatase, kallikrein, glycosaminoglycans, albumin and ß2-microglobulin, and clearances of creatinine, inulin and para-aminohippuric acid were determined, as were serum levels of creatinine, urea, ß2-microglobulin and aldosterone, and plasma renin activity. Urinary flow rate, free water clearance, and urinary excretion of NAG, kallikrein and ß2-microglobulin were significantly increased 0 to 24 hours after ESWL. The urinary excretions of alkaline phosphatase, albumin and glycosaminoglycans were unchanged. Glomerular filtration rate was significantly decreased and effective renal plasma flow was unchanged. Filtration fraction was stable. Serum lactic dehydrogenase increased significantly after ESWL and remained high through the period of observation. Serum levels of creatinine, ß2-microglobulin and aldosterone were unaltered. A decrease in plasma renin activity immediately after treatment is explained by the water immersion and the extracellular volume expansion during treatment.

Minimally Invasive Treatment of Ureteric Calculi Using Modern Techniques

Between July 1985 and July 1986, 226 upper and 62 distal ureteric calculi were treated. In situ extracorporeal shockwave lithotripsy (ESWL) is the treatment of choice for upper and distal ureteric calculi, with success rates of 81 and 76% respectively. Retrograde manipulation of the calculus was undertaken only when in situ ESWL was impossible because of difficulty in localisation. Although ESWL after successful mobilisation was successful in 95% of patients, retrograde mobilisation was possible in only 80%. Antegrade ureterorenoscopy via a percutaneous nephrostomy was performed to avoid open surgery if retrograde mobilisation was not feasible, and was successful in 90%. Two second generation lithotripters, the modified Dornier HM3+ and the Wolf Piezolith 2200, both suitable for treatment without anaesthesia, were compared in terms of efficacy. In situ ESWL of upper ureteric calculi was successful in 70.6% with the HM3+ and 37.2% with the Piezolith 2200. In situ ESWL of middle ureteric calculi was successful in 81.8% with the modified HM3+, while in situ treatment of middle ureteric calculi was impossible with the Piezolith 2200 because of inadequate ultrasound localisation. Distal ureteric calculi were treated successfully in 71.4% with the modified Dornier HM3+ and in 64% with the Piezolith 2200. We report our experience of ESWL using the prone position for iliac ureteric calculi; 8 of 10 patients were treated successfully in situ.

Two Cases of Anesthesia-Free Extracorporeal Shock Wave Lithotripsy in Stone-Bearing Pelvic Kidneys

We report 2 cases of urolithiasis in pelvic kidneys and discuss the therapy of difficult stone locations with extracorporeal shock wave lithotripsy (ESWL) alone using new techniques of positioning (prone and upright sitting position) and the modified Dornier HM3 lithotriptor for anesthesia-free ESWL.

Experience with a New Multifunctional Lithotripter, the Dornier MFL 5000: Results of 415 Treatments

The Dornier MFL 5000 is a new multifunctional work station for urologic diagnosis, endourology, and extracorporeal shock wave lithotripsy (ESWL). Features of this bathfree device include a tiltable U-arm with an under-table x-ray tube for stone localization, a low-pressure generator with twin-pulse technique, a modified semiellipsoid reflector, and an ultrasound unit for stone localization and monitoring. From April 1988 until January 31, 1989, 415 ESWL treatments were performed on this machine. The stones were 45.6% (189) caliceal, 25% (108) renal pelvic, 26% (108) ureteral, and 2.4% (10) branched. The majority of stones had a diameter between 8 and 20 mm. Stone disintegration required a mean of 2450 impulses. Mean treatment time was 33 minutes. Mean final generator voltage was 20 kV (range 17 to 24 kV). Post-ESWL ancillary procedures proved to be necessary in 24 patients (5.8%). The retreatment rate was 19.5% (81) including 4.8% (20) with planned multiple treatments. In 86.6% (359) of patients, a noninvasive oral analgesia technique was used successfully. Follow-up at 3 months could be obtained in 59.5% (247). The overall stone-free rate was 77.5% (191). ESWL was unsuccessful in 2.4% (10). The results of this study are comparable to those achieved with the modified Dornier HM3. The MFL 5000 has advantages, especially in the treatment of lumbar ureteral stones in situ, less radiopaque stones, and in obese patients. The under-table x-ray tube considerably reduces radiation exposure to room personnel and the treating urologist. Excellent imaging qualities are provided by the 14-inch image intensifier. The MFL 5000 proved to be satisfactory for a variety of endourologic procedures.

Extracorporeal piezoelectric lithotripsy using the Wolf-lithotriptor versus low energy lithotripsy with the modified Dornier HM-3: a cooperative study

In January 1986, a cooperative study was started at the Katharinenhospital in Stuttgart, FRG (modified Dornier HM-3) and Kreiskrankenhaus in Kempten, FRG (Wolf Piezolith 2200) to evaluate the range of indications, efficacy and required anesthesia of both lithotriptors. Stone classification and general indications for interventional therapy were similar in both centers. The Dornier HM-3 operates with a modified generator and a new ellipsoid which provide low pressure lithotripsy. With the Piezolith 2200, 99% of ESWL-treatments were performed without any anesthesia, whereas with the modified Dornier HM-3 lithotriptor, minor analgesia using tramadol was necessary in 92%, epidural anesthesia in 8%. The overall success rate was similar in both centers (Piezolith 2200: 94.5% vs Dornier HM-3: 98%). Only 46% of the patients were treated successfully in one session with the Wolf lithotriptor compared to 88% with the Dornier HM-3. Ultrasound localization with the Piezolith 2200 failed in 58% of ureteral calculi, whereas fluoroscopic stone localization (Dornier HM-3) was insufficient in the majority of slightly or nonopaque calculi.