Seven lithotripters (Dornier HM3, Dornier HM3 +, Dornier MPL 9000, Technomed Sonolith 2000, Wolf Piezolith, Siemens Lithostar, EDAP LT01) were compared with respect to shock-wave efficacy, pain during treatment, and machine handling. Because up to now no reliable or standardized methods for physical characterization of shock waves have been available, we used two in vitro stone models for characterization of shock-wave efficacy: (1) a 1.2-cm cube of chalk was used to measure the total number of impulses for pulverization, and (2) a piece of plaster (3.5 x 3.5 x 1.5 cm) was used to measure the volume and dimension of the cavity produced after 100 shock waves (SW). Corresponding to the focal size, the electrohydraulic systems necessitated between 80 SW (Dornier HM3) and 560 SW (MPL 9000) for disintegration of the chalk, in contrast to the piezoelectric lithotripters (Piezolith, 830 SW; EDAP LT01 1500 SW). In the plaster model, the MPL 9000 provided a wide range of disintegrative efficacy (22 mm3/14 kV to 300 mm3/20 kV), whereas the piezosystems were significantly less effective (Piezolith 31-83 mm3; EDAP LT01 12-33 mm3). Pain was measured in a self trial at mean treatment energy. The only lithotripters allowing pain-free ESWL were the Piezolith, EDAP LT01, and MPL 9000 (14 to 17 kV). The introduction of the different second-generation lithotripters has led to a new hardware and software philosophy for ESWL.

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