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

Zehnder, Pascal; Roth, Beat; Birkhäuser, Frédéric D.; Schneider, Silvia; Schmutz, Rolf; Thalmann, George N.; Studer, Urs E.

doi:10.1016/j.eururo.2011.01.026

Cited by 55 publications

(35 citation statements)

References 19 publications

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“…In our series, the overall stone-free rate was 74.4%, which is lower than that reported in a recent ESWL series. 20 However, these results were obtained from one session and involved a short followup duration. Another limitation is that data pertaining to stone composition were not collected in our study.…”

Section: Discussionmentioning

confidence: 95%

Body mass index and buttock circumference are independent predictors of disintegration failure in extracorporeal shock wave lithotripsy for ureteral calculi

Yang

Lee

et al. 2013

Journal of the Formosan Medical Association

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Section: Discussionmentioning

confidence: 95%

Body mass index and buttock circumference are independent predictors of disintegration failure in extracorporeal shock wave lithotripsy for ureteral calculi

Yang

Lee

et al. 2013

Journal of the Formosan Medical Association

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“…In comparison with the original lens, both in vitro and in vivo results have demonstrated the advantage of the new lens with improved stone comminution and minimal tissue injury at a clinically relevant high output setting. The general principle in lens modification and associated implementation strategy described in this work are also applicable to design improvement of other EM lithotripters equipped with either convex lenses (37) or parabolic reflectors (38). The design and technical refinements of EM lithotripters from the late 1980s to middle 1990s were largely driven by empirical experience, practical concern for user convenience, and multifunctionality of the lithotripter system (39,40).…”

Section: Discussionmentioning

confidence: 99%

“…The transition of SWL technology during this period from EH to predominately EM was carried out by lithotripter manufacturers with an incomplete understanding about the mechanisms of tissue injury and stone comminution in SWL (41). Consequently, clinical experience with the third-generation EM lithotripters, characterized by high p + and small FW, often resulted in low stone comminution efficiency with high retreatment rate compared with the original HM3 (9,38,41,42). Attempts to boost stone comminution by significantly augmenting the output pressure or energy of the lithotripter have been unsuccessful, which is likely associated with the greater risk of hematoma formation in the perirenal region at high output settings (35).…”

Section: Discussionmentioning

confidence: 99%

Improving the lens design and performance of a contemporary electromagnetic shock wave lithotripter

Neisius

Smith

Sankin

et al. 2014

Proc. Natl. Acad. Sci. U.S.A.

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The efficiency of shock wave lithotripsy (SWL), a noninvasive firstline therapy for millions of nephrolithiasis patients, has not improved substantially in the past two decades, especially in regard to stone clearance. Here, we report a new acoustic lens design for a contemporary electromagnetic (EM) shock wave lithotripter, based on recently acquired knowledge of the key lithotripter field characteristics that correlate with efficient and safe SWL. The new lens design addresses concomitantly three fundamental drawbacks in EM lithotripters, namely, narrow focal width, nonidealized pulse profile, and significant misalignment in acoustic focus and cavitation activities with the target stone at high output settings. Key design features and performance of the new lens were evaluated using model calculations and experimental measurements against the original lens under comparable acoustic pulse energy (E + ) of 40 mJ. The −6-dB focal width of the new lens was enhanced from 7.4 to 11 mm at this energy level, and peak pressure (41 MPa) and maximum cavitation activity were both realigned to be within 5 mm of the lithotripter focus. Stone comminution produced by the new lens was either statistically improved or similar to that of the original lens under various in vitro test conditions and was significantly improved in vivo in a swine model (89% vs. 54%, P = 0.01), and tissue injury was minimal using a clinical treatment protocol. The general principle and associated techniques described in this work can be applied to design improvement of all EM lithotripters. electromagnetic lithotripter | lens modification | stone fragmentation

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“…Clinical experience has demonstrated that the treatment outcome of SWL depends critically on the design features and operating conditions of a lithotripter, with much emphasis given to the pulserepetition frequency (PRF) [3][4][5][6][7]. Even a slight increase in the PRF from 1 to 2 Hz is shown to significantly decrease the effectiveness of treatment [8].…”

Section: Introductionmentioning

confidence: 99%

Bubble Proliferation or Dissolution of Cavitation Nuclei in the Beam Path of a Shock-Wave Lithotripter

et al. 2015

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It is hypothesized that the decreased treatment efficiency in contemporary shock-wave lithotripters is related to tensile wave attenuation due to cavitation in the prefocal beam path. Utilizing high-speed imaging of the beam path and focal pressure waveform measurements, tensile attenuation is associated with bubble proliferation. By systematically testing different combinations of pulse-repetition frequency and gas concentration, we modulate the bubble-dissolution time to identify which conditions lead to bubble proliferation and show that reducing bubble proliferation in the beam path significantly improves acoustic transmission and stone comminution efficiency in vitro. In addition to experiments, a bubbleproliferation model is developed that takes gas diffusion across the bubble wall and bubble fragmentation into account. By aligning the model with experimental observations, the number of daughter bubbles produced after a single lithotripter bubble collapse is estimated to be in the range of 253 ∼ 510. This finding is on the same order of magnitude with previous measurements of an isolated bubble collapse in a lithotripter field by Williams [BJU Int. 102, 1681 (2008)], and this estimate improves the general understanding of lithotripsy bubble dynamics in the beam path.

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

Cited by 55 publications

References 19 publications

Body mass index and buttock circumference are independent predictors of disintegration failure in extracorporeal shock wave lithotripsy for ureteral calculi

Body mass index and buttock circumference are independent predictors of disintegration failure in extracorporeal shock wave lithotripsy for ureteral calculi

Improving the lens design and performance of a contemporary electromagnetic shock wave lithotripter

Bubble Proliferation or Dissolution of Cavitation Nuclei in the Beam Path of a Shock-Wave Lithotripter

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