Extracorporeal shock wave lithotripsy with a transportable electrohydraulic lithotripter: experience with >300 patients

Abstract

OBJECTIVETo review a multicentre experience of using a transportable lithotripter (STS-T, Medstone, Inc, Aliso Viejo, CA. USA) for treating patients with urolithiasis in all parts of the urinary tract. PATIENTS AND METHODSIn all, 326 patients with a total of 370 stones were treated as outpatients with the STS-T lithotripter. All patients received a single shock wave lithotripsy treatment and were followed after 4-6 weeks in the outpatient clinic, the primary endpoint being to determine the efficacy (as defined by the stone-free rate). Secondary objectives included establishing a database of patient demographic information, stone characteristics, stone location, procedural endpoints, and complication rates. RESULTSIn all there were 370 procedures, with a mean of 2394 shocks administered at an energy level of 24 kV. The mean treatment time was 51 min, excluding anaesthesia-induction time. The mean stone aggregate size was 8.2 mm; 62% of the stones were in the kidney while 38% were in various locations in the ureter. Of the treated stones, 90% had definite or probable evidence of fragmentation. The overall stone-free rate after one treatment with the STS-T was 52.8%. Of patients with residual fragments, most (61%) had fragments of < 4 mm in aggregate diameter. The overall complication rate was 3.8%, the most common complication being postoperative pain. CONCLUSIONThe Medstone STS-T lithotripter was an effective device for treating urolithiasis in all parts of the urinary tract. This system had a high margin of safety, as shown by the low complication rate. With no apparent sacrifice of efficacy compared to first-generation or fixed (not transportable) second-generation devices, the Medstone STS-T represents an important advance in the development of a truly transportable lithotripter.

Efficacy of commercialised extracorporeal shock wave lithotripsy service: a review of 589 renal stones

“…Furthermore, the efficacy of ESWL is very dependent on the skills of the technician performing the treatment and in the present study treatments were carried out by a small team of very skilled and dedicated technicians [ 8 ]. In a previous multicentre study it was demonstrated that a transportable ESWL system had a high margin of safety with low complications rates and no apparent sacrifice of efficacy with regard to non-transportable systems [ 9 ].…”

A new transportable shock‐wave lithotripsy machine for managing urinary stones: a single‐centre experience with a dual‐focus lithotripter

“…The results show that SLX-F2 is effective in fragmenting solitary stones throughout the urinary tract. The overall stone-free rate of 76.3% and EQ of 0.64 are acceptable, particularly when compared with other electromagnetic and newer generation lithotripters [14][15][16][17][18][19][20][21][22][23][24] (Table 5). It could be argued that to obtain good results we selected our patients, but comparing the results achieved with various lithotripsy units at various institutions is difficult, if not impossible, due to variability in patient selection, definition of success, follow-up methods and the reported use and classification of auxiliary procedures.…”

“…Of all patients treated at our institution with the Modulith SLX-F2 lithotripter from September 2004 to August 2006, we selected 233 (mean age 51 years; 172 males and 61 females) with either symptomatic solitary renal (group A, 170, mean diameter 15.5 mm, range [8][9][10][11][12][13][14][15][16][17][18][19][20] or ureteric stones (group B, 63, mean diameter 9.5 mm, range [5][6][7][8][9][10][11][12][13][14][15]. Exclusion criteria from the study were: PUJ obstruction, multiple stones, stone diameter > 2 cm, stones in a lower calyx with unfavourable anatomy (considering the following factors: angle between the pelvis and the lower calyx; infundibulum diameter and length), active infection, and impacted ureteric stones (defined as the one with hydroureteronephrosis up to the stone and no visualization of the ureter below it, and no changes in stone location during the last 2 months).…”