Outcomes using a fourth‐generation lithotripter: a new benchmark for comparison?

Abstract

OBJECTIVE To evaluate the efficacy of a fourth‐generation lithotripter, the Sonolith Vision (Technomed Medical Systems, Vaulx‐en‐Velin, France) for treating single previously untreated renal calculi, and to compare the results with the reference standard HM‐3 (Dornier MedTech Europe GmbH, Wessling, Germany) in the same population originally studied by the USA Cooperative Study Group in 1986. PATIENTS AND METHODS The Sonolith Vision uses an innovative electroconductive shock‐wave generator with an elliptical reflector specially designed to give the maximum concentration of energy on the stone. We reviewed the treatment sessions from our prospectively maintained database of the first 1000 consecutive patients with urinary stone disease who were treated with the Sonolith Vision between September 2004 and March 2006. Patients with previously untreated solitary renal calculi in anatomically normal kidneys were included. The outcome was assessed by plain films for radio‐opaque stones, and renal ultrasonography for radiolucent stones, at 1 and 3 months after lithotripsy; the results were analysed according to stone size and location. RESULTS Data from 309 patients who had a complete follow‐up and with 373 renal calculi that matched the above criteria were analysed. The initial fragmentation rate was 94%. The stone‐free rate for stones of <10 mm was 77%, for 11–20 mm was 69% and for >20 mm was 50%. The overall stone‐free rate 3 months after lithotripsy was 75%. Within a month of lithotripsy, 221 patients (59%) became stone‐free. Additional procedures to render patients stone‐free after lithotripsy were needed in only 22 cases (7%). The overall efficiency quotient was 62%. The stone‐free rates for lower, upper, middle calyceal and renal pelvic calculi were 74%, 70%, 78.5% and 75%, respectively. There were no serious complications. CONCLUSIONS When similar populations of stone formers were assessed the Sonolith Vision achieved a high success rate, comparable with that using the HM‐3 machine but with lower analgesia requirements and very low re‐treatment rates. This method of comparison belies the commonly held view that newer lithotripters are less effective than the original spark‐gap machines.

Novel Electromagnetic Lithotriptor for Upper Tract Stones With and Without a Ureteral Stent

“…Therefore, electromagnetic shock wave systems were developed with variations in the focal zone, allowing the delivery of greater energy per impulse. 1,18,20 We evaluated and compared the treatment outcome in renal and ureteral stone cases with and without prior ureteral stent placement using the novel Pulso electromagnetic shock wave system integrated into the Lithoskop platform. Its large focal width allows the delivery of increased energy per impulse to the stone and low energy density to minimize adverse effects.…”

“…These new generation lithotriptors have improved functionality but an inferior SFR, partly due to a smaller focal zone compared to that of the HM3. 1 Recent retrospective studies of new generation lithotriptors showed a favorable disintegration rate with further improvement in treatment safety. 2,3 Treatment success correlates with stone size.…”

The usefulness of stone density and patient stoutness in predicting extracorporeal shock wave efficiency: Results in a North African ethnic group

“…Failure of ESWL results in unnecessary exposure of renal parenchyma to shock waves and complications; therefore, alternative treatments are needed, incurring additional expense. 10 In our unit, these are estimated at $500 US per ESWL session. A number of stone characteristics, such as fragility, size, location and composition, are known to affect outcome.…”

Shock Wave Lithotripsy for the Treatment of Ureteral Stones

“…In contrast, Tiselius published higher rates using two third-generation lithotripters, however, this study included no direct comparison to the HM3 [ 17 ]. Nomikos and co-workers presented a comparison of a fourth-generation lithotripter with the HM3: the demonstrated comparable results, but fewer analgesics were required using the fourth-generation machine [ 22 ]. In summary, evidence suggests that lithotripters of every generation can be used for treatment of ureteral stones with reasonable effi cacy.…”