H A Fuselier1, L Prats, C Fontenot, A Gauthier. 1. Department of Urology, Ochsner Clinic and Alton Ochsner Medical Foundation, New Orleans, Louisiana 70121, USA.
Abstract
BACKGROUND AND PURPOSE: Extracorporeal shockwave lithotripsy (SWL) has replaced most surgical and endourologic procedures for upper urinary tract stone disease. Our institution contracted with mobile lithotripter companies to provide SWL. We reviewed the outcomes of 50 patients treated on each machine with regard to efficacy, complications, and retreatment rates. PATIENTS AND METHODS: One hundred fifty patients over 21 years of age were treated at Ochsner Foundation Hospital from April 1995 through June 1998. All stones were in either the kidney or the upper ureter, and all were <20 mm. Three mobile lithotripters-the Dornier MFL-5000 (4/95-9/96), the Dornier Doli (9/96-11/97), and the HealthTronics Lithotron (12/97-4/98)-were each used to treat 50 patients. Conscious monitored intravenous sedation was used in all patients. Post-treatment evaluations were made at 2 weeks, 1 month, and 3 months. RESULTS: A successful outcome (stone free or fragments <4 mm) was achieved in 72% (MLF-5000), 68% (Doli), and 80% (Lithotron) of patients (P = 0.39). Treatments that were followed by retreatments or other further procedures (ureteroscopy or percutaneous nephrolithotomy) were counted as failures. The retreatment rate was 10%, 22%, and 10%, respectively. There were three significant complications with the Doli unit: two large perirenal hematomas (4%) and one delayed splenic rupture in a patient with a history of pelvic surgery that necessitated transfusions and urgent splenectomy. The minor complication rates with all three lithotripters were similar to those reported in the literature. The three-month efficiency quotients were 0.55 for the Lithotron and MFL-5000 and 0.41 for the Doli. CONCLUSIONS: Statistically equivalent success rates were achieved with all three machines. The electromagnetic unit (Doli) had higher rates of retreatment and significant complications than the electrohydraulic lithotripters (MFL-5000, Lithotron).
BACKGROUND AND PURPOSE: Extracorporeal shockwave lithotripsy (SWL) has replaced most surgical and endourologic procedures for upper urinary tract stone disease. Our institution contracted with mobile lithotripter companies to provide SWL. We reviewed the outcomes of 50 patients treated on each machine with regard to efficacy, complications, and retreatment rates. PATIENTS AND METHODS: One hundred fifty patients over 21 years of age were treated at Ochsner Foundation Hospital from April 1995 through June 1998. All stones were in either the kidney or the upper ureter, and all were <20 mm. Three mobile lithotripters-the Dornier MFL-5000 (4/95-9/96), the Dornier Doli (9/96-11/97), and the HealthTronics Lithotron (12/97-4/98)-were each used to treat 50 patients. Conscious monitored intravenous sedation was used in all patients. Post-treatment evaluations were made at 2 weeks, 1 month, and 3 months. RESULTS: A successful outcome (stone free or fragments <4 mm) was achieved in 72% (MLF-5000), 68% (Doli), and 80% (Lithotron) of patients (P = 0.39). Treatments that were followed by retreatments or other further procedures (ureteroscopy or percutaneous nephrolithotomy) were counted as failures. The retreatment rate was 10%, 22%, and 10%, respectively. There were three significant complications with the Doli unit: two large perirenal hematomas (4%) and one delayed splenic rupture in a patient with a history of pelvic surgery that necessitated transfusions and urgent splenectomy. The minor complication rates with all three lithotripters were similar to those reported in the literature. The three-month efficiency quotients were 0.55 for the Lithotron and MFL-5000 and 0.41 for the Doli. CONCLUSIONS: Statistically equivalent success rates were achieved with all three machines. The electromagnetic unit (Doli) had higher rates of retreatment and significant complications than the electrohydraulic lithotripters (MFL-5000, Lithotron).