BACKGROUND: The relative efficacy of first- versus last-generation lithotripters is unknown. OBJECTIVES: To compare the clinical effectiveness and complications of the modified Dornier HM3 lithotripter (Dornier MedTech, Wessling, Germany) to the MODULITH(®) SLX-F2 lithotripter (Storz Medical AG, Tägerwilen, Switzerland) for extracorporeal shock wave lithotripsy (ESWL). DESIGN, SETTING AND PARTICIPANTS: We conducted a prospective, randomised, single-institution trial that included elective and emergency patients. INTERVENTIONS: Shock wave treatments were performed under anaesthesia. MEASUREMENTS: Stone disintegration, residual fragments, collecting system dilatation, colic pain, and possible kidney haematoma were evaluated 1 d and 3 mo after ESWL. Complications, ESWL retreatments, and adjuvant procedures were documented. RESULTS AND LIMITATIONS: Patients treated with the HM3 lithotripter (n=405) required fewer shock waves and shorter fluoroscopy times than patients treated with the MODULITH(®) SLX-F2 lithotripter (n=415). For solitary kidney stones, the HM3 lithotripter produced a slightly higher stone-free rate (p=0.06) on day 1; stone-free rates were not significantly different at 3 mo (HM3: 74% vs MODULITH(®) SLX-F2: 67%; p=0.36). For solitary ureteral stones, the stone-free rate was higher at 3 mo with the HM3 lithotripter (HM3: 90% vs MODULITH(®) SLX-F2: 81%; p=0.05). For solitary lower calyx stones, stone-free rates were equal at 3 mo (63%). In patients with multiple stones, the HM3 lithotripter's stone-free rate was higher at 3 mo (HM3: 64% vs MODULITH(®) SLX-F2: 44%; p=0.003). Overall, HM3 lithotripter led to fewer secondary treatments (HM3: 11% vs MODULITH(®) SLX-F2: 19%; p=0.001) and fewer kidney haematomas (HM3: 1% vs. MODULITH(®) SLX-F2: 3%; p=0.02). CONCLUSIONS: The modified HM3 lithotripter required fewer shock waves and shorter fluoroscopy times, showed higher stone-free rates for solitary ureteral stones and multiple stones, and led to fewer kidney haematomas and fewer secondary treatments than the MODULITH(®) SLX-F2 lithotripter. In patients with a solitary kidney and solitary lower calyx stones, results were comparable for both lithotripters.
RCT Entities:
BACKGROUND: The relative efficacy of first- versus last-generation lithotripters is unknown. OBJECTIVES: To compare the clinical effectiveness and complications of the modified Dornier HM3 lithotripter (Dornier MedTech, Wessling, Germany) to the MODULITH(®) SLX-F2 lithotripter (Storz Medical AG, Tägerwilen, Switzerland) for extracorporeal shock wave lithotripsy (ESWL). DESIGN, SETTING AND PARTICIPANTS: We conducted a prospective, randomised, single-institution trial that included elective and emergency patients. INTERVENTIONS: Shock wave treatments were performed under anaesthesia. MEASUREMENTS: Stone disintegration, residual fragments, collecting system dilatation, colic pain, and possible kidney haematoma were evaluated 1 d and 3 mo after ESWL. Complications, ESWL retreatments, and adjuvant procedures were documented. RESULTS AND LIMITATIONS: Patients treated with the HM3 lithotripter (n=405) required fewer shock waves and shorter fluoroscopy times than patients treated with the MODULITH(®) SLX-F2 lithotripter (n=415). For solitary kidney stones, the HM3 lithotripter produced a slightly higher stone-free rate (p=0.06) on day 1; stone-free rates were not significantly different at 3 mo (HM3: 74% vs MODULITH(®) SLX-F2: 67%; p=0.36). For solitary ureteral stones, the stone-free rate was higher at 3 mo with the HM3 lithotripter (HM3: 90% vs MODULITH(®) SLX-F2: 81%; p=0.05). For solitary lower calyx stones, stone-free rates were equal at 3 mo (63%). In patients with multiple stones, the HM3 lithotripter's stone-free rate was higher at 3 mo (HM3: 64% vs MODULITH(®) SLX-F2: 44%; p=0.003). Overall, HM3 lithotripter led to fewer secondary treatments (HM3: 11% vs MODULITH(®) SLX-F2: 19%; p=0.001) and fewer kidney haematomas (HM3: 1% vs. MODULITH(®) SLX-F2: 3%; p=0.02). CONCLUSIONS: The modified HM3 lithotripter required fewer shock waves and shorter fluoroscopy times, showed higher stone-free rates for solitary ureteral stones and multiple stones, and led to fewer kidney haematomas and fewer secondary treatments than the MODULITH(®) SLX-F2 lithotripter. In patients with a solitary kidney and solitary lower calyx stones, results were comparable for both lithotripters.
Authors: Andreas Neisius; Nathan B Smith; Georgy Sankin; Nicholas John Kuntz; John Francis Madden; Daniel E Fovargue; Sorin Mitran; Michael Eric Lipkin; Walter Neal Simmons; Glenn M Preminger; Pei Zhong Journal: Proc Natl Acad Sci U S A Date: 2014-03-17 Impact factor: 11.205
Authors: Bret A Connors; Andrew P Evan; Philip M Blomgren; Ryan S Hsi; Jonathan D Harper; Mathew D Sorensen; Yak-Nam Wang; Julianna C Simon; Marla Paun; Frank Starr; Bryan W Cunitz; Michael R Bailey; James E Lingeman Journal: J Urol Date: 2013-08-02 Impact factor: 7.450
Authors: Naeem Bhojani; Jessica A Mandeville; Tariq A Hameed; Trevor M Soergel; James A McAteer; James C Williams; Amy E Krambeck; James E Lingeman Journal: J Urol Date: 2014-10-08 Impact factor: 7.450