Neisius A et al, 2013: Treatment efficacy and outcomes using a third generation shockwave lithotripter
Neisius A, Wöllner J, Thomas C, Roos FC, Brenner W, Hampel C, Preminger GM, Thüroff JW, Gillitzer R
Department of Urology, University Medical Center Mainz, Mainz, Germany; Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
OBJECTIVES: To evaluate the clinical efficiency of a third generation electromagnetic shock wave lithotripter, the Lithoskop(®) (Siemens, Erlangen, Germany), regarding outcomes, stone disintegration, retreatment and complication rates. To compare the results of the Lithoskop with other currently available systems and the reference standard lithotripter, the HM-3 (Dornier MedTech Europe GmbH, Wessling, Germany).
PATIENTS AND METHODS: We analysed the data from 183 patients, including 13 children, undergoing extracorporeal shock wave lithotripsy (ESWL) for renal and ureteric calculi collected from a prospectively populated database. Outcomes were assessed by plain abdominal film of kidney, ureter and bladder and renal ultrasonography for radiopaque and computerized tomography for radiolucent stones 1 day after treatment and after 3 months. We analysed stone size and location before and after treatment, stone disintegration rate, retreatment rate, stone-free and residual fragment rates after 3 months, along with auxiliary procedures and complications.
RESULTS: The mean (range) patient age was 48.6 (1.3-81.4) years, including 13 children with a mean (range) age of 8.4 (1.3-16.7) years, and 77% of the patients were male. In all, 46% of the calculi were localized in the kidney and 54% in the ureter. Renal stones were localized in the upper, middle and lower calyx and in the renal pelvis in 9, 29, 30 and 32% of patients, respectively. Ureteric stones were localized in the upper, mid- and distal ureter in 29, 19 and 52% of patients, respectively. The median (range) stone size before ESWL was 10 (4-25) mm in the kidney and 8 (4-28) mm in the ureteric calculi. The overall stone-free rate after 3 months was 91% (88% for renal and 93% for ureteric calculi); the mean number of sessions to achieve these rates was 1.3. Stone-free rates and the required number of sessions were determined only by stone size. In 7.1% of the patients (n = 13) post-interventional auxiliary procedures were necessary. We observed one perirenal haematoma as a major complication (0.5%), but this did not require any further therapy.
CONCLUSIONS: Clinical stone-free rates with the Lithoskop are high and similar to those of other available systems, including the reference standard HM-3 lithotripter. Retreatment and complication rates are low, supporting the use of ESWL as first-line therapy for urinary calculi
BJU Int. 2013 Nov;112(7):972-81. doi: 10.1111/bju.12159. PMID:24118958 [PubMed - indexed for MEDLINE]. FREE ARTICLE
This is one of the most promising and positive reports of SWL that I have read during past years. In a period when reports of poor or inferior SWL results have been the rule rather than the exception it is reassuring to note the results obtained with the third generation lithotripter Lithoskop®. The authors report stone free rates of 88% for renal and 91% for ureteral stones with a mean number of 1.3 sessions. Interestingly the focal volume of the lithotripter measured 160 x 6-12 mm. From this report it is obvious that when appropriate attention is paid to the technical details of SWL and a good lithotripter is available, outstanding results can be achieved. To which degree the new lens design with the large focus has contributed to the outcome is difficult to know because a good treatment result is not only the effect of how efficient the lithotripter power is, but even more how the technology is applied. Future results will show whether it is the new lithotripter design or the handling of the equipment that results in a good treatment effect.
This article is important reading for all those who consider endo-urology to be the superior way of stone removal.