Park H. et al., 2025: A randomized controlled trial comparing efficacy, safety, and patient-reported outcomes of electroconductive and electrohydraulic extracorporeal shockwave lithotripsy.

Hyeji Park, Christine Joy Castillo, Sung Yong Cho
Urologia. 2025 Nov 20:3915603251390743. doi: 10.1177/03915603251390743 FREE TEXT

Abstract

Objectives: To evaluate the efficacy, safety, and patient-reported outcomes, including satisfaction and pain level, of electroconductive (EC) and electrohydraulic (EH) extracorporeal shock wave lithotripsy (ESWL) for the treatment of ureter and kidney stones in a randomized controlled trial.

Materials and methods: A total of 56 patients were randomly allocated to the EC or EH groups. Patient and stone characteristics and treatment outcomes were compared.

Results: The stone-free rates were not different between the groups. The EH group achieved the same stone-free rates as the EC group with less energy use. Pain scores were higher in the EH group (mean 4.76 ± 3.53) than in the EC group (mean 3.04 ± 2.84), with borderline significance (p = 0.063). Satisfaction scores and radiation exposure were significantly lower in the EH group than in the EC group, regardless of the stone location. Univariate and multivariate analyses identified the total number of shocks and stone location as significant predictors of stone-free status.

Conclusions: EC and EH lithotripters demonstrated comparable efficacy and complication rates across different stone locations. While the EC group showed lower pain scores and higher satisfaction, these outcomes required greater energy use and resulted in higher radiation exposure. Patient satisfaction and pain level, as patient-reported outcomes, may be considered as additional measures alongside safety and efficacy in the evaluation of ESWL modalities.

Comment Hans-Göran Tiselius

The electroconductive electrode (EC) was developed with the aim of reducing the need of electrode replacements that was the rule for work with the electrohydraulic electrodes (EH). The two systems were compared in a randomized study on 56 patients.

The results with EH-lithotripsy were obtained from the Rifle lithotripter (HNT Medical, Korea) and those with EC-lithotripsy from treatments on EDAP Sonolith i-move. The latter device used embedded ultrasonic EC-electrodes. The EC system used localization with ultrasound and x-ray whereas the EH-system only used fluoroscopy.

The study groups were small and the differences difficult to evaluate although minor differences were recorded.

That EC-treated patients had higher exposure to radiation is not immediately easy to understand, but it is explained by the ultrasound embedded technique.

It is surprising that no analgesics were used and that patients accordingly were able to control when breaks were necessary or desirable.

One of the basic reasons for the development of EC-electrodes was the high cost for EH-electrodes, but it is not mentioned in the report how much the electrode cost differed between the methods.

Hans-Göran Tiselius