Zehnder P et al, 2011: A prospective randomised trial comparing the modified HM3 with the MODULITH® SLX-F2 lithotripter
Zehnder P, Roth B, Birkhäuser F, Schneider S, Schmutz R, Thalmann GN, Studer UE.
Department of Urology, University of Bern, Bern, Switzerland.
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.
Copyright © 2011 European Association of Urology. Published by Elsevier B.V. All rights reserved.
Eur Urol. 2011 Apr;59(4):637-44. doi: 10.1016/j.eururo.2011.01.026. Epub 2011 Jan 25
PMID: 21296481 [PubMed - in process]
This is yet another study documenting that “the most expensive bathtub of the world”, the HM3 lithotripter was a bull's eye hit.