Evidence-Based, Non-Invasive Stone Therapy (SWL) With High Success Rates – MODULITH® SLK »inline«

The field of urolithiasis treatment continues to evolve rapidly, balancing technological innovation with clinical outcomes and patient-centered care. Among available options, Shock Wave Lithotripsy (SWL) remains the only non-invasive treatment modality. Prof. Kemal Sarica, a globally recognised long-time advocate for SWL, has extensively studied the clinical applications of the MODULITH® SLK »inline« from STORZ MEDICAL. His recent peer-reviewed publications provide evidence-based insights that not only reaffirm the effectiveness of SWL but also position the MODULITH® SLK »inline« as a cornerstone in modern stone management – both clinically and economically.

Presented below are four of Prof. Sarica’s most recent studies, each contributing important clinical insights into the ongoing role of non-invasive lithotripsy in modern urology.

1. The Power of Precision: MODULITH® SLK »inline« in Renal Stone Management¹

In a recently published study in the World Journal of Urology, Prof. Sarica and his colleagues retrospectively evaluated the outcomes of 208 patients treated for renal stones (<15 mm) using the MODULITH® SLK »inline« lithotripter. The study showcased an impressive overall success rate of 92.3% when considering clinically insignificant residual fragments (CIRF) less than 4 mm – well in line with EAU guidelines for successful outcomes​.

Key clinical takeaways include:

• Complete Stone-Free Rate: 78.8%
• Mean Stone Size: 10.3 mm
• Predictive Factors: Lower Hounsfield Units (<1000 HU) and smaller stone sizes strongly correlated with success.
• Complication Rate: Minimal and self-limiting (hematuria being the most common, renal hematoma <1%).

Perhaps most importantly, the study emphasised the critical role of real-time stone targeting and shock wave path alignment offered by the MODULITH® SLK »inline«'s in-line imaging, which significantly enhances fragmentation efficiency while reducing complication risks.

 »The success of SWL is not solely about energy – it’s about precision. The MODULITH® SLK »inline« delivers both,« Prof. Sarica noted.

2. Comparative Effectiveness: SWL vs URS for Lower Ureteral Stones²

Another critical contribution by Prof. Sarica appeared in Urolithiasis (2025), comparing SWL and ureteroscopic treatment (URS) for lower ureteral stones (5–10 mm). The study involved 174 patients and introduced an important variable often overlooked: Quality of Life (QoL).

While URS achieved a slightly higher stone-free rate (96.9% vs. 84.6%, p = 0.009), SWL outperformed in several patient-centric metrics:

• Patient Preference: 96.2% of SWL patients would choose the same modality again.
• Shorter Recovery & No Anesthesia: SWL required no general anesthesia and had quicker return-to-activity timelines.
• QoL Dimensions: SWL matched URS in physical functioning and general health, while lagging slightly in pain and emotional well-being – likely due to residual fragment-related anxiety​.

From a health system perspective, the combination of reduced resource utilisation, high efficacy, and patient-centered outcomes positions the MODULITH® SLK »inline« as a valuable solution in clinical practice.

3. Evaluating Medium-Sized Stones: SWL vs. fURS (10–20 mm)³ 

Addressing the growing debate over best practices for treating medium-sized renal stones (10–20 mm), Prof. Sarica co-authored a head-to-head comparison of SWL and flexible ureteroscopy (fURS) published in Urologia Internationalis (2025). In this study of 112 patients, the 3-month stone-free rates were statistically comparable:

• SWL: 85.2%
• fURS: 89.8% (p = 0.098)

However, the SWL group demonstrated:

• Lower Pain Scores: Statistically significant improvement at 4 hours post-procedure.
• Better Energy/Fatigue Scores (SF-36 domains): SWL patients reported higher vitality (p = 0.017).
• Comparable Safety: No significant difference in complication rates.

These findings are pivotal for hospitals in resource-constrained settings. SWL avoids general anesthesia, shortens hospital stays, and offers repeatability with minimal logistical overhead – while maintaining parity in long-term efficacy.

4. Urine Chemistry Matters: The Impact of Urine pH on SWL Outcomes⁴

In one of the most novel contributions, Prof. Sarica explored the relationship between urine pH and energy requirements during SWL. Published in Urolithiasis (2024), this study involved 129 patients and revealed that alkaline urine environments required less total energy for effective stone fragmentation (p = 0.038).

This finding has two major implications:

• Clinical Strategy: Pre-procedural urine alkalisation could optimise outcomes and reduce tissue trauma.
• Technical Efficiency: The MODULITH® SLK »inline«’s precision delivery system synergises well with this approach, offering high-impact fragmentation even with reduced energy settings.

Moreover, no other variable – including BMI, HU, stone size, or skin-to-stone distance – showed significant correlation with total energy used, underscoring urine pH as a modifiable and impactful parameter​.

Bridging Clinical Outcomes and Operational Efficiency (Why the MODULITH® SLK »inline« is a Smarter Investment in Urology)

Prof. Sarica’s research across varied patient groups – ranging from renal to ureteral stones, and from small to medium-sized calculi – demonstrates the comprehensive utility of the MODULITH® SLK »inline«. Its high efficacy, minimal complication rates, and non-invasive nature not only support superior clinical outcomes but also optimise patient workflow and resource use.

By reducing the need for anesthesia, hospitalisation, and retreatment, SWL with the MODULITH® SLK »inline« presents significant cost advantages. Faster patient recovery enhances throughput, while the system’s advanced imaging and robust engineering ensure long-term reliability and minimal maintenance. In a healthcare environment focused on value-based care, the synergy of clinical excellence and operational efficiency offered by the MODULITH® SLK »inline« makes it a strategic asset for any modern urology department.

Conclusion

Prof. Kemal Sarica’s pioneering work confirms what urologists worldwide are increasingly recognising – SWL remains a frontline therapy for a wide range of stone scenarios, and the MODULITH® SLK »inline« elevates this modality to a new clinical standard.

His publications reinforce SWL’s value as not only a clinical but as a strategic, patient-preferred tool. With rising global stone incidence and healthcare cost pressures, hospitals and clinics should consider revisiting their SWL programs – and there's no better platform than the MODULITH® SLK »inline« to lead that renaissance.

¹ Erdoğan, E., Şimşek, G., Aşık, A. et al. Impact of advanced lithotripter technology on SWL success: insights from Modulith SLK inline outcomes. World J Urol. 43, 139 (2025). doi: 10.1007/s00345-025-05517-4.

² Erdoğan, E., Aşık, A., Yaşar, H. et al. What is the preferred management of lower ureteral stones? SWL or URS - a critical evaluation with an emphasis on the changes in patient’s quality of life. Urolithiasis 53, 29 (2025). doi: 10.1007/s00240-025-01693-5.

³ Erdoğan E, Kanberoğlu AF, Aşık A, Sarıca G, Sarıca K. Outcomes of 10-20 mm Renal Stones: Shock Wave Lithotripsy versus Flexible Ureteroscopy. Urol Int. 2025 Mar 7:1-7. doi: 10.1159/000545108. Epub ahead of print. PMID: 40058343.

 ⁴ Erdoğan E, Sarica K. Evaluating the role of urine chemistry in shock wave lithotripsy outcomes. Urolithiasis. 2024 Oct 9: 52(1):136.  doi: 10.1007/s00240-024-01639-3.