Treatment efficacy and outcomes using a third generation shockwave lithotripter

Authors


Correspondence: PD Dr Rolf Gillitzer, Department of Urology, Klinikum Darmstadt GmbH, Darmstadt Grafenstrasse 9, 64283 Darmstadt, Germany.

e-mail: rolf.gillitzer@klinikum-darmstadt.de

Abstract

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 <10 mm, independent of stone location.

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