Treatment efficacy and outcomes using a third generation shockwave lithotripter. (11th October 2013)

• Record Type: Journal Article
• Authors: Neisius, Andreas; Wöllner, Jens; Thomas, Christian; Roos, Frederik C.; Brenner, Walburgis; Hampel, Christian; Preminger, Glenn M.; Thüroff, Joachim W.; Gillitzer, Rolf
• Is Part Of: BJU international. Volume 112:Number 7(2013:Oct.)
• Page Start: 972
• Page End: 981
• Publication Date: 2013-10-11
• Subjects: Genitourinary organs -- Diseases -- Periodicals; Genitourinary organs -- Surgery -- Periodicals; Urology -- Periodicals; 616.6
• DOI: 10.1111/bju.12159
• Languages: English
• ISSNs: 1464-4096

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bju12159-sec-0001" sec-type="section"> <title>Objectives</title> <p> <list id="bju12159-list-0001" list-type="bullet"> <list-item> <p>To evaluate the clinical efficiency of a third generation electromagnetic shock wave lithotripter, the Lithoskop<sup>®</sup> (Siemens, Erlangen, Germany), regarding outcomes, stone disintegration, retreatment and complication rates.</p> </list-item> <list-item> <p>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).</p> </list-item> </list> </p> </sec> <sec id="bju12159-sec-0002" sec-type="section"> <title>Patients and Methods</title> <p> <list id="bju12159-list-0002" list-type="bullet"> <list-item> <p>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.</p> </list-item> <list-item> <p>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.</p> </list-item> <list-item> <p>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.</p> </list-item> </list> </p> </sec> <sec id="bju12159-sec-0003" sec-type="section"> <title>Results</title> <p> <list id="bju12159-list-0003" list-type="bullet"> <list-item> <p>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.</p> </list-item> <list-item> <p>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.</p> </list-item> <list-item> <p>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.</p> </list-item> <list-item> <p>Stone‐free rates and the required number of sessions were determined only by stone size. In 7.1% of the patients (<italic>n</italic> = 13) post‐interventional auxiliary procedures were necessary.</p> </list-item> <list-item> <p>We observed one perirenal haematoma as a major complication (0.5%), but this did not require any further therapy.</p> </list-item> </list> </p> </sec> <sec id="bju12159-sec-0004" sec-type="section"> <title>Conclusions</title> <p> <list id="bju12159-list-0004" list-type="bullet"> <list-item> <p>Clinical stone‐free rates with the Lithoskop are high and similar to those of other available systems, including the reference standard HM‐3 lithotripter.</p> </list-item> <list-item> <p>Retreatment and complication rates are low, supporting the use of ESWL as first‐line therapy for urinary calculi <10 mm, independent of stone location.</p> </list-item> </list> </p> </sec> </abstract>