Efficacy and Treatment Outcome of a New Electromagnetic Lithotripter for Upper Urinary Tract Calculi

Seitz, Christian; Martini, Thomas; Berner, Lukas; Signorello, Diego; Galantini, Andrea; Pycha, Armin

doi:10.1089/end.2008.0346

Cited by 10 publications

(14 citation statements)

References 19 publications

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“…We evaluated success after only one treatment session. By contrast, other authors have regarded SWL treatment as successful, when patients were free of stones within three sessions [17,26]. Therefore, the overall therapy success in the present series was only 53.1%.…”

Section: Discussioncontrasting

confidence: 63%

Prognostic variables for shockwave lithotripsy (SWL) treatment success: no impact of body mass index (BMI) using a third generation lithotripter

et al. 2011

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stent in situ were evaluated for their prognostic relevance on therapy success. RESULTS• The mean (range) BMI of all patients was 27.8 (19.0-58.6) kg/m 2 .• Patients were categorized into two groups: A) patients that were stone free after one treatment; B) patients with residual stones. The mean ( SD ) BMI was 27.4 (4.6) kg/m 2 and 28.4 (6.1) kg/m 2 for A and B, respectively.• Univariate and multivariate analysis for freedom of stones showed that only stone size ( P < 0.01) and presence of a ureteric stent ( P = 0.01) were independent prognostic variables.• BMI had no significant influence on therapy outcome ( P = 0.51). CONCLUSIONS• Using a third generation lithotripter, BMI was not an independent predictor of stonefree rate after SWL therapy of kidney stones.• This effect might be attributed to a greater penetration depth of the shockwave energy. Stone size and a ureteric stent in situ were the only variables with prognostic significance. KEYWORDSshockwave lithotripsy (SWL), urolithiasis, body mass index (BMI), prognostic factor What's known on the subject? and What does the study add? Therapy success in SWL treatment differs between individuals. According to recent studies done with first and second generation lithotripters, different prognostic variables like stone size, stone location, stone composition, age of patient and BMI have been shown to have prognostic relevance for outcome after SWL treatment.This study has been performed with a newer, third generation lithotripter. According to this study, BMI has no impact on SWL treatment success. Therefore, SWL treatment with newer generation lithotripters should be considered for the treatment of kidney stones in overweight and obese patients.Study Type -Therapy (case series) Level of Evidence 4 OBJECTIVE• To investigate the effect of different variables including body mass index (BMI) on therapy outcome in patients with upper urinary tract stones treated with a third generation lithotripter, as BMI has been reported to be an independent predictor for stone-free status after extracorporeal shockwave lithotripsy (SWL) performed with first or second generation lithotripters. PATIENTS AND METHODS• In all, 172 patients with kidney stones with a mean (range) size of 9.2 (3.0-32.0) mm were included in the study.• In all, 91 patients (52.9%) were treated with a ureteric stent in situ .• For SWL therapy a third generation, electromagnetic lithotripter (Siemens Lithoskop TM

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Section: Discussioncontrasting

confidence: 63%

Prognostic variables for shockwave lithotripsy (SWL) treatment success: no impact of body mass index (BMI) using a third generation lithotripter

et al. 2011

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“…With increased size, the number of sessions, shocks and also the rate of voltage were increased while the post procedure stone–free rate decreased. Other authors report similar findings such as Seitz et al, 2008 [15]. Abdelghany et al, 2011 [5] reported a significantly higher stone–free rate when stone size was <8 mm.…”

Section: Discussionsupporting

confidence: 58%

“…However, Seitz et al, 2008 [15] reported that only the maximum diameter of the stone affected the ESWL success. The authors of this study emphasized that these findings are in accordance with the AUA recommendations that ESWL can be used for the management of distal ureteric stones of 11 to 20 mm.…”

Section: Discussionmentioning

confidence: 99%

Management of lower ureteric stones: a prospective study

Etafy

Morsi

Beshir

et al. 2013

CEJU

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ObjectiveTo discuss the current concepts in lower ureteric stone management.Material and methodsBetween October 2008 and November 2010, 190 patients of both sexes and of different age groups with lower ureteric stones, underwent in situ extracorporeal shock wave lithotripsy (ESWL) (48 cases), ureterorenoscopy (URS) (120 cases) and open stone surgery (OSS) (22 cases).The patients’ clinical and radiological findings, as well as stone characteristics, were reviewed and correlated with the stone–free status.ResultsIn the ESWL group, the operative time was 43.13 +22.5 min; the average number of sessions/patients was 1.5 sessions; the average number of SW/patients was 4500 SW/patients; the average energy was 16.5 kV; the average stone burden was 7.8/mm; the overall stone–free rate was 75% (36/48); and the average radiation exposure time was 3.5 min.In the URS group, the operative time was 49.21 +16.09 min; the average stone burden was 10.81mm; the overall stone–free rate was 97.5% (117/120); the average hospital stay was 3.99 days; and the average radiation exposure time was 0.75 min.In the OSS group, the operative time was 112.38 +37.1 min; the overall stone–free rate was 100% (22/22); and the average hospital stay was 9.74 days.ConclusionIn the management of patients with lower ureteral stones, URS, SWL and OSS were considered acceptable treatment options.This recommendation was based on the stone–free results, morbidity and retreatment rates for each therapy.

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“…The energy setting (cumulated total energy dose of ~90 J) used for this study was at an intermediate level of clinical SWL. 29 At high energy and PRF, the enhancement of cavitation activity may increase the propensity of renal injury from rupture of small vessels during bubble expansion. 30 Additional studies at higher energy settings and PRFs >1 Hz will be needed to define the safety limit of acoustic pulse energy and total dose applicable to the treatment of kidney and ureteral stones.…”

Section: Discussionmentioning

confidence: 99%

Assessment of a Modified Acoustic Lens for Electromagnetic Shock Wave Lithotripters in a Swine Model

et al. 2013

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Purpose-The acoustic lens of the Siemens Modularis electromagnetic (EM) shock wave lithotripter has been modified to produce a pressure waveform and focal zone more closely resembling that of the original Dornier HM3 device. Herein, we assess the newly designed acoustic lens in vivo in an animal model. Materials and Methods-Stone fragmentation and tissue injury produced by the original and modified lenses of a Siemens lithotripter were evaluated in a swine model under equivalent acoustic pulse energy (~45 mJ) at 1 Hz pulse repetition frequency. Stone fragmentation was determined by the weight percent of stone fragments less than 2 mm. For tissue injury assessment, shock wave-treated kidneys were perfused, dehydrated, cast in paraffin wax and sectioned. Digital images were captured every 120 µm and processed to determine the functional renal volume damage.Results-After 500 shocks, stone fragmentation efficiency produced by the original and modified lenses was 48 ± 12% and 52 ± 17% (p=0.60), respectively. However, after 2000 shocks, the modified lens showed significantly improved stone fragmentation of 86 ± 10%, compared to 72 ± 12% for the original lens (p=0.02). Tissue injury caused by the original and modified lenses was minimal at 0.57 ± 0.44% and 0.25 ± 0.25% (p=0.27), respectively.Conclusions-With lens modification, the Siemens Modularis lithotripter demonstrates significantly improved stone fragmentation with minimal tissue injury at clinically relevant acoustic pulse energy. This new lens design could potentially be retrofitted to existing lithotripters, thereby improving the effectiveness of EM lithotripters.

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Efficacy and Treatment Outcome of a New Electromagnetic Lithotripter for Upper Urinary Tract Calculi

Abstract: Outpatient based electromagnetic SWL using the Lithoskop achieves high fragmentation and success rates with minimal analgesia requirements and a low complication rate.

Cited by 10 publications

References 19 publications

Prognostic variables for shockwave lithotripsy (SWL) treatment success: no impact of body mass index (BMI) using a third generation lithotripter

Prognostic variables for shockwave lithotripsy (SWL) treatment success: no impact of body mass index (BMI) using a third generation lithotripter

Management of lower ureteric stones: a prospective study

Assessment of a Modified Acoustic Lens for Electromagnetic Shock Wave Lithotripters in a Swine Model

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