Extracorporeal shock wave lithotripsy with a transportable electrohydraulic lithotripter: experience with >300 patients.
OBJECTIVE
To review a multicentre experience of using a transportable lithotripter (STS-T, Medstone, Inc, Aliso Viejo, CA. USA) for treating patients with urolithiasis in all parts of the urinary tract.


METHODS
In all, 326 patients with a total of 370 stones were treated as outpatients with the STS-T lithotripter. All patients received a single shock wave lithotripsy treatment and were followed after 4-6 weeks in the outpatient clinic, the primary endpoint being to determine the efficacy (as defined by the stone-free rate). Secondary objectives included establishing a database of patient demographic information, stone characteristics, stone location, procedural endpoints, and complication rates.


RESULTS
In all there were 370 procedures, with a mean of 2394 shocks administered at an energy level of 24 kV. The mean treatment time was 51 min, excluding anaesthesia-induction time. The mean stone aggregate size was 8.2 mm; 62% of the stones were in the kidney while 38% were in various locations in the ureter. Of the treated stones, 90% had definite or probable evidence of fragmentation. The overall stone-free rate after one treatment with the STS-T was 52.8%. Of patients with residual fragments, most (61%) had fragments of <4 mm in aggregate diameter. The overall complication rate was 3.8%, the most common complication being postoperative pain.


CONCLUSIONS
The Medstone STS-T lithotripter was an effective device for treating urolithiasis in all parts of the urinary tract. This system had a high margin of safety, as shown by the low complication rate. With no apparent sacrifice of efficacy compared to first-generation or fixed (not transportable) second-generation devices, the Medstone STS-T represents an important advance in the development of a truly transportable lithotripter.
Albala
David M
DM
Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA. albal002@mc.duke.edu
Siddiqui
Khurram M
KM
Fulmer
Brant
B
Alioto
Joseph
J
Frankel
Jeffery
J
Monga
Manoj
M
D000328:Adult; D000368:Aged; D003628:Database Management Systems; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007669:Kidney Calculi / Q000628:therapy; D008096:Lithotripsy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain; D012189:Retrospective Studies; D016896:Treatment Outcome; D014514:Ureteral Calculi / Q000628:therapy; D014545:Urinary Calculi / Q000628:therapy*; D014555:Urination Disorders / Q000209:etiology