title: A new transportable shock-wave lithotripsy machine for managing urinary stones: a single-centre experience with a dual-focus lithotripter.
abstract: OBJECTIVE
  To assess the efficacy and safety of a transportable extracorporeal shock wave lithotripsy (ESWL) machine, the Modulith SLX-F2(TM) (Storz Medical Italia, Rome, Italy), in the management of solitary urinary calculi.
  
  
  METHODS
  The study included 233 patients (mean age 51 years; 172 male, 61 female) with symptomatic solitary renal (group A, 170, mean diameter 15.5 mm) or ureteric stones (group B, 63, mean diameter 9.5 mm) treated in a tertiary care institution. Exclusion criteria for the analysis were: pelvi-ureteric junction obstruction, multiple stones, stone diameter >2 cm, stones in a lower calyx with unfavourable anatomy, active infection, or impacted ureteric stones. Selected patients had ureteric stenting before treatment, and all patients were treated with no anaesthesia. Hospitalization, complications and subsequent auxiliary procedures were evaluated. Patients were assessed after a single ESWL session and after 3 months by a plain abdominal film and renal ultrasonography. Stone-free status was defined as no evidence of calculi, and clinical success as the presence of stone fragments of <4 mm. An efficiency quotient (EQ) was calculated for the ESWL treatment. Pain was assessed using a visual analogue scale.
  
  
  RESULTS
  The mean number of shocks used was 3779 and the mean (range) treatment time was 35 (5-55) min. The overall clinical success rate after one ESWL session was 83.7% and 82.5% for renal and ureteric stones, respectively, and the overall 3-month stone-free rate was 77% and 74.6%, respectively; the overall EQ was 0.64. When risk factors for persistent calculi were analysed simultaneously in a logistic regression model, only stones of >1 cm were statistically significant (P < 0.05). Most patients reported that pain during ESWL was mild to moderate and easily tolerated. Only minor complications occurred, with an overall complication rate of 3.8%.
  
  
  CONCLUSIONS
  This transportable lithotripter is a safe and effective device for managing solitary stones throughout the urinary tract. Its main advantage is represented by the dual-focus system. Moreover, it shares with other contemporary machines several important features such as outpatient setting, no need for anaesthesia, easy patient positioning, and the capability of ancillary procedures.
authors.affiliation: Clinica Urologica, AOU Policlinico, Seconda Università degli Studi, Napoli, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: De Sio
authors.forename: Riccardo
authors.initials: R
authors.lastname: Autorino
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Quarto
authors.forename: Salvatore
authors.initials: S
authors.lastname: Mordente
authors.forename: Francesco
authors.initials: F
authors.lastname: Giugliano
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Di Giacomo
authors.forename: Fabio
authors.initials: F
authors.lastname: Neri
authors.forename: Carmelo
authors.initials: C
authors.lastname: Quattrone
authors.forename: Domenico
authors.initials: D
authors.lastname: Sorrentino
authors.forename: Renato
authors.initials: R
authors.lastname: De Domenico
authors.forename: Massimo
authors.initials: M
authors.lastname: D'Armiento
mesh_terms: D004867:Equipment Design; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000628:therapy*; D008096:Lithotripsy / Q000009:adverse effects / Q000295:instrumentation* / Q000592:standards; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014514:Ureteral Calculi / Q000628:therapy*