title: Treatment efficacy and outcomes using a third generation shockwave lithotripter.
abstract: OBJECTIVE
  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).
  
  
  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.
authors.affiliation: Department of Urology, University Medical Center Mainz, Mainz, Germany; Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA.
authors.forename: Andreas
authors.initials: A
authors.lastname: Neisius
authors.forename: Jens
authors.initials: J
authors.lastname: Wöllner
authors.forename: Christian
authors.initials: C
authors.lastname: Thomas
authors.forename: Frederik C
authors.initials: FC
authors.lastname: Roos
authors.forename: Walburgis
authors.initials: W
authors.lastname: Brenner
authors.forename: Christian
authors.initials: C
authors.lastname: Hampel
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Preminger
authors.forename: Joachim W
authors.initials: JW
authors.lastname: Thüroff
authors.forename: Rolf
authors.initials: R
authors.lastname: Gillitzer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004867:Equipment Design; D005260:Female; D006801:Humans; D007223:Infant; D007669:Kidney Calculi / Q000628:therapy*; D008096:Lithotripsy / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D014514:Ureteral Calculi / Q000628:therapy*; D055815:Young Adult
keywords: ESWL; Lithoskop®; efficacy and outcomes; electromagnetic third generation lithotripter