Nomikos Michael S, Sowter Steven J, Tolley David A
Department of Urology, The Scottish Lithotriptor Centre, Western General Hospital, Edinburgh, UK.
BJU Int. 2007 Dec;100(6):1356-60. doi: 10.1111/j.1464-410X.2007.07117.x. Epub 2007 Sep 11.
To evaluate the efficacy of a fourth-generation lithotripter, the Sonolith Vision (Technomed Medical Systems, Vaulx-en-Velin, France) for treating single previously untreated renal calculi, and to compare the results with the reference standard HM-3 (Dornier MedTech Europe GmbH, Wessling, Germany) in the same population originally studied by the USA Cooperative Study Group in 1986.
The Sonolith Vision uses an innovative electroconductive shock-wave generator with an elliptical reflector specially designed to give the maximum concentration of energy on the stone. We reviewed the treatment sessions from our prospectively maintained database of the first 1000 consecutive patients with urinary stone disease who were treated with the Sonolith Vision between September 2004 and March 2006. Patients with previously untreated solitary renal calculi in anatomically normal kidneys were included. The outcome was assessed by plain films for radio-opaque stones, and renal ultrasonography for radiolucent stones, at 1 and 3 months after lithotripsy; the results were analysed according to stone size and location.
Data from 309 patients who had a complete follow-up and with 373 renal calculi that matched the above criteria were analysed. The initial fragmentation rate was 94%. The stone-free rate for stones of <10 mm was 77%, for 11-20 mm was 69% and for >20 mm was 50%. The overall stone-free rate 3 months after lithotripsy was 75%. Within a month of lithotripsy, 221 patients (59%) became stone-free. Additional procedures to render patients stone-free after lithotripsy were needed in only 22 cases (7%). The overall efficiency quotient was 62%. The stone-free rates for lower, upper, middle calyceal and renal pelvic calculi were 74%, 70%, 78.5% and 75%, respectively. There were no serious complications.
When similar populations of stone formers were assessed the Sonolith Vision achieved a high success rate, comparable with that using the HM-3 machine but with lower analgesia requirements and very low re-treatment rates. This method of comparison belies the commonly held view that newer lithotripters are less effective than the original spark-gap machines.
评估第四代碎石机Sonolith Vision（法国Technomed Medical Systems公司，沃勒-昂韦兰）治疗单个未经治疗的肾结石的疗效，并将结果与1986年美国合作研究小组最初研究的同一人群中使用的参考标准HM-3（德国多尼尔医疗技术欧洲有限公司，韦斯林）进行比较。
Sonolith Vision采用创新的导电冲击波发生器和专门设计的椭圆形反射器，以在结石上实现最大能量集中。我们回顾了2004年9月至2006年3月期间接受Sonolith Vision治疗的前1000例连续尿路结石病患者的前瞻性维护数据库中的治疗记录。纳入解剖结构正常的肾脏中单个未经治疗的肾结石患者。在碎石术后1个月和3个月时，通过腹部平片评估不透X线结石，通过肾脏超声评估透X线结石来评估结果；根据结石大小和位置分析结果。
分析了309例具有完整随访且有373颗符合上述标准的肾结石患者的数据。初始碎石率为94%。<10mm结石的无石率为77%，11 - 20mm结石的无石率为69%，>20mm结石的无石率为50%。碎石术后3个月的总体无石率为75%。在碎石术后1个月内，221例患者（59%）结石清除。仅22例患者（7%）需要在碎石术后进行额外的使患者结石清除的操作。总体效率商为62%。下盏、上盏、中盏和肾盂结石的无石率分别为74%、70%、78.5%和75%。无严重并发症。
当评估类似的结石形成人群时，Sonolith Vision取得了较高的成功率，与使用HM-3机器相当，但镇痛需求较低且再次治疗率非常低。这种比较方法与普遍认为的新碎石机不如原始火花隙机器有效的观点相悖。
