Department of Urology, University of Bern, Bern, Switzerland.
Eur Urol. 2011 Apr;59(4):637-44. doi: 10.1016/j.eururo.2011.01.026. Epub 2011 Jan 25.
The relative efficacy of first- versus last-generation lithotripters is unknown.
To compare the clinical effectiveness and complications of the modified Dornier HM3 lithotripter (Dornier MedTech, Wessling, Germany) to the MODULITH(®) SLX-F2 lithotripter (Storz Medical AG, Tägerwilen, Switzerland) for extracorporeal shock wave lithotripsy (ESWL).
DESIGN, SETTING AND PARTICIPANTS: We conducted a prospective, randomised, single-institution trial that included elective and emergency patients.
Shock wave treatments were performed under anaesthesia.
Stone disintegration, residual fragments, collecting system dilatation, colic pain, and possible kidney haematoma were evaluated 1 d and 3 mo after ESWL. Complications, ESWL retreatments, and adjuvant procedures were documented.
Patients treated with the HM3 lithotripter (n=405) required fewer shock waves and shorter fluoroscopy times than patients treated with the MODULITH(®) SLX-F2 lithotripter (n=415). For solitary kidney stones, the HM3 lithotripter produced a slightly higher stone-free rate (p=0.06) on day 1; stone-free rates were not significantly different at 3 mo (HM3: 74% vs MODULITH(®) SLX-F2: 67%; p=0.36). For solitary ureteral stones, the stone-free rate was higher at 3 mo with the HM3 lithotripter (HM3: 90% vs MODULITH(®) SLX-F2: 81%; p=0.05). For solitary lower calyx stones, stone-free rates were equal at 3 mo (63%). In patients with multiple stones, the HM3 lithotripter's stone-free rate was higher at 3 mo (HM3: 64% vs MODULITH(®) SLX-F2: 44%; p=0.003). Overall, HM3 lithotripter led to fewer secondary treatments (HM3: 11% vs MODULITH(®) SLX-F2: 19%; p=0.001) and fewer kidney haematomas (HM3: 1% vs. MODULITH(®) SLX-F2: 3%; p=0.02).
The modified HM3 lithotripter required fewer shock waves and shorter fluoroscopy times, showed higher stone-free rates for solitary ureteral stones and multiple stones, and led to fewer kidney haematomas and fewer secondary treatments than the MODULITH(®) SLX-F2 lithotripter. In patients with a solitary kidney and solitary lower calyx stones, results were comparable for both lithotripters.
目前尚不清楚第一代和最后一代碎石机的相对疗效。
比较改良的多尼尔 HM3 碎石机（多尼尔医疗技术公司，德国韦斯林）与 MODULITH(®) SLX-F2 碎石机（STORZ 医疗公司，瑞士泰格伦）在体外冲击波碎石术（ESWL）中的临床效果和并发症。
设计、地点和参与者：我们进行了一项前瞻性、随机、单机构试验，纳入了选择性和急诊患者。
在麻醉下进行冲击波治疗。
在 ESWL 后 1 天和 3 个月评估结石碎裂、残留碎片、收集系统扩张、绞痛和可能的肾血肿。记录并发症、ESWL 再治疗和辅助治疗。
接受 HM3 碎石机治疗的患者（n=405）需要的冲击波次数和透视时间比接受 MODULITH(®) SLX-F2 碎石机治疗的患者（n=415）少。对于单个肾结石，HM3 碎石机在第 1 天的结石清除率略高（p=0.06）；3 个月时结石清除率无显著差异（HM3：74% vs MODULITH(®) SLX-F2：67%；p=0.36）。对于单个输尿管结石，HM3 碎石机的 3 个月结石清除率较高（HM3：90% vs MODULITH(®) SLX-F2：81%；p=0.05）。对于单个下盏结石，3 个月时结石清除率相等（63%）。对于多发性结石患者，HM3 碎石机的 3 个月结石清除率较高（HM3：64% vs MODULITH(®) SLX-F2：44%；p=0.003）。总体而言，HM3 碎石机导致的二次治疗较少（HM3：11% vs MODULITH(®) SLX-F2：19%；p=0.001），肾血肿也较少（HM3：1% vs. MODULITH(®) SLX-F2：3%；p=0.02）。
改良的 HM3 碎石机需要的冲击波次数和透视时间更少，对单个输尿管结石和多发性结石的结石清除率更高，导致肾血肿和二次治疗的发生率也更低。对于单个肾结石和单个下盏结石患者，两种碎石机的结果相当。
