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Stone DiseaseA Prospective Randomised Trial Comparing the Modified HM3with the MODULITHWSLX-F2 LithotripterPascal Zehnder, Beat Roth, Fre´de´ric Birkhaüser, Silvia Schneider, Rolf Schmutz,George N. Thalmann, Urs E. Studer*Department of Urology, University of Bern, Bern, SwitzerlandEURO PEAN UROLOGY 59 ( 2011) 637–644available at www.sciencedirect.comjournal homepage: www.europeanurology.comArticle infoArticle history:Accepted January 14, 2011Published online ahead ofprint on January 25, 2011Keywords:HM3Prospective randomisedcomparisonShock wave lithotripsySLX-F2AbstractBackground: The relative efficacy of first- versus last-generation lithotripters isunknown.Objectives: To compare the clinical effectiveness and complications of the modi-fied Dornier HM3 lithotripter (Dornier MedTech, Wessling, Germany) to theMODULITH1SLX-F2 lithotripter (Storz Medical AG, Ta¨gerwilen, Switzerland) forextracorporeal shock wave lithotripsy (ESWL).Design, setting and participants: We conducted a prospective, randomised, single-institution trial that included elective and emergency patients.Interventions: Shock wave treatments were performed under anaesthesia.Measurements: Stone disintegration, residual fragments, collecting system dilata-tion, colic pain, and possible kidney haematoma were evaluated 1 d and 3 mo afterESWL. Complications, ESWL retreatments, and adjuvant procedures were docu-mented.Results and limitations: Patients treated with the HM3 lithotripter (n = 405)required fewer shock waves and shorter fluoroscopy times than patients treatedwith the MODULITH1SLX-F2 lithotripter (n = 415). For solitary kidney stones, theHM3 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 MODULITH1SLX-F2: 67%; p = 0.36). For solitary ureteral stones, the stone-free rate was higher at3 mo with the HM3 lithotripter (HM3: 90% vs MODULITH1SLX-F2: 81%; p = 0.05).Forsolitarylowercalyxstones,stone-freerateswereequalat3mo(63%).Inpatientswithmultiplestones,theHM3lithotripter’sstone-freeratewashigherat3mo(HM3:64% vs MODULITH1SLX-F2: 44%; p = 0.003). Overall, HM3 lithotripter led to fewersecondarytreatments(HM3: 11% vsMODULITH1SLX-F2:19%;p = 0.001) andfewerkidney haematomas (HM3: 1% vs. MODULITH1SLX-F2: 3%; p = 0.02).Conclusions: ThemodifiedHM3lithotripterrequiredfewershockwavesandshorterfluoroscopy times, showed higher stone-free rates for solitary ureteral stones andmultiple stones, and led to fewer kidney haematomas and fewer secondary treat-ments than the MODULITH1SLX-F2 lithotripter. In patients with a solitary kidneyand solitary lower calyx stones, results were comparable for both lithotripters.# 2011 European Association of Urology. Published by Elsevier B.V. All rights reserved.* Corresponding author. Department of Urology, University Hospital of Bern, Inselspital, 3010 Bern,Switzerland. Tel. +41 31 632 3641; Fax: +41 31 632 2180.E-mail address: urs.studer@insel.ch (U.E. Studer).0302-2838/$ – see back matter # 2011 European Association of Urology. Published by Elsevier B.V. All rights reserved.doi:10.1016/j.eururo.2011.01.026