Stone Disease A Prospective Randomised Trial Comparing the Modified HM3 with the MODULITH W SLX-F2 Lithotripter Pascal Zehnder, Beat Roth, Fre ´de ´ric Birkha ¨user, Silvia Schneider, Rolf Schmutz, George N. Thalmann, Urs E. Studer * Department of Urology, University of Bern, Bern, Switzerland EUROPEAN UROLOGY 59 (2011) 637–644 available at www.sciencedirect.com journal homepage: www.europeanurology.com Article info Article history: Accepted January 14, 2011 Published online ahead of print on January 25, 2011 Keywords: HM3 Prospective randomised comparison Shock wave lithotripsy SLX-F2 Abstract Background: The relative efficacy of first- versus last-generation lithotripters is unknown. Objectives: To compare the clinical effectiveness and complications of the modi- fied Dornier HM3 lithotripter (Dornier MedTech, Wessling, Germany) to the MODULITH 1 SLX-F2 lithotripter (Storz Medical AG, Ta ¨ gerwilen, 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. 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 after ESWL. 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 treated with the MODULITH 1 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 1 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 1 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 1 SLX-F2: 44%; p = 0.003). Overall, HM3 lithotripter led to fewer secondary treatments (HM3: 11% vs MODULITH 1 SLX-F2: 19%; p = 0.001) and fewer kidney haematomas (HM3: 1% vs. MODULITH 1 SLX-F2: 3%; p = 0.02). Conclusions: 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 treat- ments than the MODULITH 1 SLX-F2 lithotripter. In patients with a solitary kidney and 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