Lithotripter Technology: Present and Future

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Abstract
Lithotripters can be categorized "low-cost" (Direx Tripter XI, Storz Modulith SL5, Northgate SD3, Siemens Lithostar Ultra, Dornier Compact), "second-generation" (EDAP LT01, Wolf Piezolith 2300, Technomed Sonolith 3000, Siemens Lithostar, Dornier MPL 9000), and "third-generation" (Storz Modulith SL20, Siemens Lithostar Plus, Dornier MFL 5000-u and MPL 9000-x, Wolf Piezolith 2500, EDAP LT02). The main features of third-generation lithotripters are a combined localization system allowing interdisciplinary shock wave lithotripsy; a wide energy range of the shock wave source, resultingin an efficacy similar to that of the Dornier HM3; and integration of the shock wave source and fluoroscopy unit in an endoscopic treatment table for multifunctional use. The advantages and disadvantages of the various shock wave sources, coupling, methods, localization systems, and handling of various third-generation lithotripters are outlined. A comparison of the possibilities and limitations of the different machines is given. A modification of the Clayman-Preminger efficacy quotient is introduced. Finally, the main factors determining the specific choice of a lithotripter are described.