Shock wave lithotripsy at 60 or 120 shocks per minute: a randomized, double-blind trial

The rate of shock wave administration is a factor in the per shock efficiency of shock wave lithotripsy (SWL). Experimental evidence suggests that decreasing shock wave frequency from 120 shocks per minute results in improved stone fragmentation. To our knowledge this study is the first to examine the effect of decreased shock wave frequency in patients with renal stones.

Patients with previously untreated radiopaque stones in the renal collecting system were randomized to SWL at 60 or 120 shocks per minute. They were followed at 2 weeks and 3 months. The primary outcome was the success rate, defined as stone-free status or asymptomatic fragments less than 5 mm 3 months after treatment.

A total of 220 patients were randomized, including 111 to 60 shocks per minute and 109 to 120 shocks per minute. The 2 groups were comparable in regard to age, sex, body mass index, stent status and initial stone area. The success rate was higher for 60 shocks per minute (75% vs 61%, p = 0.027). Patients with larger stones (stone area 100 mm or greater) experienced a greater benefit with treatment at 60 shocks per minute. The success rate was 71% for 60 shocks per minute vs 32% (p = 0.002) and the stone-free rate was 60% vs 28% (p = 0.015). Repeat SWL was required in 32% of patients treated with 120 shocks per minute vs 18% (p = 0.018). Fewer shocks were required with 60 shocks per minute (2,423 vs 2,906, p <0.001) but treatment time was longer (40.6 vs 24.2 minutes, p <0.001). There was a trend toward fewer complications with 60 shocks per minute (p = 0.079).

SWL treatment at 60 shocks per minute yields better outcomes than at 120 shocks per minute, particularly for stones 100 mm or greater, without any increase in morbidity and with an acceptable increase in treatment time.