[Lithostar Multiline. A multi-function lithotripter for ESWL and endourology: initial clinical experiences]

After > 10,000 treatments-our HM3/4 and MPL 9000 have been replaced by the Siemens Lithostar multiline. As a ESWL center with ESWL as the primary treatment indication for all types of stones in kidney and ureter we report our initial experience with this new multifunctional lithotripter. The system consists of an electromagnetic shock-wave emitter (Focus 80 x 5 mm) and a digital fluoroscopy unit. Stone localization is achieved in a - 10 degrees and + 30 degrees position without movement of the patient. The treatment table itself allows most endourologic and percutaneous auxiliary procedures. Additionally, an intergrated inline ultrasound is available. From 10/94 to 08/95, 204 male and 96 female patients with a mean age of 50.7 (4-92) years underwent ESWL with the Lithostar multiline. The mean stone diameter was 10.3 (2-20) mm with 53% ureteral and 47% renal stones. 300 patients underwent 480 treatments (average shocks 3673, range 793-8000; mean energy level 5.5, range 1-9). Stone localization was achieved after 5 (1-39) min (mean fluoroscopy time 3.1 (0.5-16.2) min). In 92.7% no analgesic premedication was done, 56% of the patients needed no analgesics at all during ESWL. 44% received 8.1 (2-15) mg Piritramid intravenously. Epidural anesthesia was performed in only 2.3% for a second treatment. 95% of the patients had complete stone disintegration. In 68% disintegration was achieved in one session. ESWL was repeated for further disintegration in 18.5%, because of an unsuccessful treatment in 11.5% and because of technical interruption of the previous session in 2.5%. We saw subkapsular haematomas in 2%. Auxiliary procedures following ESWL were necessary in only 9.2% of the patients. In situ ESWL with the new Lithostar Multiline seems to be effective as the Domler HM3/4. Analgesia-free treatment was performed in more than 50% of the patients. Auxiliary procedures were less frequently necessary as compared to our previous experience with in situ ESWL.