Comparison of Northgate SD-3 and Modulith SLX Lithotriptors: Treatment Results with 2,000 Renal and Ureteral Stones

Northgate SD-3와 Modulith SLX 쇄석기를 이용한 체외충격파쇄석술의 비교분석: 단일 신결석 및 요로결석 2,000례의 치료결과 분석

Some reports have shown a decreased effectiveness of extracorporeal shock wave lithotripsy(ESWL) with newer lithotriptors. We compared the treatment results of ESWL with a second generation Northgate SD-3 and a third generation Modulith SLX device. A total of 2,000 patients underwent ESWL treatments for single urinary calculus between September, 1988 and July, 1998. 1,241 patients were treated with Northgate SD-3 between September, 1988 and December, 1995. And 759 patients were treated with Modulith SLX between January, 1996 and July 1998. The treatment results were compared using chi-square test to determine statistical significance. The overall success rate, success rate according to the location and size, the mean number of sessions, complication rate and retreatment rate were calculated, according to lithotriptor. The overall success rate was 90.6% with Northgate SD-3 and 89.1% with Modulith SLX. With Northgate SD-3 and Modulith SLX, the success rate according to the location was 91.0%(579/636) and 88.1%(236/268) in kidney: 93.2%(517/555) and 89.9%(258/287) in upper ureter: 83.3%10/12) and 94.4%167/177) in middle and lower ureter: 47.4%(18/38) and 55. 6%(15/27) in staghorn stone, respectively. The success rate according to the size of stone with Northgate SD-3 and Modulith SLX for stones with the size under 10mm was 96.1%(612/637) and 93.1%(470/505); from 11mm to 20mm was 87.3%(421/482) and 86.4%(165/191); from 21mm to 30mm, 77.5%(62/80) and 67.5%(23/34): and for stones larger than 31mm was 69%(29/42) and 62.1%(18/29), respectively. Mean number of sessions for successful fragmentation was 1.21 and 1.69, respectively with Northgate SD-3 and Modulith SLX. Retreatment rate was 16.7% and 17.5%, respectively. The complications after treatment were severe pain(6.2% with Northgate SD-3 vs. 2.0% with Modulith SLX), steinstrasse(3.4% vs. 1.9%), fever(1.2% vs. 0.5%) and perirenal hematoma(0.2% vs. 0%) in order of frequency. There was no significant difference in the effectiveness of Northgate SD-3 and Modulith SLX. However, a statistically significant difference was observed between the two lithotriptors. We concluded that ESWL with Modulith SLX is more safe compared to Northgate SD-3.

세대 및 특징이 다른 쇄석기종의 치료효과와 안전성을 비교하기 위해 2세대 Northgate사의 SD-3 쇄석기와 3세대 Storz사의 Modulith SLX 쇄석기로 체외충격과 쇄석술을 시행한 단일요로결석 환자 2000례를 분석한 결과, 치료효과를 판정해 볼 수 있는 요로결석의 위치 및 크기에 따른 성공률과 재시행률에서는 큰 차이가 없는 것으로 분석되어, 제 3세대 쇄석기인 Modulith SLX와 Northgate SD-3의 치료효과는 비슷한 것으로 나타났다. 그리고, 두 쇄석기종 모두에서 심각한 합병증의 발생은 없었으나, Northgate SD-3에서 Modulith SLX 보다 합병증으로 인한 입원치료를 받은 환자의 수가 많았다. 이상으로 두 기종 사이의 치료효과에는 큰 차이가 없고, Modulith SLX률 이용한 체외충격파쇄석술이 조금 더 안전한 것으로 나타났지만 두 기종의 장단점을 서로 보완하여 사용한다면 더욱 효과적인 치료방법이 될 것으로 생각된다.