World J Nephrol Urol

World Journal of Nephrology and Urology, ISSN 1927-1239 print, 1927-1247 online, Open Access

Article copyright, the authors; Journal compilation copyright, World J Nephrol Urol and Elmer Press Inc

Journal website http://www.wjnu.org

Original Article

Volume 3, Number 1, March 2014, pages 7-17

Single-Center Experience With the Dual-Focus Storz Modulith SLX-F2 Lithotripter: A Retrospective Study

**Table 1.** Technical Parameters of the Storz Modulith SLX-F2
Parameter	Description
Shock wave source	Electromagnetic cylindrical coil source
Coupling system	Water filled cushion
Focusing system	Parabolic reflection system
Maximal treatment depth (mm)	≤ 180
Variable focus volume at level 50 (mm)
Wide	36 × 4.8 × 4.7
Narrow	20 × 2 × 2
Variable focus pressure (MPa)	6.4-107 ± 20%
Peak compressional acoustic pressure (MPa)
Wide	16-44
Narrow	18-107
Energy per shot (mJ)
Wide	2.9-15
Narrow	2.5-16
Imaging system	In-line imaging system with up to 30° lateral fluoroscopy

Table 1. Technical Parameters of the Storz Modulith SLX-F2

Parameter

Description

Shock wave source

Electromagnetic cylindrical coil source

Coupling system

Water filled cushion

Focusing system

Parabolic reflection system

Maximal treatment depth (mm)

≤ 180

Variable focus volume at level 50 (mm)

Wide

36 × 4.8 × 4.7

Narrow

20 × 2 × 2

Variable focus pressure (MPa)

6.4-107 ± 20%

Peak compressional acoustic pressure (MPa)

Wide

16-44

Narrow

18-107

Energy per shot (mJ)

Wide

2.9-15

Narrow

2.5-16

Imaging system

In-line imaging system with up to 30° lateral fluoroscopy

**Table 2.** Patient Characteristics (n = 416)
Characteristics	Value/SD/Range*
*were applicable; SD: standard deviation.
Mean age in years	46.1 ± 14.4 (range: 6-83)
Male/female patients	243 (58.4%)/173 (41.6%)
Mean body mass index (kg/m²)	30.5 ± 7.04 (range: 16.5-58.8)
Race
Caucasian	Male: 147 (35.3%); female: 95 (22.8%)
Hispanic	Male: 65 (15.5%); female: 66 (15.9%)
African-American	Male: 8 (1.90%); female: 3 (0.70%)
Other	Male: 23 (5.50%); female: 9 (2.20%)

Table 2. Patient Characteristics (n = 416)

Characteristics

Value/SD/Range*

*were applicable; SD: standard deviation.

Mean age in years

46.1 ± 14.4 (range: 6-83)

Male/female patients

243 (58.4%)/173 (41.6%)

Mean body mass index (kg/m²)

30.5 ± 7.04 (range: 16.5-58.8)

Race

Caucasian

Male: 147 (35.3%); female: 95 (22.8%)

Hispanic

Male: 65 (15.5%); female: 66 (15.9%)

African-American

Male: 8 (1.90%); female: 3 (0.70%)

Other

Male: 23 (5.50%); female: 9 (2.20%)

**Table 3.** Descriptive Statistic of Stone Localization
Characteristics	N/SD
Laterality
Left	225 (54.1%)
Right	191 (45.9%)
Renal localization
Renal pelvis	116 (27.9%)
Upper calyx	36 (8.7%)
Middle calyx	45 (10.8%)
Lower calyx	97 (23.3%)
Ureteral localization
Proximal ureter	88 (21.2%)
Middle ureter	16 (3.8%)
Distal ureter	18 (4.3%)
Mean stone size (mm)	9.3 ± 4.5 (range: 5-20)
Stone size (mm)
≥ 5; < 10	256 (61.5%)
≥ 10; ≤ 20	160 (38.5%)

Table 3. Descriptive Statistic of Stone Localization

Characteristics

N/SD

Laterality

Left

225 (54.1%)

Right

191 (45.9%)

Renal localization

Renal pelvis

116 (27.9%)

Upper calyx

36 (8.7%)

Middle calyx

45 (10.8%)

Lower calyx

97 (23.3%)

Ureteral localization

Proximal ureter

88 (21.2%)

Middle ureter

16 (3.8%)

Distal ureter

18 (4.3%)

Mean stone size (mm)

9.3 ± 4.5 (range: 5-20)

Stone size (mm)

≥ 5; < 10

256 (61.5%)

≥ 10; ≤ 20

160 (38.5%)

**Table 4.** Treatment Outcomes Depending on Auxiliary Procedures
Characteristics	Clinical success	Failure	P value
Auxiliary procedures
JJ stent
Yes	37	20	0.0002
No	316	43
Nephrostomy
Yes	6	0	0.5971
No	347	63

Table 4. Treatment Outcomes Depending on Auxiliary Procedures

Characteristics

Clinical success

Failure

P value

Auxiliary procedures

JJ stent

Yes

0.0002

316

Nephrostomy

Yes

0.5971

347

**Table 5.** Specific Patient and Stone Characteristics in Relationship to Clinical Success Status Versus Treatment Failure
Variable	Stone-free	Failure	P value	95% CI
*renal or ^‡ureteral stone location only; °for detailed analysis (see Fig. 2); CI: confidence interval.
Age (years)	45.6	49.1	0.086	(-7.47; 0.49)
Male	201	42	0.166
Female	152	21
Mean body mass index (kg/m²)	30.5	30.4	0.486	(-1.80; 2.52)
Race
Caucasian	208	34	0.666	-
Hispanic	110	21
African-American	8	3
Other	27	5
Stone characteristics
Mean stone size (mm)	9.1	10.5	0.003	(-2.66; -0.08)
Stone size (mm)
≥ 5; < 10	226	30	0.016	-
≥ 10; ≤ 20	127	33
Laterality
Left	192	33	0.671	-
Right	161	30
Renal localization
Renal pelvis	102	14	0.04*^o	-
Upper calyx	34	2
Middle calyx	42	3
Lower calyx	73	24
Ureteral localization
Proximal ureter	70	18	0.092^‡	-
Middle ureter	14	2
Distal ureter	18	0

Table 5. Specific Patient and Stone Characteristics in Relationship to Clinical Success Status Versus Treatment Failure

Variable

Stone-free

Failure

P value

95% CI

*renal or ^‡ureteral stone location only; °for detailed analysis (see Fig. 2); CI: confidence interval.

Age (years)

45.6

49.1

0.086

(-7.47; 0.49)

Male

201

0.166

Female

152

Mean body mass index (kg/m²)

30.5

30.4

0.486

(-1.80; 2.52)

Race

Caucasian

208

0.666

Hispanic

110

African-American

Other

Stone characteristics

Mean stone size (mm)

9.1

10.5

0.003

(-2.66; -0.08)

Stone size (mm)

≥ 5; < 10

226

0.016

≥ 10; ≤ 20

127

Laterality

Left

192

0.671

Right

161

Renal localization

Renal pelvis

102

0.04*^o

Upper calyx

Middle calyx

Lower calyx

Ureteral localization

Proximal ureter

0.092^‡

Middle ureter

Distal ureter

**Table 6.** Comparison of the Modulith SLX-F2 With Other Portable and Non-Portable Lithotripters
Ref	Lithotripter machine	SW source	# patients	Mean stone size (mm)	Stone-free rate (%)	Re-treatment rate (%)	EQ
N/A: data not available; SW: shock wave; EM: electromagnetic; PE: piezoelectric; EC: electroconductive. Clinical success rate; *for most of the patients.
de Sio et al [4]	Modulith SLX-F2 (focus NA)	EM	233	12.6	76.3	11.5	0.64
Albala et al [25]	Modulith SLX-F2 (focus NA)	EM	599	7	69.8	N/A	N/A
Suzuki et al [27]	Modulith SLX-F219 (standard vs. wide focus)	EM	361	Renal: 14; Ureteral: 11	N/A	N/A	0.553 vs. 0.565
Elkoushi et al [26]	Modulith SLX-F2 (standard focus)	EM	474	Renal: 10.5; Ureteral: 8.7	77	14.7	0.66
Zehnder et al [3]	Modulith SLX-F2^#	EM	415	N/A	67 (solitary stones)	11	0.58
Present study	Modulith SLX-F2 (standard and wide focus)	EM	416	9.3	84.6*	11.29	0.69
Cass et al [31]	Dornier HM3	EH	2,402	< 20**	70	6	0.64
Sheir et al [32]	Dornier Lithotripter S	EM	347	12.7	88.5	34.6	0.54
Nabi et al [33]	Dornier Compact Delta	EM	137	10	82	29.3	0.53
Portis et al [34]	Healthtronics LithoTron	EH	38	9.6	13.4	21	N/A
Jain et al [35]	Healthtronics LithoTron	EH	256	8	66	7.7	0.59
Ng et al [36]	Wolf Piezolith 3000	PE	26	N/A	36	N/A	N/A
Albala et al [37]	Medstone STS-T	EH	326	8.2	52.8	N/A	0.43
Vega et al [38]	Siemens Modularis	EM	1,000	12.2	> 90	19	N/A
White et al [39]	Doriner Compact Delta	EM	4,621	N/A	58.5	7.2	0.51
Heretis et al [40]	Dornier Lithotriper S	EM	140	7.6-9.5	75	7	0.67
Pemberton et al [41]	Technomed Sonolith Vision	EC	107	8.9	88.8	20.6	0.67
Nomikos et al [42]	Sonolith Vision	EM	309	10.8	75	16.8	0.62
Egilmez et al [43]	Siemens Modularis	EM	2,670	N/A	79	N/A	0.67

Table 6. Comparison of the Modulith SLX-F2 With Other Portable and Non-Portable Lithotripters

Ref

Lithotripter machine

SW source

# patients

Mean stone size (mm)

Stone-free rate (%)

Re-treatment rate (%)

N/A: data not available; SW: shock wave; EM: electromagnetic; PE: piezoelectric; EC: electroconductive. *Clinical success rate; **for most of the patients.

de Sio et al [4]

Modulith SLX-F2 (focus NA)

233

12.6

76.3

11.5

0.64

Albala et al [25]

Modulith SLX-F2 (focus NA)

599

69.8

N/A

Suzuki et al [27]

Modulith SLX-F219 (standard vs. wide focus)

361

Renal: 14; Ureteral: 11

N/A

0.553 vs. 0.565

Elkoushi et al [26]

Modulith SLX-F2 (standard focus)

474

Renal: 10.5; Ureteral: 8.7

14.7

0.66

Zehnder et al [3]

Modulith SLX-F2^#

415

N/A

67 (solitary stones)

0.58

Present study

Modulith SLX-F2 (standard and wide focus)

416

9.3

84.6*

11.29

0.69

Cass et al [31]

Dornier HM3

2,402

< 20**

0.64

Sheir et al [32]

Dornier Lithotripter S

347

12.7

88.5

34.6

0.54

Nabi et al [33]

Dornier Compact Delta

137

29.3

0.53

Portis et al [34]

Healthtronics LithoTron

9.6

13.4

N/A

Jain et al [35]

Healthtronics LithoTron

256

7.7

0.59

Ng et al [36]

Wolf Piezolith 3000

N/A

Albala et al [37]

Medstone STS-T

326

8.2

52.8

N/A

0.43

Vega et al [38]

Siemens Modularis

1,000

12.2

> 90

N/A

White et al [39]

Doriner Compact Delta

4,621

N/A

58.5

7.2

0.51

Heretis et al [40]

Dornier Lithotriper S

140

7.6-9.5

0.67

Pemberton et al [41]

Technomed Sonolith Vision

107

8.9

88.8

20.6

0.67

Nomikos et al [42]

Sonolith Vision

309

10.8

16.8

0.62

Egilmez et al [43]

Siemens Modularis

2,670

N/A

0.67