Does the type of lithotripter affect outcomes in children with upper tract urolithiasis?

Purpose: To compare the treatment outcome and short-term safety of electrohydraulic and electromagnetic lithotripters in children. Patients and Methods: Comparative analysis of children undergoing shockwave lithotripsy (SWL) with a Dornier MPL 9000™ electrohydraulic lithotripter (EHL) and a Siemens Modularis™ electromagnetic lithotripter (EML) was performed. All SWL treatments were performed by a single operator under the supervision of an admitting urologist. The demographic features, stone, and treatment-related parameters, including complications, were analyzed for both groups. Stone-free (SF) rates, re-treatment rate, and efficiency quotient (EQ) were calculated and compared for the two groups. Results: Ninety-eight children had SWL for renal and proximal ureteral stones. There were 58 children in the EHL group and 40 in the EML group. There were no statistically significant differences between the groups in terms of age, sex, type of anesthesia, diagnostic modality, site, side, and size of the stones. Number of shockwaves used with EML was greater than with EHL (P < 0.00). SF rate was 95% and 77% for EHL and EML, respectively, with a statistically significant difference (P < 0.00). The re-treatment rate was equal in either group. The complication rate was higher with the EHL compared with the EML, although it did not reach statistical significance. Steinstrasse was the most common complication noted. EQ was 66% for the EHL, in comparison with 53% for the EML. Conclusion: The EHL has a better SF and EQ than the EML; however, short-term safety is marginally better with the EML.