{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T15:22:05Z","timestamp":1772119325346,"version":"3.50.1"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,2,25]],"date-time":"2025-02-25T00:00:00Z","timestamp":1740441600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,2,25]],"date-time":"2025-02-25T00:00:00Z","timestamp":1740441600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"University of Health Sciences"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World J Urol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>This study aims to evaluate the success rate of Shock Wave Lithotripsy (SWL) in treating kidney stones using the Modulith SLK Inline lithotripter, with a focus on the importance of device efficacy as emphasized in EAU guidelines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and methods<\/jats:title>\n                    <jats:p>This retrospective single-center study was conducted between June 2023 and June 2024. Inclusion criteria were adult patients (&gt;\u200918\u00a0years) with radiologically confirmed renal stones smaller than 15\u00a0mm in diameter. Exclusion criteria included patients with solitary kidneys, significant renal functional deterioration, skeletal deformities, active urinary tract infections, pregnancy, or coagulopathies. Treatment outcomes were collected and analyzed in detail, considering patients\u2019 demographic characteristics (age, gender) and stone parameters (size, location, and hardness [Hounsfield Unit, HU]). The SWL procedures were performed using the Modulith SLK Inline lithotripter (Storz Medical, Switzerland). The success of SWL was defined as achieving complete stone clearance or the presence of clinically insignificant residual fragments (CIRF) (&lt;\u20094\u00a0mm). This study seeks to provide detailed insights into the optimal use cases of SWL as a non-invasive yet effective treatment option for smaller, more manageable stones.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The mean age of the 208 patients included in the study was 42.2\u2009\u00b1\u200912.7\u00a0years (18\u201375), with a male-to-female ratio of 1.9:1. The mean stone size across all patients was 10.3\u00a0mm, and the average HU value was 874.0\u2009\u00b1\u2009283.2. Patients who achieved a completely stone-free status had significantly lower HU values (p\u2009=\u20090.049). The overall success rate of SWL was 78.8%, with 164 patients achieving complete stone clearance. When cases with clinically insignificant residual fragments (CIRF,\u2009&lt;\u20094\u00a0mm) were included as successful outcomes, the overall success rate increased to 92.3%. This distinction highlights the inclusion of patients with small residual fragments that are deemed clinically irrelevant in the adjusted success rate. In cases with successful outcomes, the mean stone size was 10.3\u00a0mm, whereas it was 12.5\u00a0mm in patients with residual fragments or treatment failure. A statistically significant relationship was identified between stone size and treatment success rates (p\u2009&lt;\u20090.001). In contrast, stone localization did not have a significant impact on SWL success rates (p\u2009=\u20090.377).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>SWL has demonstrated its effectiveness in kidney stone treatment with a 78.8% complete stone-free rate using the Modulith SLK Inline lithotripter. Higher success rates were achieved with smaller stones (&lt;\u200915\u00a0mm) and lower HU values. These findings support the significance of advanced lithotripter technology in establishing SWL as a valuable non-invasive option for stones under 15\u00a0mm.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00345-025-05517-4","type":"journal-article","created":{"date-parts":[[2025,2,25]],"date-time":"2025-02-25T09:51:12Z","timestamp":1740477072000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Impact of advanced lithotripter technology on SWL success: \u0131nsights from Modulith SLK \u0131nline outcomes"],"prefix":"10.1007","volume":"43","author":[{"given":"Erhan","family":"Erdo\u011fan","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gamze","family":"\u015eim\u015fek","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alper","family":"A\u015f\u0131k","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G\u00f6ksu","family":"Sar\u0131ca","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kemal","family":"Sar\u0131ca","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,2,25]]},"reference":[{"key":"5517_CR1","unstructured":"American Urological Association (2019) Medical management of kidney stones: AUA guideline. Retrieved from https:\/\/www.auanet.org\/guidelines-and-quality\/guidelines\/kidney-stones-medical-mangement-guideline"},{"key":"5517_CR2","unstructured":"European Association of Urology (2024) EAU guidelines on urolithiasis. Retrieved from https:\/\/uroweb.org\/guidelines\/urolithiasis"},{"issue":"5","key":"5517_CR3","doi-asserted-by":"publisher","first-page":"573","DOI":"10.23736\/S0026-4806.24.09291-7","volume":"115","author":"S Moretto","year":"2024","unstructured":"Moretto S, Zazzara M, Marino F, Nazaraj A, Scarcia M, Ludovico GM (2024) Robotic pyelolithotomy for the treatment of large renal stones: a single-center experience over seven years. Minerva Med 115(5):573\u2013580. https:\/\/doi.org\/10.23736\/S0026-4806.24.09291-7","journal-title":"Minerva Med"},{"issue":"4","key":"5517_CR4","doi-asserted-by":"publisher","first-page":"1153","DOI":"10.1016\/j.juro.2016.05.090","volume":"196","author":"D Assimos","year":"2016","unstructured":"Assimos D, Krambeck A, Miller NL et al (2016) Surgical management of stones: American Urological Association\/Endourological Society Guideline, Part I. J Urol 196(4):1153\u20131160. https:\/\/doi.org\/10.1016\/j.juro.2016.05.090","journal-title":"J Urol"},{"issue":"3","key":"5517_CR5","doi-asserted-by":"publisher","first-page":"417","DOI":"10.1016\/s0022-5347(17)53841-0","volume":"127","author":"C Chaussy","year":"1982","unstructured":"Chaussy C, Schmiedt E, Jocham D, Brendel W, Forssmann B, Walther V (1982) First clinical experience with extracorporeally induced destruction of kidney stones by shock waves. J Urol 127(3):417\u2013420. https:\/\/doi.org\/10.1016\/s0022-5347(17)53841-0","journal-title":"J Urol"},{"issue":"12","key":"5517_CR6","doi-asserted-by":"publisher","first-page":"660","DOI":"10.1038\/nrurol.2009.216","volume":"6","author":"JE Lingeman","year":"2009","unstructured":"Lingeman JE, McAteer JA, Gnessin E, Evan AP (2009) Shock wave lithotripsy: advances in technology and technique. Nat Rev Urol 6(12):660\u2013670. https:\/\/doi.org\/10.1038\/nrurol.2009.216","journal-title":"Nat Rev Urol"},{"issue":"4","key":"5517_CR7","first-page":"285","volume":"41","author":"K Sarica","year":"2013","unstructured":"Sarica K et al (2013) The impact of technological advancements on the clinical outcomes of extracorporeal shock wave lithotripsy. Urolithiasis 41(4):285\u2013290","journal-title":"Urolithiasis"},{"issue":"1","key":"5517_CR8","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1016\/j.urology.2004.08.004","volume":"65","author":"G Pareek","year":"2005","unstructured":"Pareek G, Armenakas NA, Panagopoulos G, Bruno JJ, Fracchia JA (2005) Extracorporeal shock wave lithotripsy success based on body mass index and Hounsfield units. Urology 65(1):33\u201336. https:\/\/doi.org\/10.1016\/j.urology.2004.08.004","journal-title":"Urology"},{"issue":"3","key":"5517_CR9","doi-asserted-by":"publisher","first-page":"444","DOI":"10.1111\/bju.13393","volume":"118","author":"PG Deutsch","year":"2016","unstructured":"Deutsch PG, Subramonian K (2016) Conservative management of staghorn calculi: a single-centre experience. BJU Int 118(3):444\u2013450. https:\/\/doi.org\/10.1111\/bju.13393","journal-title":"BJU Int"},{"issue":"1","key":"5517_CR10","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1016\/S0094-0143(21)00324-4","volume":"17","author":"WT Wilson","year":"1990","unstructured":"Wilson WT, Preminger GM (1990) Extracorporeal shock wave lithotripsy: an update. Urol Clin North Am 17(1):231\u2013242","journal-title":"Urol Clin North Am"},{"issue":"3","key":"5517_CR11","doi-asserted-by":"publisher","first-page":"483","DOI":"10.1016\/j.eururo.2015.08.010","volume":"69","author":"M Bultitude","year":"2016","unstructured":"Bultitude M, Smith D, Thomas K (2016) Contemporary management of stone disease: the new EAU Urolithiasis Guidelines for 2015. Eur Urol 69(3):483\u2013484. https:\/\/doi.org\/10.1016\/j.eururo.2015.08.010","journal-title":"Eur Urol"},{"issue":"4","key":"5517_CR12","doi-asserted-by":"publisher","first-page":"345","DOI":"10.1007\/s00240-020-01193-8","volume":"48","author":"M\u0130 G\u00f6kce","year":"2020","unstructured":"G\u00f6kce M\u0130, Yin S, S\u00f6nmez MG, Eryildirim B, Kallidonis P, Petkova K, Guven S, Kiremit MC, de Lorenzis E, Tefik T, Villa L, Zeng G, Sarica K (2020) How does the COVID-19 pandemic affect the preoperative evaluation and anesthesia applied for urinary stones? EULIS eCORE-IAU multicenter collaborative cohort study. Urolithiasis 48(4):345\u2013351. https:\/\/doi.org\/10.1007\/s00240-020-01193-8","journal-title":"Urolithiasis"},{"issue":"1","key":"5517_CR13","doi-asserted-by":"publisher","first-page":"e21","DOI":"10.1016\/j.eururo.2020.04.057","volume":"78","author":"T Tefik","year":"2020","unstructured":"Tefik T, Guven S, Villa L, Gokce MI, Kallidonis P, Petkova K, Kiremit MC, Sonmez MG, de Lorenzis E, Eryildirim B, Sarica K (2020) Urolithiasis practice patterns following the COVID-19 pandemic: overview from the EULIS Collaborative Research Working Group. Eur Urol 78(1):e21\u2013e24. https:\/\/doi.org\/10.1016\/j.eururo.2020.04.057","journal-title":"Eur Urol"},{"key":"5517_CR14","doi-asserted-by":"publisher","first-page":"471","DOI":"10.1089\/end.2000.14.471","volume":"14","author":"KC Saw","year":"2000","unstructured":"Saw KC, McAteer JA, Fineberg NS, Monga AG, Chua GT, Lingeman JE (2000) Calcium stone fragility is predicted by helical CT attenuation values. J Endourol 14:471\u2013474","journal-title":"J Endourol"},{"key":"5517_CR15","doi-asserted-by":"publisher","first-page":"1679","DOI":"10.1097\/01.ju.0000055608.92069.3a","volume":"169","author":"G Pareek","year":"2003","unstructured":"Pareek G, Armenakas NA, Fracchia JA (2003) Hounsfield units on computerized tomography predict stone-free rates after extracorporeal shock wave lithotripsy. J Urol 169:1679\u20131681","journal-title":"J Urol"},{"key":"5517_CR16","doi-asserted-by":"publisher","first-page":"E438","DOI":"10.1111\/j.1464-410X.2012.10964.x","volume":"110","author":"I Ouzaid","year":"2012","unstructured":"Ouzaid I, Al-qahtani S, Dominique S, Hupertan V, Fernandez P, Hermieu JF et al (2012) A 970 Hounsfield units (HU) threshold of kidney stone density on non-contrast computed tomography (NCCT) improves patients\u2019 selection for extracorporeal shockwave lithotripsy (ESWL): evidence from a prospective study. BJU Int 110:E438\u2013E442","journal-title":"BJU Int"},{"key":"5517_CR17","doi-asserted-by":"publisher","first-page":"40","DOI":"10.4111\/kju.2012.53.1.40","volume":"53","author":"BH Park","year":"2012","unstructured":"Park BH, Choi H, Kim JB, Chang YS (2012) Analyzing the effect of distance from skin to stone by computed tomography scan on the extracorporeal shock wave lithotripsy stone-free rate of renal stones. Korean J Urol 53:40\u201343","journal-title":"Korean J Urol"},{"key":"5517_CR18","doi-asserted-by":"publisher","first-page":"556","DOI":"10.1016\/S0090-4295(96)00297-5","volume":"48","author":"D Bon","year":"1996","unstructured":"Bon D, Dore B, Irani J, Marroncle M, Aubert J (1996) Radiographic prognostic criteria for extracorporeal shock-wave lithotripsy: a study of 485 patients. Urology 48:556\u2013560. https:\/\/doi.org\/10.1016\/S0090-4295(96)00297-5","journal-title":"Urology"},{"issue":"2","key":"5517_CR19","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1097\/MOU.0b013e32802b70bc","volume":"17","author":"S Madaan","year":"2007","unstructured":"Madaan S, Joyce AD (2007) Limitations of extracorporeal shock wave lithotripsy. Curr Opin Urol 17(2):109\u2013113. https:\/\/doi.org\/10.1097\/MOU.0b013e32802b70bc","journal-title":"Curr Opin Urol"},{"issue":"4","key":"5517_CR20","doi-asserted-by":"publisher","first-page":"1157","DOI":"10.1016\/j.juro.2007.05.132","volume":"178","author":"K Kijvikai","year":"2007","unstructured":"Kijvikai K, Haleblian GE, Preminger GM, De La Rosette J (2007) Shock wave lithotripsy or ureteroscopy for the management of proximal ureteral calculi: an old discussion revisited. J Urol 178(4):1157\u20131163. https:\/\/doi.org\/10.1016\/j.juro.2007.05.132","journal-title":"J Urol"},{"issue":"5","key":"5517_CR21","doi-asserted-by":"publisher","first-page":"441","DOI":"10.1007\/s00240-015-0857-2","volume":"44","author":"VY Chung","year":"2016","unstructured":"Chung VY, Turney BW (2016) The success of shock wave lithotripsy (SWL) in treating moderate-sized (10\u201320 mm) renal stones. Urolithiasis 44(5):441\u2013444. https:\/\/doi.org\/10.1007\/s00240-015-0857-2","journal-title":"Urolithiasis"},{"issue":"5","key":"5517_CR22","doi-asserted-by":"publisher","first-page":"321","DOI":"10.4111\/icu.2018.59.5.321","volume":"59","author":"M Kumar","year":"2018","unstructured":"Kumar M, Pandey S, Aggarwal A, Sharma D, Garg G, Agarwal S et al (2018) Unplanned 30-day readmission rates in patients undergoing endourological surgeries for upper urinary tract calculi. Investig Clin Urol 59(5):321\u2013327. https:\/\/doi.org\/10.4111\/icu.2018.59.5.321","journal-title":"Investig Clin Urol"},{"issue":"2","key":"5517_CR23","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1002\/bco2.55","volume":"2","author":"M Farag","year":"2021","unstructured":"Farag M, Jack GS, Wong L, Bolton DM, Lenaghan D (2021) What is the best way to manage ureteric calculi in the time of COVID-19? A comparison of extracorporeal shockwave lithotripsy (SWL) and ureteroscopy (URS) in an Australian health-care setting. BJUI Compass 2(2):92\u201396. https:\/\/doi.org\/10.1002\/bco2.55","journal-title":"BJUI Compass"},{"issue":"4","key":"5517_CR24","doi-asserted-by":"publisher","first-page":"486","DOI":"10.4103\/0970-1591.44253","volume":"24","author":"AS Padhye","year":"2008","unstructured":"Padhye AS, Yadav PB, Mahajan PM, Bhave AA, Kshirsagar YB, Sovani YB, Bapat SS (2008) Shock wave lithotripsy as a primary modality for treating upper ureteric stones: a 10-year experience. Indian J Urol 24(4):486\u2013489. https:\/\/doi.org\/10.4103\/0970-1591.44253","journal-title":"Indian J Urol"},{"issue":"1","key":"5517_CR25","doi-asserted-by":"publisher","first-page":"3","DOI":"10.3126\/njms.v1i1.5787","volume":"1","author":"P Ghimire","year":"2012","unstructured":"Ghimire P, Yogi N, Acharya GB (2012) Outcome of extracorporeal shock wave lithotripsy in western region of Nepal. Nepal J Med Sci 1(1):3\u20136. https:\/\/doi.org\/10.3126\/njms.v1i1.5787","journal-title":"Nepal J Med Sci"},{"issue":"4","key":"5517_CR26","doi-asserted-by":"publisher","first-page":"255","DOI":"10.5001\/omj.2013.72","volume":"28","author":"MS Al-Marhoon","year":"2013","unstructured":"Al-Marhoon MS, Shareef O, Al-Habsi IS, Al Balushi AS, Mathew J, Venkiteswaran KP (2013) Extracorporeal shockwave lithotripsy success rate and complications: initial experience at Sultan Qaboos University Hospital. Oman Med J 28(4):255\u2013259. https:\/\/doi.org\/10.5001\/omj.2013.72","journal-title":"Oman Med J"},{"issue":"9","key":"5517_CR27","doi-asserted-by":"publisher","first-page":"1285","DOI":"10.1111\/j.1464-410X.2005.05520.x","volume":"95","author":"NP Gupta","year":"2005","unstructured":"Gupta NP, Ansari MS, Kesarvani P, Kapoor A, Mukhopadhyay S (2005) Role of computed tomography with no contrast medium enhancement in predicting the outcome of extracorporeal shock wave lithotripsy for urinary calculi. BJU Int 95(9):1285\u20131288. https:\/\/doi.org\/10.1111\/j.1464-410X.2005.05520.x","journal-title":"BJU Int"},{"issue":"1","key":"5517_CR28","doi-asserted-by":"publisher","first-page":"4","DOI":"10.3126\/jpahs.v1i1.13007","volume":"20","author":"BK Hamal","year":"2015","unstructured":"Hamal BK, Bhandari BB, Thapa N (2015) Extracorporeal shock wave lithotripsy in management of urolithiasis. J Patan Acad Health Sci 20(1):4\u20137","journal-title":"J Patan Acad Health Sci"},{"issue":"2","key":"5517_CR29","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1007\/s00240-009-0247-8","volume":"38","author":"S Salem","year":"2010","unstructured":"Salem S, Mehrsai A, Zartab H, Shahdadi N, Pourmand G (2010) Complications and outcomes following extracorporeal shock wave lithotripsy: a prospective study of 3,241 patients. Urol Res 38(2):135\u2013142. https:\/\/doi.org\/10.1007\/s00240-009-0247-8","journal-title":"Urol Res"}],"container-title":["World Journal of Urology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00345-025-05517-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00345-025-05517-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00345-025-05517-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T22:03:43Z","timestamp":1767996223000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00345-025-05517-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,25]]},"references-count":29,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["5517"],"URL":"https:\/\/doi.org\/10.1007\/s00345-025-05517-4","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-5441405\/v1","asserted-by":"object"}]},"ISSN":["1433-8726"],"issn-type":[{"value":"1433-8726","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,25]]},"assertion":[{"value":"12 November 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 February 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 February 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}],"article-number":"139"}}