02 Dec 2022
30 Nov 2022
The invention of extracorporeal shockwave lithotripsy (ESWL) marked the new era of kidney stone management. ESWL machine utilizes several types of shockwave lithotripters to fragment the stone, such as either piezoelectric, electromagnetic or the original electrohydraulic. This study aims to assess the efficacy and safety of several types of lithotripters utilized by ESWL machine on the management of kidney stone under 2 cm. Studies published from inception to November 2021 was conducted from several databases. Publications reported the outcome of ESWL management on kidney stone based on the type of lithotripter were included. Literatures that not mentioning the stone size, type of lithotripter and inaccessible full text were excluded. Literature review was performed on included studies and further meta-analysis was accomplished on applicable publications using Review Manager software version 5.4. Fifteen studies reporting the outcome of various types of ESWL lithotripters were included in the review. Three studies showed the outcome of piezoelectric lithotripters and the rests reported the outcome of either or both electromagnetic and electrohydraulic groups. The stone free and retreatment rate of piezoelectric lithotripter were 67.88% and 19.47% respectively. The stone free, retreatment and complication rate of electromagnetic lithotripter were 70.01%, 46.26% and 19.7%, respectively. While those rates on electrohydraulic group were 51.22%, 41.65% and 18.84%, respectively. Seven studies comparing the outcome of electromagnetic versus electrohydraulic were further included into meta-analysis. No differences were found regarding stone free status (OR 1.54 (95% CI 0.73 – 3.23), p = 0.26, I2 = 88%), retreatment rate (OR 1.39 (95% CI 0.4 – 4.79), p = 0.61, I2 = 92%), and complication rate (OR 0.92 (95% CI 0.65 – 1.30, p = 0.65, I2 = 32%) on both groups. Piezoelectric, electrohydraulic and electromagnetic as a source of energy for ESWL provide satisfactory results as a treatment for kidney stone below 2 cm. Moreover, electrohydraulic and electromagnetic have comparable results in terms of efficacy and safety.