Abstract
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The use of artificial stones is very important in such an experimental study as it limits variability and provides a more accurate means of directly comparing lithotripters. In contrast to the opinion of the authors that these targets are less clinically relevant than human urinary calculi, I think they give a better and more accurate assessment of the lithotripters' efficiency, which in the clinical situation will be less efficacious because of patient's and stones' characteristics. I mean that, in general, the power of the lithotripters will be lower in a clinical situation than in an in vitro experiment, so the findings of experimental studies could be applied to a clinical situation after correction according to variations in patient's and stones' characteristics.
Application of lithotripter parameters in clinical use (as regard the power and frequency) in this study is of utmost importance to be comparable to a clinical situation. Many other experimental studies in the literature used high parameters that could not be applied clinically.
The findings of this study give important messages for both the clinicians and manufacturers.
For the clinicians: (1) The piezoelectric and electromagnetic lithotripters are comparable and both of them are far better than the electroconductive lithotripter at any count of shock waves. (2) There appears to be a significant reduction in performance of the electroconductive lithotripter above a threshold generator electrode age of 6000 shock waves. Also, this is a self-observation with an electroconductive lithotripter. So, improved performance may be achieved with more regular electrode replacement.
For manufacturers, it is the time to rethink about the electroconductive electrodes either by improving the technology or by changing the guidelines for electrode replacement.