1. Dr. Sandro Varea, Fernando Santomil, Alfredo Penida, Cristian Grillo, Jorge Quezada Department of Urology. Hospital Privado de Comunidad, Mar del Plata, Argentina Urología Electromagnetic DSWL Double Shockwave Lithotripsy: Initial experience

2. Urología 1- Sokolov DL, Bailey MR and Crum LA: Dual-pulse lithotripter accelerates stone fragmentation and reduces cell lysis in vitro. Ultrasound Med Biol 2003; 29: 1045. 2- Sheir KZ, El-Diasty TA and Ismail AM: Evaluation of a synchronous twin-pulse technique for shock wave lithotripsy: the first prospective clinical study. BJU Int 2005; 95: 389. 3- Greenstein A, Sofer M and Matzkin H: Efficacy of the Duet lithotripter using two energy sources for stone fragmentation by shockwaves: an in vitro study. J Endourol 2004; 18: 942. New design concept for Lithotripters: Double shockwave (1-3). Electromagnetic DSWL Double Shockwave Lithotripsy: Initial experience Double shockwave Two independent generators/ reflectors angle of 76 degrees between generators Convergence into a single focal point

3. Urología 4- Rajash K. Handa et al. Assessment of Renal Injury With a Clinical Dual Head Lithotriptor Delivering 240 Shock Waves per Minute. J Urol. 181, 884-889, February 2009. Double shockwave (4). Butterfly Focal area Electromagnetic DSWL Double Shockwave Lithotripsy: Initial experience

4. Urología 4- Rajash K. Handa et al. Assessment of Renal Injury With a Clinical Dual Head Lithotriptor Delivering 240 Shock Waves per Minute. J Urol. 181, 884-889, February 2009. Electromagnetic DSWL Double Shockwave Lithotripsy: Initial experience Double shockwave Reduce kidney damage Increase treatments efficacy Decreased treatment time Results?

5. Show our initial experience using an extracorporeal double shockwave lithotriptor (Duet Magna, Direx/Initia). Evaluate safety and effectivness. Urología Goal

6.  Cross-sectional study.  Period March-May 2010.  Patients with renal and uretral stones indicated for ESWL treatment.  Treatments performed with intravenous sedation.  Ambulatory procedure. Urología Method and Materials

7. VARIABLES  Double J catheter.  Treatment side.  Fragmentation.  Complications.  Retreats.  Removal rate  Age.  Sex.  Weight.  Size.  Body mass index.  Stone sizes and location. Urología Method and Materials

8. 33 urinary stones in 30 patients Urología Patients distribution according to age 0,0 2,5 5,0 7,5 10,0 304050607080  Average: 53,1 (31 – 76) Results

9. (n= 30) Urología Patients distribution according to sex Results

10. (n= 33) Urología Patients distribution according to side treated Results

11. (n= 33) Urología Patients distribution according to stone localization Results

12. (n= 33) Urología Patients distribution according to stone size treated Results

13. Stone fragmentation: 100 % Elimination rate: 85% There were no complications. Urología

14. The double shockwave treatment is a safe and effective procedure. It is necesary to perform additional prospective trials on a larger number of patients in order to confirm the results. Urología Conclusions