Comparison of Efficacy between Thai-Made Replacement Parts (Smart Litho Plus) and Standard Electromagnetic Shock Wave Systems for Renal Stone Treatment

Background: Urinary stones are one of the most common urological problems in Thailand. Extracorporeal shock wave lithotripsy (ESWL) is one of the most frequently used treatments due to its noninvasive nature and widespread availability. However, the effectiveness of lithotripters with power sources produced in Thailand (Smart Litho Plus) compared with that of standard machines is poorly established. Therefore, we aim to compare the efficacy of Thai-made replacement parts with that of standard electromagnetic shock wave systems for the treatment of renal stones. Methods: We conducted a multicenter retrospective cohort study involving 121 patients with renal stones across three sites in Thailand. All patients underwent urinary tract imaging at their initial visit and were followed up at four weeksafter stone treatment. A stone-free rate was considered achieved if residual stones measured less than 4 mm. Results: A significant difference in stone-free rates was found between the two groups. The Smart Litho Plus group showed a 44% stone-free rate, whereas the standard machine group achieved a 64% stone-free rate (p = 0.048). However, we noted a difference in the number of shock waves used in the standard machine group. Regarding safety, both treatments did not differ significantly in terms of adverse events. One patient in the standard machine group developed sepsis after ESWL. Additionally, one patient in the standard machine group and three patients in the Smart Litho Plus group experienced steinstrasse (stone street). No findings of renal injury were observed in either group at 4-week follow-up after imaging. Conclusions: The standard electromagnetic lithotripter demonstrated a higher stone-free rate than the Smart Litho Plus system for renal stone treatment. The difference in efficacy may be attributed to the variation in the number of shock waves used between the two systems. Although Smart Litho Plus showed lower efficacy than standard machines, its performance still falls within an acceptable range. The Smart Litho Plus system has demonstrated proven efficacy and good tolerability. It offers effective and promising stone fragmentation coupled with low adverse event rates.