Re: comparison between two shock wave regimens using frequencies of 60 and 90 impulses per minute for urinary stones

Dear Editor, I read with interest the manuscript by Mazzucchi et al. on the comparison between two shock wave regimens using frequencies of 60 and 90 impulses/min for urinary stones. In their study, the authors randomized one group to 3000 impulses at a rate of 60 impulses/min and another group to 4000 impulses at a rate of 90 impulses/min. Their results showed no significant differences in stone-free and complication rates. In my view, the findings of this study may not be accurate because the number of shock waves delivered for both groups were not similar. Delivering 3000 impulses would definitely have less effect on the stone compared with delivering 4000 impulses. Therefore, the expected better outcome in the group with a slower frequency of shock wave (60 impulses/min) was negated by the lower number of shock waves delivered (3000 impulses vs. 4000 impulses). In my humble opinion, if the number of shock waves were made equal in both groups, the authors may find that the lower frequency of shock wave would give a better stone-free rate, as seen in other studies.