Histopathologic effects of extracorporeal shock wave lithotripsy on rabbit kidney

Summary Despite the widespread clinical use of the lithotriptor, the margin of safety for the kidney during shock wave application is substantially unknown. Although a series of pilot studies have been performed in laboratory animals, long-term follow-up is mandatory to establish the effect of extracorporeal shock wave lithotripsy (ESWL) and subsequent dose-dependent changes on the kidneys. An experimental study was performed in 45 rabbits; to define and compare the early and late complications of ESWL in the kidneys. The rabbits were divided into three groups of 15 animals each that received 1000, 1500 or 3000 shock waves respectively at 15–20 kV. The rabbits in each group were killed and necropsy performed within 24 h for the first 5 animals, 1 week for the second 5 animals and 2 months post-ESWL for the last 5 animals. Dose-dependent moderate damage (subcapsular hemorrhage, interstitial hemorrhage, capsular tension and perirenal hemorrhage) were noted in all kidneys at 24 h after treatment. Evidence of permanent changes (some fibrosis, tubular and glomerular damage, chronic inflammatory alterations) was noted in long-term follow up. Complete necrosis of the treated kidney was not encountered in this study.     

Serum Interleukin-6 levels after Urologic Operations

Background: Endourology, extracorporeal shock wave lithotripsy (ESWL), and laparoscopic surgery are considered minimally invasive procedures; however, estimation of operative invasiveness has not been fully accomplished. We measured serum interleukin-6 (IL-6) levels, as an indicator for systemic reaction, to examine operative invasiveness of these operations in comparison with open surgery. Method: Serum IL-6 levels were measured in 119 patients undergoing open surgery, laparoscopic surgery, endourology, and ESWL.
Results: The median IL-6 levels on day 1 after the operation varied according to operative procedures: 83.5 pg/mL (range, 15–340 pg/mL) for open surgery, 24.8 pg/mL (range, 12–42 pg/mL) for laparoscopic surgery, and 10.8 pg/mL (range, 0–85 pg/mL) for endourology and ESWL. The extent of tissue injury and blood loss were found to be 2 major factors responsible for the serum IL-6 elevation.
Conclusion: The minimally invasive character of endourology, ESWL, and laparoscopic surgery is attributable to low levels of tissue injury and blood loss, regardless of operative time.     

Urinary NAG excretion after anesthesia-free extracorporeal lithotripsy of renal stones: a marker of early tubular damage

Summary Second generation lithotripters require a higher number of shocks per session as well as an increased rate of secondary treatments for complete stone disintegration compared to the original spark gap lithotripter. The clinical relevance of biological side effects caused by such treatment are less known. We evaluated urinary excretion of N-acetyl-glucosaminidase (NAG) before and after lithotripsy in 50 patients treated with a low pressure spark gap lithotripter (Dornier HM3) and in 36 patients treated with a piezoelectric lithotripter (Wolf Piezolith 2200) in an attempt to evaluate their side effects on renal tissue. The urinary excretion of NAG increased after both spark gap lithotripsy using the modified HM3 and piezoelectric lithtripsy. These changes may be associated with slight tubular damage that would occur after anesthesia-free lithotripsy in patients subjected both to a high number of shocks and to secondary treatments.     

体外碎石及体位排石床治疗肾下盏结石疗效观察

目的探讨体外冲击波碎石后联合体位排石床并体位排石仪在肾下盏结石治疗中的应用价值。方法分为经体外碎石后联合体外排石床并体位排石仪治疗的观察组和非联合治疗组即对照组，观察组与对照组对比碎石治疗后4周和12周的结石排净率。结果观察组比对照组碎石治疗后4周和12周结石排净率高，明显优于对照组，差异有统计学意义。结论体外冲击波碎石后联合体位排石床并体位排石仪治疗单纯肾下盏结石可明显提高结石排净率并缩短治疗时间，值得临床推广使用。     

ESWL治疗泌尿系结石2620例报告

目的 总结ESWL治疗泌尿系结石的经验。方法 采用YC－9200型碎石机治疗泌尿系结石2620例。术中均采用B超定位，根据病情低能量，有计划地分次碎石，每次冲击2400－3000次，2次间隔多在2－3周以上。结果 2620例的碎石率达99.39%，无效率0.61%，无街发生率0.88%。结论 ESWL治疗泌尿系结石，术前充分准备，术中B超定位，根据病情有计划分次低能量高频次碎石；对巨大结石进行疗效预测，选择合适病人进行治疗；术后积极配合中西药物排石止血、预防感染等均是预防并发症、提高疗效的关键。     

The clinical and immunological features of the post-extracorporeal shock wave lithotripsy anti-glomerular basement membrane disease

IntroductionExtracorporeal shock wave lithotripsy (ESWL) is a noninvasive modality to treat urolithiasis, with complications including tissue damage and hematoma of kidney parenchyma. Anti-glomerular basement membrane (GBM) disease is suggested to be a rare complication of ESWL since it was reported in several cases to occur after ESWL. However, the clinical and immunological features of the ESWL-associated anti-GBM disease have not been fully investigated so far.Case PresentationHere, we present the clinical, pathological, and immunological characteristics of three patients with the post-ESWL anti-GBM disease in our hospital. Anti-GBM disease occurred within a median of 22 months after ESWL treatment. It presented with similar clinical features to the classic anti-GBM disease, including fever, gross hematuria, and rapidly progressive glomerulonephritis (RPGN) with poor renal prognosis. Sera from all patients recognized the α3(IV)NC1 in GBM, but with IgG2 and IgG4 as the dominant IgG subclasses.ConclusionAlthough further exploration is required to prove the causal relationship in this rare condition, our study reminds physicians that patients developing acute renal insufficiency after ESWL should lead to the suspicion of anti-GBM disease and in-time diagnosis and treatment.     

Symptomatic gallbladder stones

In order to strike the most favorable balance between health benefits and costs, three treatment modalities for symptomatic cholelithiasis were compared in a cost-effectiveness study: extracorporeal shockwave lithotripsy (ESWL), conventional cholecystectomy (CC), and laparoscopic cholecystectomy (LC).Data were analyzed from 55 patients who were treated by ESWL, 45 patients who had CC, and 47 patients who had LC. The study was performed by analysis of patients charts and a written questionnaire.After ESWL 35% of the patients were free of stones, 23% had fragments5mm, and 42% had fragments>5 mm at 1-year follow-up. Persistent complaints were reported by 59% after ESWL, 11% after CC, and 14% after LC (P<0.001). New complaints arose in 12% after ESWL, 11% after CC, and in 5% after LC (P=NS). Patient appreciation score was highest for LC and lowest for ESWL. Mean hospital stay was 2.4 days for ESWL, 10 days for CC, and 3.5 days for LC. Overall costs of treatment were: $5,066 for ESWL; $5,893 for CC; and $3,117 for LC.This study reveals that laparoscopic cholecystectomy is the most effective treatment of the large majority of patients with symptomatic cholelithiasis. ESWL should only be considered in the case of a solitary, relatively small, completely radiolucent stone.     

肾结石体外震波碎石（ESWL）治疗后石街的处理

目的探讨肾结石ＥＳＷＬ术后石街的自然病程、预防及其治疗方法。方法应用ＰＮ－Ⅲ型碎石机治疗肾结石６７５例,其中有８３例发生石街（１２％）,石街长度在２－１５ｃｍ之间,大多患者采取复震及其它辅助治疗。结果石街排净最短１２天,最长６８天,排净率１００％,无其它严重并发症发生。结论采用ＥＳＷＬ复震处理石街是一种简单、安全、有效的程序,作者认为石街治疗的难度主要与其密实程度有关。     

ESWL治疗泌尿系结石的监护

泌尿系的体外震波碎石术(以下简称ESWL),就是通过震波碎石机把肾、输尿管或膀胱内的结石击碎成砂粒或粉末后,随尿流排出体外.我院自施行ESWL治疗泌尿系结石,取得了良好的效果,现将临床监护经验作一综合报道.     

复式脉冲碎石机治疗儿童上尿路结石

目的探讨低能量复式脉冲碎石机对儿童上尿路结石治疗的可行性。方法采用国产BH-VG低能量复式脉冲碎石机治疗儿童上尿路结石21例，男童11例，女童10例；学龄前儿童（2-7岁）13例；学龄期儿童（8-16岁）8例。肾结石每次治疗不超过2500次，治疗电压3-7．5kV；输尿管结石每次治疗不超过3500次，治疗电压4-8kV。结果肾结石粉碎率100％，两周内结石排空率100％；输尿管结石粉碎率100％，两周内结石排空率100％。结论低能量复式脉冲碎石机治疗儿童上尿路结石是一种安全、有效的治疗方法。