Clinical treatment of renal and ureteral stones by extracorporeal shock wave lithotripsy (ESWL). IV: Treatment of distal ureteral stones with ESWL

ESWL has been used to treat distal ureteral stones in ten patients. All stones were broken up to sandy fragments. In six patients, all fragments were discharged completely within 3 days and in two patients within 20 days without any additional manipulation. The other two patients were lost to follow up regarding complete discharge.     

Clinical experiences of renal and upper ureter stone by extracorporeal shock wave lithotripsy (ESWL). II: 3-month follow-up of cases treated with ESWL

Fifty three out of 60 cases treated with Extracorporeal Shock Wave Lithotripsy (ESWL), were followed up for 3 months. Forty four of the patients had renal stones (2 had bilateral renal stones, 3 had staghorn calculi, 2 had incomplete staghorn calculi, 10 had multiple renal stones), 2 had the unilateral renal and ureteral stones and 16 had ureteral stone. The stone had been discharged completely within 3 months in 47 cases (86.8%), and residual stones were noticed in 6 cases (11%), two of which had stone discharge after retreatment with ESWL. The other cases are being followed up without further treatment, because the residual sandy stones are thought to be able to be discharged spontaneously.     

Clinical experience with extracorporeal shock wave lithotripsy (ESWL) in renal and ureteral stones. The 3rd report: Treatment of 59 cases (64 renal stones) of complete staghorn calculi

This report describes the treatment of 64 cases of complete staghorn calculi using extracorporeal shock wave lithotripsy (ESWL). Thirty cases (46.8%) were successfully treated using ESWL monotherapy and the rest of the cases (53.2%) required ESWL combined with an auxiliary procedure. Forty-four of the cases (68.7%) had symptoms such as fever and pain after ESWL. These cases were treated with chemotherapeutic agents and an auxiliary procedure. X-ray examination showed that the result of ESWL treatment was satisfactory in 97.4% of the 34 cases followed up for more than 12 weeks after ESWL. Based on the results of this study, the following plan of treatment for complete staghorn calculi has been adopted in our hospital. ESWL monotherapy is performed in cases without a dilated collecting system or stricture. ESWL combined with an auxiliary procedure is performed in cases with a dilated collecting system, stricture, ileal conduit and solitary kidney.     

Two years clinical experiences with extracorporeal shock-wave lithotripsy and transurethral ureterolithotripsy for ureteral stones at Osaka City University Hospital

From July 1985 to June 1987, 303 patients with ureteral stones were treated by either extracorporeal shock-wave lithotripsy (ESWL) or transurethral ureterolithotripsy (TUL). The ureteral stones were classified into two groups, upper and lower ureteral stones. The upper ureteral stone was defined as a stone located above the pelvic brim in radiological examinations. ESWL was performed using a Dornier lithotriptor HM-3. For TUL, following the insertion of a guide wire and dilatation of the intramural ureter by ureteral bougie, a ureteroscope was introduced into the ureter. The success rate included both patients who became stone free and patients whose stones were disintegrated into less than 4 mm. The success rate of ESWL for upper ureteral stones was 90%, and 8.5% were treated subsequently by TUL. The success rate of TUL for upper ureteral stones was 42%, and the remaining required another session of TUL or another procedure, mainly ESWL. On the other hand, the success rate of TUL for lower ureteral stones was 71%, and the remainder also required another session of TUL or another procedure, mainly ESWL. The efficacy of TUL for stone street was comparably low by the evaluation done at 5 days after the procedure. However, almost all patients with stone street, which had developed after ESWL treatment, became stone free several weeks after TUL and insertion of a stent catheter. Major complications or side effects for ESWL were fever of more than 37.5 degrees C (7.5%) and pain attacks (8.9%).(ABSTRACT TRUNCATED AT 250 WORDS)     

Emergency extracorporeal shock wave lithotripsy (ESWL) for obstructing ureteral stones

OBJECTIVE: To evaluate emergency treatment of obstructing ureteral stones by in situ extracorporeal shock wave lithotripsy (ESWL) during acute renal colic. PATIENTS AND METHODS: From January 1994 to February 2000, 200 patients (mean age: 42 years) were treated by ESWL (EDAP LT-02) for obstructing ureteral stones causing acute renal colic refractory to medical treatment or recurring within 24hours of such treatment. Stones were visualised by fluoroscopic imaging and/or ultrasound. Follow-up included radiological and/or ultrasound examinations and lasted three months. RESULTS: Mean stone size was 7mm (3-20mm). At three months, 164/200 (82%) patients were stone-free. This rate ranged from 79% to 83% according to the location of the stone, and from 75% to 86% according to the size of the stone. These differences in rate were not significant. Two or three ESWL sessions were required in 79 patients. ESWL was well tolerated in 90% of patients. The only complication was a case of pyelonephritis requiring the placement of a JJ stent, administration of antibiotics, and distant ureteroscopy. The 36 patients, in whom ESWL failed, underwent ureteroscopy (n=23) or lithotripsy with a Dornier machine (n=13). CONCLUSION: Non-deferred ESWL for acute renal colic secondary to obstructing ureteral stones has a satisfactory success rate and very low morbidity.     

Treatment of ureteral calculi by extracorporeal shock-wave lithotripsy. UCLA experience

One hundred sixteen patients underwent extracorporeal shock-wave lithotripsy (ESWL) for ureteral stones. In 108 patients, the stones were manipulated pre-ESWL whereas 8 patients underwent ESWL without prior stone manipulation. Ureteral lubrication using a 2% Xylocaine jelly solution greatly facilitated the retrograde advancement of the calculus or the passage of ureteral catheters alongside the stone. ESWL disintegrated all but 4 stones for an overall success rate of 96.6 per cent. It is considered that the combination of retrograde ureteral stone repositioning and ESWL is a highly successful alternative in the management of ureteral calculi.     

Clinical experience with extracorporeal shock wave lithotripsy (ESWL) in upper urinary tract stones

We treated 100 patients of upper urinary tract stone using extracorporeal shock wave lithotripsy (ESWL), from April to October 1986. Eighty-six of the patients were treated by ESWL monotherapy, and the other cases required further treatment, such as percutaneous nephrostomy (PCN), percutaneous nephrolithotomy (PNL), and transurethral ureterolithotripsy (TUL). On the X-ray film obtained from one to three months after ESWL, 73 patients had no stones, 8 patients had sandy stones, 7 patients had small fragments less than 5 mm, 2 patients had large stones equal to or greater than 5 mm and 10 patients could not be followed up. Therefore, 97.7% of all patients were successfully treated. In conclusion, ESWL is considered to be an ideal method to treat upper urinary tract stones, and soon will become the first choice of treatment of urolithiasis together with the progress in endourological techniques.     

Experience with extracorporeal shock-wave lithotripsy (ESWL) for urinary calculi

Over a 36-month period 2800 patients were subjected to extracorporeal shock-wave lithotripsy (ESWL). A total of 5154 procedures were done. Best results were seen with renal pelvic calculi (not larger than 2.5 cm in diameter). Fragments of crushed lower calyceal calculi proved the most difficult to eliminate. As ureteral stone localization approached the bladder, the ESWL results were poorer. Post-ESWL complications were proportional to the stone mass; the higher the mass the more numerous the complications tended to be. Besides erythrocyturia and gross haematuria renal colic was the most frequent complication in almost 60% of the patients. Less prevalent were impacted ureteral stones, subcapsular haematoma and fever. At our institution, thanks to the ESWL method about 80% of the patients were spared surgery.     

弹道碎石联合体外冲击波碎石治疗输尿管结石

目的探讨气压弹道碎石术联合体外冲击波碎石(extracorporeal shock wave lithotripsy,ESWL)治疗输尿管结石的临床价值. 方法采用气压弹道碎石术联合ESWL治疗输尿管结石365例. 结果 365例中,360例(98.6%)成功,2例失败(改开放手术),3例输尿管穿孔.80例配合ESWL.术后2周复查,结石均排净. 结论气压弹道碎石术联合ESWL治疗输尿管结石具有疗效高,损伤小,适应证广等优点.     

Extracorporeal shock-wave lithotripsy (ESWL) of kidney and ureteric stones

A noninvasive method for the treatment of urolithiasis is described. By means of focussed shock waves generated outside the body, stones in the lower urinary tract are destroyed and rendered fit for spontaneous discharge. Thereby the number of operations, as well as the recurrence rate are substantially reduced.     

Management of ureteral stones by extracorporeal shock wave lithotripsy. 3 years of experience

From April 1985 to March 1987 181 patients with ureteral stones were treated by means of extracorporeal shock wave lithotripsy (ESWL). Management for proximal calculi changed from in situ ESWL treatment (group n = 27) or placement of a ureteral catheter below calculi (group II, n = 30) to retrograde stone manipulation into renal pelvis (group IV, n = 52) or ESWL treatment under intraoperative irrigation of saline in cases where repositioning failed (group III, n = 50). The best stone-free rate for upper ureteral stones was obtained in group IV with 96% after 6 weeks, presenting also the shortest hospital stay (4.2 days) and lowest quota of postoperative auxiliary procedures (2%). Stones, not being dislodged into renal pelvis (49%), could be treated successfully in 86% by irrigation with saline during ESWL (group III). The stone-free rate decreased in patients with in situ treatment (group I: 67%) or ureteral catheter placement (group II: 83%). Treatment of these stones increased the need of postoperative ancillary procedures to approximately 30%. For distal ureteral stones ESWL and preoperative Zeiss placement achieved a stone-free rate of 95%.     

ESWL治疗肾结石排空率的预测

目的:了解影响肾结石体外冲击波碎石(Extracorporeal shock wave lithotripsy,ESWL)成功的因素,建立回归模型估计碎石后结石排空率.方法:1996年5月～2006年10月对1 254例肾结石(结石直径＜20 mm)患者进行ESWL治疗,治疗效果在3个月随访时进行评价.碎石后比较无结石率与结石的特性,患者个人情况的相关性用方差检验进行分析,然后采用多变量回归分析方法进一步分析方差检验的有意义因素.结果:3个月随访时,ESWL后结石排空率为86.6%.1.44%(18例)患者结石未碎裂,7.97%(100例)患者结石碎片未被清除,36.5%患者接受三次ESWI,治疗.方差检验分析发现患者年龄、性别、结石大小、结石位置、结石数目、结石性质、肾形状和先天不规则肾对碎石后结石的排空率均有影响.多变量分析排除了结石性质和患者性别作为影响无结石率的因素.根据这些因素,我们建立了ESWL后无结石率的回归分析模型.该模型的准确率为86.6%.结论:结石大小,位置、数目、患者年龄、肾形状和先天性不规则肾是ESWL后结石清除率的影响因素.     

Treatment of renal transplant stones by extracorporeal shock-wave lithotripsy in the prone position

Two patients with renal transplant lithiasis were successfully treated with extracorporeal shock-wave lithotripsy (ESWL) in the prone position. Pathogenesis and treatment of transplant lithiasis are discussed. Performing ESWL on renal transplant patients in the prone position has advantages over standard positioning techniques.     

Outcomes of extracorporeal shock wave lithotripsy for ureteral stones according to ESWL intensity

BackgroundWe evaluated the treatment outcomes of ureteral stones according to energy intensity generated by extracorporeal shock wave lithotripsy (ESWL).MethodsWe retrospectively analyzed 150 patients who underwent ESWL for treatment of ureteral stones between September 2018 and February 2020. All stones were confirmed by a computed tomography examination, and the size, location, skin-to-stone distance, and Hounsfield units (HU) of the stones were assessed. In addition, patient characteristics including body mass index and estimated glomerular filtration rate, which can affect treatment outcome, were also evaluated. The success or failure of ESWL was confirmed according to the session, and the factors affecting the treatment outcome were analyzed using a logistic regression model.ResultsOf the 150 patients, 82 (54.7%) had stones in the proximal ureter, 5 (3.3%) in the mid, and 63 (42.0%) in the distal ureter. Patients underwent ESWL an average of 1.5 times, and the success rate according to session was 65.3% for the first, 83.3% for the second, and 90.0% for the third session. A multivariate analysis revealed that stone size [odds ratio (OR) 0.81, 95% confidence interval (CI), 0.66–0.99, P=0.049] and HU (OR 0.99, 95% CI, 0.98–0.99, P=0.001) were significant factors affecting the success rate after the first ESWL session; ESWL intensity was not related to success rate. Stone size (OR 0.78, 95% CI, 0.62–0.96, P=0.022) was the only significant factor affecting the success rate in the third session.ConclusionsStone size and HU affected the ESWL success rate. ESWL intensity was not significantly related to the success rate, so it should be adjusted according to patient pain and the degree of stone fragmentation.     

Clinical study of extracorporeal shock wave lithotripsy for 1000 patients with renal and ureteral stones

Using a Dornier HM3 lithotripter, we treated 1,000 patients with renal and ureteral stones from April, 1986 to July, 1989. They consisted of 612 solitary stones (pelvic stones, 152; calyceal stones, 167; ureteral stones, 293), 265 multiple stones and 123 staghorn calculi (complete, 48; partial, 75). The overall rate of the auxiliary procedure was 59.3% (pre-operative, 47.9%; post-operative, 11.4%). Pre-operative procedure included 430 catheterizations, 26 percutaneous nephrostomies (PNSs) and 23 pyelograms . Post-operative procedure included 69 transurethral lithotripsy , 21 PNSs, 26 percutaneous nephrolithotripsy (PNLs), 6 meatotomy , 5 chemolysis and 1 open surgery. 484 (68.3%) in 709 good follow-up cases were stone-free at the time of 3 months since the first extracorporeal shock-wave lithotripsy (ESWL). Complications were pain (34.8%), fever (4.3%), pain & fever (8.5%), subcapsular hematoma (0.1%) and ureteral obstruction (0.1%). Thus, ESWL is considered to be a useful means for renal and ureteral stones and in the case of large stone the combination therapy with PNL is more effective than ESWL-monotherapy.     

Monotherapy with extracorporeal shock wave lithotripsy for renal and ureteral stones]

We performed extracorporeal shock wave lithotripsy (ESWL) as a monotherapy using the Medstone STS lithotripter on 288 patients with renal and ureteral stones between June, 1989 and June, 1991. We compared our results with previous reports on ESWL as used in combination therapy. Our cases consisted of 121 patients with renal stones and 167 patients with ureteral stones. A total of 437 sessions of lithotripsy were performed on 288 patients, for an average of 1.52 sessions of lithotripsy per patient. The percentage of stones measuring less than 4.0 mm in diameter that were fragmented was 94.3% for renal stones and 87.6% for ureteral stones. The stone-free rates 3 months after ESWL were 60.3% and 90.4%, respectively. Our results of the monotherapy with ESWL did not differ from those reported on ESWL as used in combination therapy, in terms of the rate of stone destruction and stone-free rates. We studied the other reports carefully and determined that ESWL monotherapy could have been performed in most those cases. We concluded that ESWL monotherapy is an excellent therapeutic method in the light of fewer complications and side effects compared with those from combination therapy, and the fact that the rate of recurrence for renal and ureteral stones is high makes ESWL monotherapy very useful because the procedure can be repeated.     

Experience with extracorporeal shock-wave lithotripsy of upper urinary tract stones

The first 121 cases of upper urinary tract stone treated by extracorporeal shock wave lithotripsy (ESWL) at our clinic were analyzed. Three months after ESWL, 78% of the patients became stone free, and 17% of the patients had residual stone fragments which were less than 5 mm in diameter and considered passable. The success rate was therefore about 94.6%. No severe side effects were observed, although temporary elevations in serum creatinine phosphokinase, lactate dehydrogenase, glutamic-oxaloacetic transaminase, aldolase and total bilirubin occurred. These results indicated that ESWL was a safe and effective procedure for upper urinary tract stones.     

Clinical results of extracorporeal shock-wave lithotripsy (ESWL) and percutaneous nephroureterolithotripsy (PNL) in combination

Forty-two (44 renal units) were treated by combination of ESWL and percutaneous nephrostomy or PNL. Staghorn calculi were found in 33, renal stones in 6 and ureter stones in 5. Residual stone rate was 18.2% in staghorn calculi. No severe complications were seen.