Clinical experiences of renal and ureteral stones by extracorporeal shock-wave lithotripsy (ESWL). IV: 3-year clinical experience of cases treated with ESWL

We report our 3-year experience with extracorporeal shock wave lithotripsy (ESWL) since we first used it for upper urinary tract stones on September 1st, 1984. A total of 1,225 patients (1,320 cases) underwent 1,647 sessions with ESWL; They consisted of 855 males (70%) and 370 females (30%). Treated stone locations were 593 renal stones, which contained 112 complete staghorn calculi, 504 ureteral stones, 110 renoureteral stones, and 1 bladder stone. ESWL monotherapy was performed on 90% of cases with renal and ureteral stones, and 46% of cases with complete staghorn calculi. In all the cases so far observed for more than 12 weeks after ESWL, 84.9% of the former showed complete discharge of the stones, and 0.7% showed no change. Only 48.9% of the later showed the complete discharge of the stones, 43.3% of which had residual stones, and 7.8% had fragments of the size of small beans. Complications, which were fever and pain, were noticed in 33.6% of the cases with renal and ureteral stones, and 64.3% of the cases with complete staghorn calculi. After ESWL, hematuria was noticed in almost cases, but the average volume of hemorrhage was 28 +/- 33 ml/day. The only contraindication of ESWL was severe obesity, and in the cases in which spontaneous stone discharge can be expected.     

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 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.     

A case of stone former with pacemaker treated by extracorporeal shock wave lithotripsy

A stone former, a 60-year-old male with a pacemaker, was treated by extracorporeal shock wave lithotripsy (ESWL). He had been on a DVI pacemaker due to sick sinus syndrome since the age of 52. During treatment for left ureteral stone by ESWL, the pacemaker was stopped, since there was a possibility of extra systoles caused by coupled triggering of the shock wave with the pacemaker spike wave in ECG. Pulse and blood pressure were maintained by continuous drip infusion of phenylephrine chloride and isoproterenol. As a result, ESWL was accomplished and pacemaking was reestablished without any problem. KUB revealed that the patient became stone free on the postoperative 17th day.     

Treatment of upper urinary tract stones with extracorporeal shock wave lithotripsy (ESWL) Sonolith vision

Background

There is no confirmed strategy for treating painful bladder syndrome/interstitial cystitis (PBS/IC) with unclear etiology. Therefore, a pilot study was carried out to evaluate the efficacy and safety of hyperbaric oxygen (HBO) therapy in treatment-resistant PBS/IC patients.

Methods

HBO treatment (2.0 ATA for 60 minutes/day × 5 days/week for 2 or 4 weeks) was performed on 11 patients with severe symptoms that had not been improved by previous therapy regimens between December 2004 and July 2009.

Results

Seven of the 11 patients demonstrated persistent improvement in symptoms during the 12 months after HBO treatment. These responders demonstrated a decrease in the pelvic pain scale and urgency scale from 7.7 ± 1.0 and, 6.6 ± 0.9 to 3.4 ± 2.5 and 4.3 ± 2.4 after 12 months, respectively (p < 0.05). The total score of the interstitial cystitis symptom index and 24-hour urinary frequency demonstrated a significant sustained decrease from the baseline. Two responders, who received an additional course of HBO 12 and 13 months after initial treatment, respectively, did not suffer impairment for more than two years. There was one case of transient eustachian tube dysfunction and three cases of reversible exudative otitis media as a consequence of HBO treatment.

Conclusions

HBO is a potent treatment for PBS/IC patients resistant to conventional therapy. It was well tolerated and provided maintained amelioration of pain, urgency and urinary frequency for at least 12 months.     

Perforation of the upper ureter: a rare complication of extracorporeal shock wave lithotripsy

Perforation of the upper ureter is a rare but serious complication of extracorporeal shock wave lithotripsy (SWL). Ureteral perforation can cause a series of problems including the retroperitoneal urinoma, urosepsis, abscess formation, infection, and subsequent renal function impairment. We reported here a rare case of SWL-induced upper ureteral rupture resulting in an expanding retroperitoneal urinoma that required percutaneous drainage. Ureteral perforation was treated successfully without major surgical intervention by employing temporary percutaneous drainage and antibiotics. The present case indicates that potential ureter rupture may form in rare cases; especially in patients having infected stones and exposed to a high number of shock waves. This complication further emphasizes the importance of adequate pre-and post-operative evaluation and the precise identification of the cause of the persistent pain after SWL.     

Clinical experience with extracorporeal shock wave lithotripsy MFL-5000 for urinary stone

A Dornier MFL 5000, a new generation extracorporeal shock wave lithotripter, was installed in our hospital and the first Japanese clinical experience has been collected between July and November in 1989. We report our experience with the first 35 patients with 45 stones who were treated in 42 treatments using ESWL. We followed up 3 weeks. No invasive anesthesia was performed except 2 cases of epidural anesthesia. A double J catheter was installed in 2 patients, a ureteral catheter in 4 patients, and PNL was performed in 2 patients before ESWL. We did not use a PNL or a TUL in the postoperative treatment. In the 3 week followed up period, 29 patients (82.9%) were completely free from stone fragments. No serious complications were observed after ESWL. We conclude that the DORNIER MFL 5000 is effective for renal and ureteral stones without serious complications.     

Multimodal treatment (extracorporeal shock wave lithotripsy and endourology) of complicated renal stone disease

From October 1983, (installation of the extracorporeal shock wave lithotripsy unit) to August 1985, 207 patients presented at the Katharinenhospital Stuttgart with complicated renal stone disease (70 borderline stones, 77 partial and 60 complete staghorn calculi). 197 patients were treated with the new technology for urinary stone therapy, i.e. extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCN), and ureterorenoscopy. The combination of PCN and ESWL proved to be the optimal therapeutic approach in the majority of cases (44%), particularly for partial and complete staghorns, whereas PCN or ESWL monotherapy are indicated for borderline stones (51% ESWL, 26% PCN, 20% combination, 3% surgery) and selected cases of staghorn calculi only. Based on this treatment policy (minimal invasiveness and morbidity), 75 patients with partial staghorn (21% ESWL, 28 PCN, 44% combination, 7% surgery) and 52 cases of complete staghorn stone (2% ESWL, 13% PCN, 74% combination, 11% surgery) have been treated successfully. The rate of major complications was low (2.5% septicemia, 2% major renal hemorrhage, 0.5% mortality). With this new concept of multimodal therapy (ESWL and endourology), even cases of malignant stone formation ('stone cancer') may be treatable, since these methods can be applied repeatedly without damaging the renal parenchyma.     

多发性多部位肾结石的体外冲击波碎石后加用经皮肾穿刺造瘘取石(附34例报告)

目的:探讨提高多发性多部位肾结石疗效的方法.方法:对34例多发性多部位肾结石采用ESWL治疗,对其中的未排净残石或未碎结石再联用PCNL治疗.结果:34例中,29例ESWL治疗3～6次排净结石,排净率为85.3%;4例经联用PCNL Ⅰ期清除残石或未碎结石,结石总排净率达97.1%.结论:经ESWL治疗后,再联用PCNL取净肾内残留结石来治疗多发性多部位肾结石,具清除率高、损伤少、安全性好、并发症少等优点,是一种经济而有效的治疗方法.     

Clinical experiences of 35 cases with upper urinary tract stones by extracorporeal shock wave lithotripter (MEDSTONE 1000)

We made clinical trials of the extracorporeal shock wave lithotripter (MEDSTONE-1000) in patients with upper urinary tract stones. Thirty-five cases (total 40 trials) treated during the period of October 1987 through March 1988 were enrolled in this study. The ages of the cases ranged from 22 to 65 (average 43.9) years old, comprising 23 men and 12 women. The site of presence of urinary tract stones was the renal pelvis and calyx in 28 cases and the upper ureter in 7 cases. The size of the stone was smaller than 1 cm in 15 cases, 1 to 2 cm in 12 cases, 2 to 3 cm in 7 cases and larger than 3 cm in 1 case. 13 patients with renal stones were treated with double-J stent catheter and all patients with ureteral stones were treated with the ureteral balloon catheter or flexible-tip ureteral catheter as preoperative manipulation. In 26 cases epidural anesthesia was used and the others were treated under general anesthesia. Stone targetting was determined by two oblique radiographs from separate axes. The intensity of shock waves was mainly 24 KV and the maximum shock wave counts to break up stones were 6800 shots. The size of the broken stone fragments was less than 2 mm in 24 cases (68.5%) and 2 to 5 mm in 10 cases (28.6%), which indicated that the procedure was very effective. However, one case in whom the stone could not be broken was with cystinuria. After three months the fragments completely passed in 22 cases (64.7%) and the residual fragments larger than 5 mm were left in 2 cases (5.9%).(ABSTRACT TRUNCATED AT 250 WORDS)     

Management of upper ureteral calculi with extracorporeal shock wave lithotripsy

The results of 471 extracorporeal shock wave lithotripsy treatments in 465 patients with solitary ureteral stones managed by several different techniques are reported. In situ treatment was performed in 123 cases without instrumentation and in 47 after placement of a ureteral catheter. Retrograde stone manipulation was performed in 245 cases immediately before extracorporeal shock wave lithotripsy and an additional 56 were manipulated with ureteral stent placement at least 1 week before extracorporeal shock wave lithotripsy. The success rate was significantly greater if the stone was manipulated into the kidney before extracorporeal shock wave lithotripsy. Significantly less energy (p less than 0.0001) was required for complete disintegration if the stone was free floating in the kidney. The need for subsequent procedures was significantly less (p less than 0.0001) for stones manipulated successfully into the kidney. Complications were infrequent, with the most common being ureteral perforation in 5.1 per cent of the cases, all of which were managed conservatively. Extracorporeal shock wave lithotripsy is the treatment of choice for proximal ureteral calculi because it is less morbid than percutaneous approaches and provides significantly better results than ureteroscopy. An attempt at manipulation of proximal ureteral calculi back into the kidney should be made before extracorporeal shock wave lithotripsy.     

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.     

Calcification of ureteral stent treated by extracorporeal shock wave lithotripsy

A patient with stones presented with large calcifications of the J ends of a Double-J stent that had been placed in the ureter for an obstructing ureteral stone 1 month previously. The J end located in the renal pelvis was treated with extracorporeal shock wave lithotripsy and the calcification was disintegrated completely. This noninvasive procedure appears to be the method of choice in the treatment of such complications.     

Multiple cystine stone formations on an indwelling ureteral stent treated by extracorporeal shock wave lithotripsy.

Multiple large cystine stones formed on an indwelling ureteral stent used in the medical management of a 12-year-old boy with obstructing renal stones and cystinuria. Extracorporeal shock wave lithotripsy fragmented the cystine stones and allowed for extraction of the stent by cystoscopy.