ESWL treatment of urinary calculi

A total of 711 patients with symptomatic upper and lower urinary tract calculi underwent extracorporeal shock-wave lithotripsy (ESWL) at the Ohio Kidney Stone Center during the first six months. At follow-up 84 percent of the first 180 patients are stone-free. Retreatment was required for 2.8 percent of the patients with residual stone material. Thirty-seven percent of the treatments required cystoscopy with ureteral stent placement for manipulation of stones or delineation of distal ureteral anatomy to facilitate ESWL. Complications were minimal at less than 3 percent.     

A case of urinary stone in ureterocele extracted transurethrally after ESWL

A 66-year-old man was referred to our hospital with chief complaints of difficulty in urination and terminal micturition pain. Ureteroceles were identified bilaterally, and a ureteral stone (19 x 12 mm) existed in the right ureterocele. After crushing the stone by extra corporeal shock wave lithotripsy (ESWL), we removed the stone transurethrally with a small incision in the right ureterocele. The vesicoureteral reflux (VUR) was not detected postoperatively. Now, we recommend the combination of ESWL and a small transurethral incision of the urelerocele for the treatment of ureteral stones in a ureterocele in order to prevent postoperative VUR.     

复式脉冲体外碎石机治疗泌尿系结石1206例小结

目的:总结新碎石设备-复式脉冲体外碎石机治疗泌尿系结石的经验.方法:应用该机治疗泌尿系结石患者1206例,其中肾结石508例,输尿管结石603例,膀胱结石95例.结石大小0.4cm×0.5cm～2.5cm×2.5cm.碎石机工作电压4.0～8.5 kV,放电次数2 000～3 000.结果:肾结石治愈率达58.3%,输尿管结石为72.7%,膀胱结石82.4%.其中986例(81.8%)ESWL后有不同程度的肉眼血尿,164例(13.6%)出现肾绞痛,14例出现高热,2例出现肾被膜下血肿,经对症处理均消失.结论:体外复式脉冲碎石技术仍然是泌尿系结石的首选治疗方法.     

腔内技术联合ESWL治疗孤立肾结石的疗效观察

目的 探讨孤立肾结石更完全高效的治疗方法。方法 应用腔内技术联合体外冲击波碎石术（ＥＳＷＬ）治疗孤立肾结石８８例，结果 ８５例成功击碎结石。成功率达９６．６％，手术痛苦轻微，肾功能损害少，无一例因手术原因输血，术后随访１－６个月，结石排净率达９１．８％，无输尿管狭窄或闭锁等严重并发症出现。结论 腔内技术联合ＥＳＷＬ治疗孤立肾结石具有高效安全，并发症少的优点，是治疗孤立肾结石，预防其术后复发的重要手     

急诊ESWL治疗输尿管结石疗效观察

为论证体外冲击波碎石术（ＥＳＷＬ）治疗输尿管结石绞痛的临床效果，对１０９例输尿管结石绞痛患者行急诊ＥＳＷＬ治疗，结果经１次ＥＳＷＬ治疗成功者９６例（８８．１％），余经第２次ＥＳＷＬ治疗全部碎石成功。经１次ＥＳＷＬ治疗后绞痛缓解者９５例（８７．１％）。认为出现输尿管结石绞痛时应及早施行ＥＳＷＬ，以求尽早解除患者痛苦；结石定位诊断应遵循简单、快捷的原则，综合分析，防止误诊；施行ＥＳＷＬ时应尽可能采用仰     

ESWL治疗输尿管石街的研究

目的：总结分析输尿管石街ESWL的技巧与方法,旨在提高其单纯ESWL的成功率。方法：将117例输尿管石街分为粉末型（26例）,蛇头型（72例）,石块型（19例）。不同类型的石街按不同治疗方法处理。结果：①粉末型石街长度≤5cm 21例,仅药物对症排石治疗2周排净13例,4周排净8例;长度〉5cm5例,ESWL一次2周排净3例,4周排净2例。②蛇头型石街72例,其中ESWL一次2周排净38例,4周排净22例,3个月排净5例,有7例2周复查时行第二次ESWL,2～4周复查均排净。③石块型石街19例,ESWL一次2周排净3例,4周排净4例,3个月排净5例;其中有7例2周复查时行第二次ESWL,4周复查排净3例,4例行第三次ESWL,2例2个月排净,1例3个月复查排净,1例历时半年排净。上述117病例中有9例出现患侧肾绞痛或（和）发热、明显肉眼血尿,予抗炎解痉等对症治疗或感染控制后即予ESWL,症状均缓解或消失,余病例均无严重并发症。结论：ESWL治疗输尿管石街具有清除率高、损伤少、安全性高、并发症少、可重复治疗等优点,对于碎石机性能较好、ESWL技术成熟的医疗单位,尤其对于无腔内微创治疗条件的医院,目前仍可作为首选的治疗方法。     

ESWL in the treatment of stone in child with horseshoe kidney

We report a case of struvite calculi in the child with horseshoe kidney treated by extracorporeal shock wave lithotripsy (ESWL). Complete stone clearance was obtained after 3 sessions using Siemens Lithostar Lithotriptor. This revised version was published online in September 2006 with corrections to the Cover Date.     

体外冲击波碎石治疗尿路结石术后复发性结石

目的探讨尿路结石术后复发结石的原因及治疗。方法1988年～1999年应用ESWL治疗尿路结石取石术后复发性结石88例。结果结石粉碎率为100％,三个月结石排净率为93．1％。结石残留、梗阻因素、尿路感染和代谢紊乱是尿路结石术后复发的主要因素。结论ESWL是治疗尿路结石术后复发性结石的有效方法,提出首次治疗结石应以消除结石,解除梗阻,防治感染,纠正代谢紊乱为原则。     

ESWL and the future of stone management

Summary Based on optimal efficacy regarding disintegration and stone clearance, combined with minimal invasiveness, extracorporeal shockwave lithotripsy (ESWL) represents the first choice therapy for urolithiasis. Further developments in ESWL have related more to economic aspects than to improvement of disintegration efficacy or reduction of side effects. Routine indications for ESWL are well known and widely accepted. Its limitations are also well established: silent calyceal stones, calyceal diverticula stones, nephrolithiasis in horse-shoe kidneys, medullary sponge kidney, and residual fragments after ESWL. Although endourology provides new, less invasive and traumatic means of stone retrieval or disintegration, including laser lithotripsy, small ureteroscopes and actively deflectable uretero- and pyeloscopes, indications for an aggressive approach in such cases are limited to those who are symptomatic. In the case of distal ureteral calculi ureteroscopy in traureteral laser-induced shockwave lithotripsy open up new and interesting possibilities for the future.     

ESWL treatment of urinary stones at an outpatient clinic]

A total of 107 patients (age: mean 51.6, range 17-85, sex: male 71, female 36) with urinary stones in 112 renoureteral units were subjected to extracorporeal shockwave lithotripsy (ESWL) in situ using an EDAP LT-01 at an outpatient clinic between June 1990 and July 1991. All patients were given an analgesic suppository before ESWL. One ESWL session required 20-60 minutes with a repetition rate of 1.25 Hz, 2.5 Hz or 5 Hz. The effectiveness of the treatment was evaluated in 94 cases consisting of 50 renal units (R1 2, R2 46, R3 2) and 44 ureteral units (U1 16, U2 1, U3 27) three months after the final session according to the criteria reported by Sonoda. Of the 94 cases, 80 cases (85.1%) were stone free and 12 cases (12.8%) had residual fragments of less than 4 mm in diameter. Macroscopic hematuria was seen in all cases. Fever or colicky pain occurred in 3 cases. Outpatient ESWL using the EDAP LT-01 is considered to be safe and efficient for the initial treatment of urinary stones.     

ESWL治疗复杂上尿路结石的体会

目的探讨ESWL治疗复杂上尿路结石的效果。方法总结自1993年以来行ESWL治疗的所有上尿路结石,对其中较大的肾、输尿管结石、肾鹿角形结石及多发性结石的碎石效果进行分析。结合文献对石街的防治和双“J”管的应用进行讨论。结果ESWL治疗上尿路结石总有效率96．4％。治愈率92．1％。较大肾结石有效率93．9％,治愈率84．8％,石街形成率63．6％。鹿角形结石治愈率40％。较大输尿管结石有效率96．6％,治愈率91．5％,石街形成率23．7％。单侧多发结石治愈率95．7％。双侧多发结石治愈率100％。结论ESEL治疗较大的上尿路结石及多发性结石均有很好的效果。对鹿角形结石应与其它治疗方法联合应用。应及时发现并治疗碎石后形成的石街,双“J”管的应用并非必要。     

ESWL治疗上尿路结石的远期效果

目的 了解体外冲击波碎石（ＥＳＷＬ）治疗上尿路结石的远期效果,方法 对我院应用ＪＤＰＮ－Ⅱ型碎石机治疗的时间超过５年的４０８例上尿路结石患进行随访。结果石被粉碎４０２例,占９８．５％其中完全排净者３７３例,仍有残留结石者２９例,结石复发２３例（复发率６．２％）碎石失败６例,ＥＳＷＬ后血压升高７例,肾萎缩４例,结论 只要严格掌握适应证,正确选择病例,控制冲击次数和治疗能量,ＥＳＷＬ治疗上尿路结石的远     

孤立肾上尿路结石的ESWL治疗

目的:总结孤立肾并发上尿路结石ESWL治疗的经验。方法:电压比非孤立肾者略低,JT-Ⅲ型机8～12kV,HB-V型机4～8kV;放电次数比非孤立肾者略少,Ⅲ型机1500～2000次,V型机3000～3500次;同时减慢冲击频率;间隔时间二周以上比非孤立肾者稍长。直径大于2cm或多发结石且颗粒较大者,先行经皮肾镜取石后残石再行ESWL,多发或直径大于1.5cm的结石留置双J管后再ESWL,梗阻引起急性肾功能减退者急诊ESWL或先行肾造瘘或逆行插管引流积水,肾功能基本恢复后再ESWL。结果:22例独肾结石除7例多发外,15例一次成功,6例输尿管结石除1例再碎石外,5例一次成功。结论:ESWL治疗孤立肾上尿路结石损伤小且疗效好。     

Evaluation of the results of extracorporeal shock-wave lithotripsy (ESWL) for solitary upper urinary tract stone

At Osaka City University Hospital, we performed extracorporeal shock-wave lithotripsy (ESWL) for 1277 patients in a total of 1788 sessions using Dornier kidney lithotripter Model HM III from July, 1985 to the end of December, 1988. Among the patients with a solitary stone, 911 cases were available for the follow-up study and we have compared the results among these cases in respect to the stone location and size. The results obtained were as follows: the ratio of kidney stone to ureter stone was found to be 2.2:1 in male, and 3.8:1 in female patients. This indicates that ureter stones are more frequently found in male than in female patients. In addition, we compared the size of kidney stones found in the patients including 415 male and 243 female patients. Stones larger than 20 mm were more frequently found in female than in male patients. Moreover, a stone composition study of these patients showed that the contents of both phosphate calcium and magnesium ammonium phosphate were higher in female than in male patients. ESWL performed against stones at pelvis and calyces exhibited the best results. The results obtained with the stones less than 20 mm in diameter were especially favorable with a success rate of 100% for the stones less than 10 mm and 83% for the stones 10-20 mm, in diameter, while the results with the stones larger than 20 mm in diameter were rather poor with a success rate of 31%. ESWL performed against ureter stones showed poor results with a success rate of 63% for the stones smaller than 20 mm in diameter.     

上尿路结石ESWL治疗后再行开放手术原因分析（附37例报告）

报告上尿路结石经ＥＳＷＬ治疗后仍需行开放手术者３７例，占同期上尿路结石开放手术的１２．５％，其中肾切除１０例。提示经ＥＳＷＬ治疗后再行开放手术时需行肾切除的可能性明显高于未经ＥＳＷＬ治疗者。肾周粘连、输尿管增粗、僵硬是术中所见的主要病理改变，占４８．６％。并着重讨论了ＥＳＷＬ治疗后开放手术的原因，认为结石残留、ＥＳＷＬ对组织的损伤是造成ＥＳＷＬ后仍需开放手术的重要因素。     

Evaluation of the results of extracorporeal shock-wave lithotripsy (ESWL) for solitary upper urinary tract stone]

We performed extracorporeal shock-wave lithotripsy (ESWL) on 1,701 patients in a total of 2,438 sessions using the Dornier kidney lithotriptor Model HM III from July 1985 to the end of June 1990. Among the patients with a solitary stone, 1,200 cases were available for the follow-up study in which the results of ESWL were analyzed according to the location and size of the stone. ESWL performed against stones at pelvis and calyces gave the best results. The results obtained on stones less than 20 mm in diameter were especially favorable with a success rate of 84%. ESWL performed against ureter stones showed poor results with a success rate of 62% for the stones smaller than 20 mm in diameter. We further studied the results of ESWL performed against ureter stones by dividing the patients into three groups: the patients treated in situ, the patients with ureteral stents and the patients with D-J stents. The results for stones larger than 10 mm in diameter were significantly better in the patients with D-J stents than in the patients treated in situ or the patients with ureteral stents. Among the patients treated in situ, the results were significantly worse for impacted stones than for non-impacted stones when the stone size was 10-20 mm in diameter.     

经皮肾穿刺造瘘碎石术联合体外冲击波碎石术治疗鹿角形肾结石

目的：探讨微创经皮肾穿刺造瘘碎石取石术(PCNL)联合体外冲击波碎石术(ESWL)治疗鹿角形肾结石的可行性。方法：对部分鹿角形结石93例，完全鹿角形结石34例，采用PCNL加ESWL加PCNL的“三明治”取石术。结果：127例均行一期穿刺取石，单通道取石78例，双通道取石38例，三通道取石21例。ESWL76例，2次以上PCNL99例。结石清除率85．03％，平均手术时间2h50min；平均住院15d。未发现明显出血等并发症。结论：PCNL加ESWL加PCNL的“三明治”取石术是一种治疗鹿角形肾结石的有效方法。     

Natural history of residual renal stone fragments after ESWL

OBJECTIVE: After extracorporeal shock wave lithotripsy (ESWL), residual fragments (RF) 4 mm or less are usually considered as clinically insignificant. We retrospectively reviewed the natural history and clinical significance of 97 noninfected and isolated RF (4 mm or less) observed 3 months after the last ESWL session on renal tomography. PATIENTS AND METHODS: They represented 83 among 1, 216 patients treated by ESWL over a 9-year period (1989-1997). These RF were mostly localized in the inferior calyx (62%). Median follow-up was 40.6 months (range: 7-96 months). Renal tomography was always performed at the end of follow-up. RESULTS: Stone-free status, or a decreased, stable or increased amount of residual stone occurred in 27 (33%), 1 (1%), 24 (29%) and 31 (37%) of the 83 patients, respectively. During this study, 18 patients (22%) were proposed for a complementary treatment related to a size increase of the residual fragments (13 ESWL, 1 retrograde endoscopy, 3 percutaneous nephrolithotomy, and 1 polar inferior nephrectomy). CONCLUSION: The term clinically insignificant should not be employed to describe RF after ESWL. Efforts should be performed to obtain true stone-free status after ESWL.     

ESWL治疗泌尿系阴性结石233例报告

探讨Ｘ线定位系统碎石机治疗泌尿系阴性结石的定位方法，应用国产ＪＴ－ＥＳＷＬⅡ型碎石机及ＨＸ９０２型碎石机治疗泌尿系阴性结石２３３例，首次碎石率为９１％，疗效满意，并提出利用双束交叉Ｘ线定位碎石机，通过尿路造影协助，对阴性结石进行ＥＳＷＬ治疗时的几种定位方法，认为Ｘ线定位碎石机，只要在尿路造影协助下，治疗阴性结石可同样取得良好效果。