Extracorporeal shock-wave lithotripsy (ESWL). I. In vitro results of blast path treatment of human gallstones

To evaluate the efficacy of extracorporeal shock-wave lithotripsy (ESWL) for human gallstone fragmentation, biliary calculi of different size and composition were evaluated to determine clinical applicability of this technique. Human biliary calculi composed primarily of cholesterol (Group I, N = 6) and calcium bilirubinate (Group II, N = 6) were shocked in vitro at varying positions along the ESWL blast path. All calculi subjected to lithotripsy were fragmented. Cumulative fragment size was less than or equal to 2, 3, 5, and 8 mm in 73, 86, 94, and 100% of all stones treated, respectively. No statistically significant differences were observed following stone fragmentation when the two groups were compared. Further, no statistically significant differences were evident when comparing the energy expended during fracture of stones in the two groups, or in comparison of fracture with old or new electrodes. However, when fragmentation for stone remnants less than or equal to 2 mm in size was compared at 6- and 10-cm positions on the blast path, a statistically significant difference was noted (P less than 0.001). Stone fragmentation was greatest at positions closest to F2. These data indicate that biliary calculi can be fragmented when subjected to lithotripsy and positioned on the ESWL blast path.     

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.     

Extracorporeal shock-wave lithotripsy (ESWL) monotherapy for stones in lower ureter.

Extracorporeal shock-wave lithotripsy (ESWL) has been accepted as the method of choice for most upper urinary tract calculi. However, in cases of stones in the lower ureter, ureteroscopic procedures have generally been preferred. Using the Dornier HM3 lithotriptor with modifications in the patient's position, we were able to successfully treat 155 unselected cases of lower ureteral calculi. The average stone size was 9.6 mm (range 5-23 mm). One hundred forty-three patients had stones located below the lower margin of the sacroiliac joint. These patients were placed in a supine position. The stones were visualized radiologically without use of a ureteral catheter in 78 percent of the patients; in 22 percent a ureteral catheter was inserted prior to ESWL to aid in stone localization. In 145 patients (94%) treatment was completed in one session; 10 patients (6%) required two sessions. Of the patients, 38 percent were free of stones one day after ESWL; 97 percent became stone free within three months, and only 3 patients required endoscopic manipulation, after ESWL. Twelve patients had stones in the midureter overlying the sacroileum. They were placed in the prone position, and the calculi were visualized with the aid of a ureteral catheter. All these patients became free of stones one month after treatment. There were no significant treatment-related complications except for bacteremia in 1 case. In view of the remarkable efficacy, negligible complication rate, and shorter hospital stay as compared to ureteroscopic stone manipulations, we recommend high energy ESWL as the primary monotherapy of mid and lower ureteral stones.     

Extracorporeal shock-wave lithotripsy. An established treatment

Extracorporeal shock wave lithotripsy (ESWL) is the most required urinary stone therapy in our country and in the rest of the world. In a way it has replaced the alternative treatments (open surgery, percutaneous nephrolithectomy, ureteroscopy). Nevertheless these therapeutic approaches have still its own indications. Although there is no a definitive agreement, it should be desirable a world-wide consensus where each therapy will have a exactly defined land with all potential of each management improved. We review ESWL technical aspects, its literature-based most accepted indications, adverse bioeffects and last, future improvements are considered.     

Extracorporeal shock-wave lithotripsy (ESWL)-induced erosions in upper gastrointestinal tract. Prospective study in 40 patients

In a prospective study in 40 patients receiving ESWL treatment, gastric and/or duodenal erosions occurred in 32 patients (80%); in 24 (60%) the erosions were in the proximal part of the stomach. There was no direct relation between the patients' weight and the development of erosions. In some patients more erosions developed in relation to the number of shock waves received and the intensity of energy given. In most patients early onset of hematuria indicated development of more erosions. To our knowledge this is the first report in the literature on ESWL-induced erosions in the upper gastrointestinal tract.     

Extracorporeal shock-wave lithotripsy (ESWL) of pelvic kidney calculus. Use of C-arm fluoroscopy for correct patient positioning

Extracorporeal shock-wave lithotripsy (ESWL) is the preferred treatment modality for renal and upper ureteral calculi. It is usually reserved, however, for urinary tract calculi above the iliac crest of the bony pelvis. A calyx calculus in a pelvic kidney was successfully treated with ESWL by using a C-arm fluoroscope to simulate the exact direction of the shock waves. The patient was then positioned so that the shock waves entered below the sacrosciatic notch. This same technique of exact patient positioning may have application in the treatment of some lower ureteral calculi.     

Extracorporeal shock-wave lithotripsy of gallstones: Boston experience with the Dornier MPL 9000 lithotripter

After the success of shock-wave therapy for fragmentation of renal stones, machines for shock-wave therapy of gallbladder stones were quick to follow. In Munich, gallstones were successfully treated in 174 of 175 patients who were also taking ursodiol to help solubilize the calculous rubble left after treatment. In Boston, of the initial 87 patients accepted, 58 were treated for a single stone (mean diameter 15.7 mm), 16 were treated for 2 stones, and 13 for 3 stones. Although reporting of exact results is not possible before the Food and Drug Administration issues a clearance, it is fair to say that both patients and physicians are generally pleased with the results.     

Extracorporeal shock-wave lithotripsy (ESWL) in removal of stones in anomalies of kidney and upper urinary tracts

The authors analyze the results of ESWL (URAT-P unit) for urolithiasis performed in 106 patients (49 females and 57 males) aged 16-67 years with anomalous kidneys and upper urinary tracts. 28, 1, 11, 14, 24, 4, 22 and 2 patients had horseshoe, L-shape, solitary, lumbar distopic, double, sponge, cystic kidneys, congenital megacallicosis, respectively. The stones ranged in size from 7 to 30 mm. Bilateral urolithiasis was in 7 patients. The number of impulses averaged 1745 +/- 168.4 per the procedure. The average number of ESWL procedures per stone was 1.4 (1-4). The stones were completely eliminated after one ESWL session in 78(73.6) patients, after two sessions in 23(21.7%) patients, after three sessions in 4, after for in 1 patient. Complications developed in 18 patients: urinary tract obstruction and attack of acute pyelonephritis (15 and 3 patients, respectively). Within 2-10-year follow-up recurrences arose in 12 patients who were retreated. Thus, ESWL is a method of choice in the treatment of urolithiasis patients with malformations of the kidneys and upper urinary tracts. Good results of ESWL are achieved in strict adherence to principles of the patients' selection, preoperative preparation technique, individual approach to patients in postoperative period, follow-up to detect complications and recurrences.     

Extracorporeal shock-wave lithotripsy monotherapy of partial staghorn calculi. Prognostic factors and long-term results

OBJECTIVE: To define factors affecting the success and long-term outcome of extracorporeal shock-wave lithotripsy (ESWL) monotherapy of partial staghorn calculi. MATERIAL AND METHODS: We retrospectively reviewed 92 patients with partial staghorn calculi who were treated with ESWL monotherapy. The outcome of the treatment was evaluated after 3 months. Long-term follow-up data (>24 months) were available for 49 patients. These data were further analyzed to determine long-term outcome. RESULTS: At 3 months, the overall stone-free rate was 59.8%. Multiple ESWL sessions were required in 85.8% of patients. Stone surface area>500 mm2 was the only factor that significantly decreased the stone-free rate. Post-ESWL complications occurred in 12 patients (13%), among whom renal obstruction was observed in 10.8%. Secondary procedures were needed in 17 cases (18.4%). After a mean follow-up period of 7.5 years, the stone-free rate was 59.2% (29/49) and one-third of patients developed recurrence. In the long term, clinically insignificant residual fragments (CIRFs) passed spontaneously in 23% of patients, remained stable in 38.5% and became bigger in 38.5%. Regrowth of CIRFs was related to a history of stone recurrence. No patients showed deterioration of kidney function on the treated side and an improvement in pre-ESWL hydronephrosis was observed in 73.3% of patients. CONCLUSIONS: ESWL is suitable for staghorn stones相似文献   

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.     

Extracorporeal shock-wave lithotripsy of bile-duct stones. Initial Swedish experience

Fifteen patients with mean age 74 (range 34-94) years were treated with extracorporeal shock-wave lithotripsy (ESWL) for bile-duct stones (intrahepatic in 4 cases) following failure of surgical or endoscopic treatment. A Dornier HM3 lithotriptor was used, and in all cases the ESWL session was preceded by establishment of external biliary drainage (endoscopic nasobiliary in 9, percutaneous transhepatic in 2 and a surgical T-tube in 4 cases) for radiologic positioning of stone. Endoscopic (14 cases) or surgical (1 case) sphincterotomy was done to facilitate spontaneous passage or endoscopic removal of fragments after ESWL. General anesthesia was not needed during the average 50 (range 25-65) min required for performance of ESWL. The number of delivered discharges was 750 to 2,100 and the generator voltage varied from 14 to 17 kV. Disintegration of stone was good in 12 cases and partial in two. Ten patients remain stone-free, five after spontaneous passage, and five after endoscopic extraction of fragments. There were few complications. ESWL may be useful in high-risk patients with failed endoscopic treatment of bile-duct stones and for management of intrahepatic stones.     

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.     

Extracorporeal shockwave lithotripsy of gallstones. Possibilities and limitations.

Recently extracorporeal shockwave lithotripsy (ESWL) has been introduced as a nonoperative treatment for gallstone disease. Except for lung damage, no significant adverse effects of ESWL of gallbladder stones have been observed in animals. In clinical use ESWL of gallbladder stones is now confined to 15% to 30% of symptomatic patients. To achieve complete stone clearance, ESWL of gallbladder stones must be supplemented by an adjuvant therapy. ESWL of bile duct stones is highly effective and can be considered in patients in whom primary endoscopic or surgical stone removal fails. Second generation lithotriptors allow anesthesia-free (outpatient) treatments, but the clinical experience with most of these ESWL devices is still limited. The likelihood of gallbladder stone recurrence is a major disadvantage of ESWL treatment, which raises the issue of cost-effectiveness. ESWL for cholelithiasis is a promising treatment modality with good short-term and unknown long-term results.     

Extracorporeal shock-wave versus pneumatic ureteroscopic lithotripsy in treatment of lower ureteral calculi

Aim: To compare the efficacy and complications of extracorporeal shock-wave lithotripsy (SWL) and pneumatic ureteroscopic lithotripsy (URS) in the treatment of lower ureteral calculi. Methods: From August 1997 to June 1999, 210 patients with calculi in the distal third of the ureter were treated with SWL and the other 180 with URS. The stones were fragmented with either HB-ESWL-V lithotripter or JML-93 pneumatic lithotripter through Wolf 7.5～9.0 Fr ureteroscope. The outcome was assessed in terms of stone clearance rate, re-treatment rate and complication incidence. Results: The stone clearance rate was 78.1% with SWL and 93.3 % with URS (P<0.05). SWL had a re-treatment rate of 11.9 %, vs 2.2 % in the URS group (P<.05). URS caused ureteral perforation in 3.3% of patients, while it was 0 with SWL (P<0.05). The differences in the incidence of other complications such as infection and stricture between the two groups were insignificant. Conclusion: Though the selection of these two options depends on equip     

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.     

Place of extracorporeal shock-wave lithotripsy (ESWL) in management of cystine calculi

We treated 12 patients with sixteen renal and one ureteral cystine stones primarily with extracorporeal shock-wave lithotripsy (ESWL). Among the stones thirteen were greater than 25 mm. In four stones less than 25 mm, three stones completely disappeared and 1 was reduced to small fragments, following ESWL. In thirteen stones greater than 25 mm, twelve were treated by ESWL initially, and one by surgery. Of the 12 cases treated initially by ESWL, 4 became stone-free, 4 remained with small fragments, and 1 remained with large fragments. Two patients were operated on because of poor response to ESWL and 1 patient lost kidney function because of prolonged obstruction. Disintegration of cystine stones greater than 25 mm required an average of 8,522 shock-waves in 4.33 sessions. The problems associated with application of ESWL monotherapy to cystine stones are presented.     

Bacterial sepsis after extracorporeal shock-wave lithotripsy (ESWL) of calyceal diverticular stone

Most calyceal diverticula are asymptomatic but symptoms occur when there is urinary stasis leading to infection and calculi. Septic shock after ESWL of calyceal stone occurs rarely. A 24-year-old woman had septic shock due to after extracorporeal shock-wave lithotripsy (ESWL) of asymptomatic calyceal diverticular stone.     

Extracorporeal electromagnetic shock-wave lithotripsy. Initial results in the treatment of ureteral calculi in situ. A series of 50 consecutive cases

Electromagnetic shock waves are sufficiently powerful to break ureteral stones in situ under X-ray control. Fifty consecutive patients were treated for ureteral stones (20 lombar, 4 iliac, 26 pelvic); the average length was 7.5 mm; 48 times in one session, twice in two sessions. At 6 months, 98% of these patients were stone-free (with IVP control) and one patient was lost to follow-up.