逆行插管与静脉造影定位ESWL治疗上尿路阴性结石的比较

为探讨不同部位上尿路阴性结石定位方法的选择，对９８例上尿路阴性结石患者采用大剂量静脉尿路造影（ＩＶＵ）和逆行插管（ＲＧＰ）定位法行体外冲击波碎石术（ＥＳＷＬ），并根据其疗效进行比较。结果：２０例肾阴性结石中，８例行ＩＶＵ定位下ＥＳＷＬ碎石，治愈率为１２．５％；１２例行ＲＧＰ定位下ＥＳＷＬ碎石，治愈率为８．３％；认为对此类患者不宜行Ｘ线定位碎石。５８例输尿管上、中段阴性结石中，２８例行ＩＶＵ定位碎石     

Extracorporeal shock wave lithotripsy for the treatment of pancreatic duct stones

The purpose of endoscopic therapy in chronic pancreatitis is to decompress the main pancreatic duct and to remove the obstacles that impede the ductal flow of pancreatic juice. The availability of extracorporeal shock wave lithotripsy (ESWL) has improved the results of endoscopic drainage of the main pancreatic duct and has also expanded the indications of endoscopic therapy for chronic pancreatitis. This article briefly reviews ESWL for pancreatic duct stones in patients with chronic pancreatitis, including our experience with ESWL. ESWL is an effective and safe procedure for endoscopically unremovable main pancreatic duct stones, and, in selected patients, ESWL alone may be effective.     

In situ extracorporeal shock wave lithotripsy with Booster technique in the treatment of ureteral stones

Summary After treatment of more than 3000 kidney and ureteral stones with the Siemens Lithostar Multiline the results of the first 1400 ureteral stone treatments using the “Booster technique” and 3-month follow-up findings are reported. There was a disintegration rate of 98 % directly after treatment; 1 week after “Booster technique” treatment 96 % of the patients were free of stones and without any symptoms. The 3-month follow-up showed a stone-free rate of 97 %. Only in 13 % of the cases auxiliary procedures were neccessary, 7 % of them before extracorporeal shock wave lithotripsy (ESWL) and 6 % after ESWL. 43 % of the treatments were performed without any premedication, anaesthesia or sedoanalgesia. Our data even prove that in situ ESWL is a safe and effective method for the treatment of ureteral stones. In comparison to endoscopic procedures, it is superior in regard to invasivity, side effects, complications and neccessity of analgesia, while being just as efficient. Therefore it is recommended as first choice method in the treatment of ureteral stones.      

等离子体冲击波碎石术治疗胆道镜难以取出的嵌顿结石

目的 应用等离子体冲击波碎石治疗术后胆管残余嵌顿结石。方法 通过胆道镜引入定向得爆破石仪（ＰＳＷ－Ｃ）探头治疗４４例常规胆道镜难以取出的胆道术后残余结石共１０１块。结果 碎石成功率为９９％（１００／１０１）,击碎一块结石所需发放冲击波２～５００次,平均６０次,平均每例病人作胆道镜２．８次,无严重不良反应。结论 等离子体冲击波碎石是一种较理想的配合胆道镜碎石的方法,值得推广。     

Comparative study of long-term stone recurrence after extracorporeal shock wave lithotripsy and open stone surgery for kidney stones

Background: Extracorporeal shock wave lithotripsy (ESWL) has become the treatment of choice for most calculi of upper urinary tract and the need for open stone surgery (OSS) have considerably reduced. However, stone recurrence is often encountered as a long-term problem requiring re-treatment.
Methods: In the present retrospective study, the recurrence rates of ESWL and OSS were compared in the treatment of kidney calculi. During the 1 year period of the present study, 43 patients were treated by OSS and 400 underwent ESWL (the Dornier MPL 9000 lithotriptor). The recurrence of stone was defined as reappearance of the stone on plain abdominal radiography during the follow-up period.
Results: Complete removal of all stone fragments was achieved in 51.2% of patients ( n = 22) treated with OSS. In the ESWL group, the stone free rate was 56.7% ( n = 237). The recurrence rate was 31.8% within a mean of 40 months (range 32–48 months) in the OSS group, whereas this figure was 13.9%, with a mean period of 46 months (range 42–48 months) in the ESWL group ( P < 0.05). The mean periods of recurrence in ESWL and OSS groups were 20 (range 6–42 months) and 11 months (range 8–44 months), respectively ( P < 0.05). However, the mean stone burdens of both groups were different (2.9 ± 0.8 vs 1.4 ± 1.1 cm). For comparable stone burdens, the recurrence rate was similar. In the ESWL group, stones in the lower calyx, multiple stones and larger stones showed a higher recurrence rate. The recurrence after OSS was also influenced by stone burden.
Conclusions: The results of the present study demonstrate that stone burden may be the primary risk factor for stone recurrence after ESWL and OSS.     

Efficacy of extracorporeal shock wave lithotripsy for ureteric stones in children

Objectives: Management of ureteral stones in children represents a challenging problem. In this study, we retrospectively analyzed our experience with extracorporeal shock wave lithotripsy (ESWL) in 192 children with ureteric stones. Methods: Between 1990 and 2003, 192 children (≤ 14 years old) with ureteric calculi were treated with the Siemens Lithostar Plus (Siemens Medical Systems, Iselin, NJ). There were 39 stones in the proximal ureter, 19 in the mid-ureter and 134 in the distal ureter. Results: Mean patient age was 7.3±4.1 years (6 months–14 years). There were 122 boys (64.2%) and 70 girls (35.8%). All procedures were performed on an outpatient basis with intravenous sedation in 73 cases (38.1%), general anesthesia in 68 cases (35.7%) and no anesthesia in 51 cases (26.2%). A maximum of 3500 shocks and 18 kV per session were used. A 94% success rate was achieved in proximal (n: 39) and mid-ureteral stones (n: 19). Stone free rates for distal ureteral calculi were 90.6% for stones less than 1 cm in diameter (n: 94) and 91.7% for stones between 1 and 2 cm (n: 26). Overall re-treatment and efficacy quotient rates for proximal ureteral stones were 45.1% and 68.9%, 62.5% and 61.5% for mid-ureteral calculi, and 49.6% and 60.0% for distal ureteral stones. Conclusion: Our results indicate that ESWL with highly satisfactory stone free rates ranging between 90 and 100% and negligible complications can be considered as a first line treatment for ureteric stones in the pediatric age group.     

经胆道镜冲击波碎石治疗胆道残余结石的体会（附75例报告）

目的探讨应用体内冲击波碎石机，经胆道镜碎石治疗手术后胆道残余结石的疗效和安全性。方法对我院2009年8月至2010年3月间75例带T管胆道残余结石的患者，在胆道镜直视下，应用冲击波碎石机将结石击碎后，用取石篮取出，并用生理盐水反复冲洗胆道。结果75例中31例1次取净结石（占41．3％），35例2次取净（46．7％），9例3次以上取净（12％）。取石成功率100％，取石次数1—3次，平均1．7次，无胆道穿孔等严重并发症，有12例（10％）患者发生术中胆道少量出血，2例（2．7％）患者呕吐，5例（6．7％）患者术中有疼痛感，均经保守治疗后缓解。结论体内冲击波碎石机与胆道镜配合，将能窥见的难取性胆道残留结石击碎取出，安全易行，疗效确切，大大提高了取石成功率，值得临床广泛推广应用。     

上尿路结石体外冲击波碎石术预后的影响因素

目的探讨影响上尿路结石体外冲击波碎石术（ESWL）预后的相关因素,为临床干预提供依据。方法将2008年7月至2012年6月期间在我院行ESWL治疗的275例上尿路结石患者分为观察组（n=154）与对照组（n=121）,观察组患者结石完全排净,对照组未排出结石或有残留结石。相关因素采用x2检验、非条件Logistic回归进行分析。结果①x2检验结果显示两组患者病程、结石长度、结石宽度、结石数目相比差异有统计学意义（P〈0．05）。②非条件Logistic回归结果显示结石长度、结石宽度是独立危险因素（P〈0．05）。结论根据相关因素的分析结果,采取相应的干预措施以改善ESWL治疗上尿路结石患者的预后。     

Extracorporeal shock wave lithotripsy produces a lower stone-free rate in patients with stones and renal cysts

BACKGROUND: Renal cysts have a space-occupying effect and therefore can distort the pelvicalyceal anatomy. This distortion often produces abnormalities in normal urinary drainage. In the same way, it may effect the ability of the kidneys to become stone free after extracorporeal shock wave lithotripsy (ESWL). The purpose of the current study is to evaluate the effect of renal cysts on the outcome of ESWL. METHODS: We studied 15 patients who had renal stones and coexistent renal cysts. Four patients had polycystic disease, five patients had multiple cysts and six patients has solitary ones. All cysts produced a distortion to the calyceal system of the kidneys, a fact confirmed by intravenous urography (IVU) and computed tomography (CT). All patients underwent ESWL and their stone-free status was evaluated 1 month later by ultrasound and plain kidney ureter bladder (KUB) X-ray. RESULTS: We had a total 60% (9/15) stone-free patients in our study group and a stone fragmentation rate of 100%. Patients with more cysts had lower stone-free rates. Patients with polycystic kidneys had a 25% (1/4) stone-free rate, while patients with multiple cysts and solitary cysts had, 60% (3/5) and 83.3% (5/6), respectively. These results are lower than the rates reported in patients without renal cysts. CONCLUSIONS: We believe that renal cysts may interfere with the passage of stone fragments, due to the impediment of drainage and urinary stasis from the stretching and distortion of the calyceal system by the renal cysts.     

Extracorporeal shock wave lithotripsy for a ureteral stone in crossed fused renal ectopia

BACKGROUND: A 63-year-old woman presented with right flank pain and macroscopic hematuria. RESULTS/METHODS: A plain film showed a calcific shadow on the right iliac bone. On excretory urography, the right kidney was seen in the normal position, but the left kidney was not. Bilateral retrograde pyelogram revealed the S-shaped kidney and mild obstruction from a 12 x 5 mm calculus in the proximal ureter of the crossed kidney. The patient was successfully treated with in situ extracorporeal shock wave lithotripsy (ESWL) treatment and is stone free at 1 month follow up. CONCLUSION: We believe this is the first case of successful ESWL in a crossed kidney.     

Use of double-J stents prior to extracorporeal shock wave lithotripsy is not beneficial: results of a prospective randomized study

Objectives Since introduction of extracorporeal shockwave lithotripsy (ESWL) in treating patients with urinary tract stones in our clinic for the first time in our city Aden 5 years ago, we stented all patients with kidney stone >1 cm routinely before the procedure. Our aim of this study is to compare symptoms and complications of patients with and without stenting. Patients and methods In 2003, 120 patients with renal stone(s) amenable to ESWL management were prospectively treated in two groups: stented (60 patients) and unstented (60 patients). All patients were admitted for 48 h after ESWL and then followed for 3 months after discharge by the same treating group of doctors. Patients were followed-up radiographically to assess stone-free rate after 1 and 3 months. Results There was no statistical difference in flank or abdominal pain, nausea, vomiting, transient hematuria, temperature or use of analgesics on the first and second day after ESWL in the stented or unstented group. Fifty-one patients (85%) of stented group complained of side effects attributable to stent including urinary frequency and urgency, bladder pain and hematuria with urination, which in all patients but 3 of them were treated as out patient and one of the unstented group, who were readmitted because of mild to severe pain, fever, and chills. In all stented patients, we removed the stents after 2 weeks; except in readmitted patients where it was removed earlier. Plain X-ray film was done for all patients after one and 3 months. Eight patients with stents (6.7%) had >5 mm residual fragments. In these patients second ESWL session was necessary. Three months stone-free rate was 88% in stented and 91% in unstented group, respectively. Conclusion The use of double-J stents prior to ESWL treatment is not beneficial.     

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.     

Chronic kidney disease affects the stone‐free rate after extracorporeal shock wave lithotripsy for proximal ureteric stones

Study Type – Therapy (case series)
Level of Evidence 4

OBJECTIVE

To investigate the effect of renal function on the stone‐free rate (SFR) of proximal ureteric stones (PUS) after extracorporeal shock wave lithotripsy (ESWL), as urinary obstruction caused by PUS can impair renal function, and elevated serum creatinine levels are associated with decreased ureteric stone passage.

PATIENTS AND METHODS

From January 2005 to December 2007, 1534 patients had ESWL for urolithiasis, 319 having ESWL in situ for PUS; they were reviewed retrospectively. Patients requiring simultaneous treatment of kidney stones, placement of a double pigtail stent, or percutaneous pigtail nephrostomy tube were excluded. We divided patients into groups by chronic kidney disease (CKD) stage according to the estimated glomerular filtration rate (eGFR) of ≥60 and <60 mL/min/1.73 m². Stone‐free status was defined as no visible stone fragments on a plain abdominal film at 3 months after ESWL. A logistic regression model was used to evaluate the possible significant factors that influenced the SFR of PUS after ESWL, and to develop a prediction model.

RESULTS

The overall SFR of PUS (276/319 patients) was 86.5%; the SFR was 93% in patients with an eGFR of ≥60 and 50% in those with an eGFR of <60 (P < 0.001). After univariate and multivariate analysis, the three significant factors affecting SFR were an eGFR of ≥60, stone width, and gender, with odds ratios (95% confidence intervals) of 19.54 (8.25–46.30) (P < 0.001), 0.67 (0.55–0.82) (P < 0.001) and 0.16 (0.05–0.50 (P = 0.002), respectively. A logistic regression model was developed to estimate the probability of SFR after ESWL, the equation being 1/(1 + exp [?(3.8137 ? 0.3967 × (stone width) + 2.9724 × eGFR ? 1.8120 × Male)]), where stone width is the observed value (mm), eGFR = 1 for eGFR ≥60 and 0 for <60, and male = 1 for male, 0 for female.

CONCLUSIONS

Gender, eGFR ≥60 and a stone width of >7 mm were significant predictors affecting the SFR after one session of ESWL for PUS.     

Noninvasive management of obstructing ureteral stones using electromagnetic extracorporeal shock wave lithotripsy

Background Extracorporeal shock wave lithotripsy (ESWL) represents noninvasive management of urolithiasis. Since the first HM3 model, technological progress has improved the efficacy and safety of this treatment. The current study aimed to evaluate the role of ESWL as a first-line emergency therapy of renal colic due to ureteral stone with impaired renal function. Methods This prospective study enrolled all the patients admitted from the emergency room with acute renal colic meeting the following criteria: serum creatinine level ranging from 1.5 to 2.5 mg/dl, hydronephrosis, ureteral stones 6 to 15 mm in size, body mass index less than 30, normal renal function at baseline, and no evidence of urinary tract infection. The patients were submitted to a single-session emergency treatment using Dornier Litothripter S. Follow-up assessment, performed at 24 and 72 h, included radiologic and ultrasound examinations with renal function serum assessment. The end points were a decrease in creatinine level and a stone-free condition. Results A total of 40 patients were eligible for the study. The mean creatinine level at admission was 1.93 ± 0.26 mg/dl. After the treatment, renal function recovery occurred for 34 subjects (85%), with a significant global decrease in creatinine levels (p = 0.00). The global stone-free rate 72 h after SWL was 67.5% (27/40). The patients with residual fragments were managed using re-SWL (n = 7) and endoscopic technique (n = 6). Conclusions Emergency SWL represents an effective tool in the treatment of ureteral stones with hydronephrosis and slight renal impairment. Although complete stone clearance after one treatment still remains a difficult target, the actual role of SWL in the management of acute obstruction is to obtain ureteral canalization and renal function recovery. An erratum to this article can be found at     

Laser-induced shock wave lithotripsy with a regenerative energy converter

Two main mechanisms govern the field of laser lithotripsy. The first mechanism produces mechanical stress inside the stone by absorbing the laser light at the stone surface. Therefore it depends on the stone's optical properties. The second method uses a Q-switched laser and an energy converter to release mechanical shock waves acting on the stone to cause its fragmentation. This method is called laser-induced shock wave lithotripsy (LISL). The converter must be attached to the light transmitting optical fibre and should not provide an increase of the overall diameter of the probe to fit in a small, flexible endoscope. So we used the irrigation liquid, which must be supplied for endoscopic lithotripsy. Adding of Fe³⁺-ions to the isotonic saline solution (0.02 mmol l⁻¹) lowered the intensity threshold for the energy conversion. With this special irrigation liquid we have a continuously regenerating energy converter. It allows the use of bare fibres with spherically shaped tips, which can be easily changed while the endoscope remains inside the patient's body.     

The impact of radiological anatomy in clearance of lower caliceal stones after shock wave lithotripsy

The goal of this study was to determine the factors affecting stone clearance after extracorporeal shock wave lithotripsy (ESWL) for lower caliceal stones. Lower pole stone clearance was investigated in 128 (80 males, 48 females) patients treated with ESWL during 1998–2003 in our clinic. Renal anatomy was determined on standard intravenous urogram. The lower infundibulopelvic angle (LIPA) was measured as the angle between the vertical pelvis axis and the vertical axis of lower infundibulum (Sampaio’s method). The mean age of the patients was 42.8 ± 12.4 (19–77) years. The mean stone diameter and burden were found to be 1.28 ± 0.58 (0.5–3.5) cm and 1.2 ± 1 (0–7) cm² respectively. The stone-free rate was 62.5% and ESWL was unsuccessful in 16 (12.5%) patients. Thirty-two (25%) patients had residual fragments ≤4 mm retained in lower calices after lithotripsy. The stone clearance was found to be unrelated to stone burden and diameter (P = 0.17 and P = 0.14, respectively). However, there was a significant difference between mean lower pole infundibulum length (P = 0.001), infundibulum width (P = 0.001) and LIPA (P = 0.0001) between stone-free patients and patients with residual fragments. Multivariate logistic regression analysis accepting stone-free as the favourable result also confirmed that LIPA, lower pole infundibulum length and width were factors that significantly affected the outcome. Lower pole anatomy has a significant influence on clearance of fragments after ESWL.     

Outpatient basis extracorporeal shock wave lithotripsy for ureter stones: Efficacy of the third generation lithotripter as the first line treatment

Aim:   We assessed the efficacy of a third generation extracorporeal shock wave lithotripsy (ESWL) machine for ureter stones using the Dornier Lithotriptor Compact Delta.
Methods:   A total of 471 consecutive ureter stones were treated with ESWL using the Dornier Lithotriptor Compact Delta from December 2001 on an outpatient basis. Four hundred and one cases were followed up at least once after the procedure and were included in this study. All of the cases, except one patient who was three years old, were treated without anesthesia, and the procedure was principally performed on outpatient basis.
Results:   The overall stone free rate was 94.5% and the mean number of treatment sessions was 1.23. The stone free rates were compared considering various clinical factors and significant differences were observed in the stone length, the stone location and the sex in univariate analysis. However, only the stone length maintained a statistically significant impact in multivariate analysis and the stone free rates were 91.2% and 98.0% respectively in larger stones (length 10mm) and smaller stones (length < 10mm) (p = 0.004). In mid-distal stones, the stone free rate was higher than that of proximal stones (97.5% vs 92.6%, p = 0.04) and not affected by stone length.
Conclusions:   Extracorporeal shock wave lithotripsy performed by the third generation machine achieved an excellent stone free rate with a relatively small number of treatment sessions. This procedure is strongly recommended as the first line therapy for all ureter stones including mid-distal ones.