Extracorporeal shock wave lithotripsy for ureteral calculi.

Second generation tubless lithotriptors allow for easy prone positioning of patients, resulting in increased use of extracorporeal shock wave lithotripsy (ESWL) for calculi in the ureter, especially in the mid and lower third portions. The 3-month stone-free rate with single stones using a Dornier HM3 and a Medstone STS lithotriptor in the upper ureter was 79% (316 patients) and 81% (188), respectively, while in the mid ureter it was 60% (20 patients) and 81% (32), respectively, and in the lower ureter it was 80% (5 patients) and 85% (26), respectively. The retreatment rate with single stones using the Dornier HM3 and the Medstone STS devices was 5% and 4%, respectively, in the upper ureter, 13% and 12%, respectively, in the mid ureter, and 0% and 5%, respectively, in the lower ureter. The second procedure rate after ESWL with single stones using the Dornier HM3 and the Medstone STS units was 6% and 6%, respectively, in the upper ureter, 15% and 16%, respectively, in the mid ureter, and 0% and 17%, respectively, in the lower ureter. Expectant management is still an acceptable method to treat small ureteral stones, and it is questionable whether ESWL is the appropriate treatment for lower third ureteral stones compared to equally effective and less expensive ureteroscopy.     

体外震波碎石治疗肾结石

目的探讨体外震波碎石(ESWL)治疗肾结石的有效性。方法1997年8月至2001年8月应用德国DornierCompacts型体外震波碎石机治疗802例肾结石(直径为0.5～2.5cm)门诊病人。结果结石直径≤0.8cm(196例)、0.9～1.9cm(574例),≥2.0cm(32例),在二月内的排出率分别为62.7%、52.6%、20.5%;总排出率为54.9%。并发症少见,2例肾包膜下血肿,采用保守治疗;19例肾绞痛及24例“石街”形成,采用输尿管镜、再次碎石或保守治疗,结石完全排出。结论ESWL是治疗肾结石(直径<2.0cm)的有效方法,对大于2.0cm的结石,应首先行开放手术或经皮肾镜碎石(PCNL)治疗。     

体外震波碎石治疗肾结石

本院于１９９７年８月至２００１年８月，用德国DonrnierCompacts碎石机治疗肾结石８０２例，取得满意的疗效。现报告如下。资料与方法１．对象：８０２例肾结石门诊病人，男５４７例，女２５５例；年龄１９～６７岁（平均４３．４岁）；其中单侧５７３例，双侧２２９例。２．方法：所有病人在碎石前均进行KUB＋IVP检查，部分病人还作尿培养＋药敏，肾脏B超或CT等。病人在碎石治疗后３天行KUB或B超检查，若结石散开不够完全，则再次ESWL。按照结石的大小，将所有病人分为３组：Ⅰ组：直径≤０．８cm，１９６例；Ⅱ组：０．９～１．…     

Extracorporeal shock wave lithotripsy for renal calculi in children.

Fifteen children (8 male and 7 female) with an age range of 18 months to 15 years were treated with extracorporeal shock wave lithotripsy (ESWL) using the Siemens Lithostar. Two children had a history of metabolic stone disease and 1 child had previously undergone open stone surgery. Four children were treated with a ureteric stent in place and 1 nephrostomy was inserted before treatment. All children were treated under general anaesthesia and all of the stones treated were confined to the kidney and ranged in size from 5 mm to a complete staghorn. The number of treatments ranged from 1 to 6 and generator voltage ranged from 16 to 19 kV with a maximum number of 30,000 shocks to a complete staghorn. Complications were minimal, with 3 children presenting with colic, 1 child requiring a stent and none requiring a nephrostomy after treatment. The overall stone clearance rate at 3 months was 65%. ESWL provides an effective treatment for selected calculi in children. In the short term, complications are minimal but the long-term effects on children need to be monitored.     

Extracorporeal shock wave lithotripsy of staghorn calculi

A total of 260 patients underwent treatment with extracorporeal shock wave lithotripsy (ESWL). Staghorn calculi were found in 32 cases. In carrying out ESWL for staghorn calculi, double pigtail stent was previously retained in principle. When the ureter was occluded by stone street in case a fever of more than 38° C lasted for 4–5 days after the first treatment with ESWL, percutaneous nephrostomy (PNS) was performed. In ESWL treatment alone a large number of shock waves were required, but double pigtail stent and PNS were used in combination individually, and larger stones were treated by the same waves. When combination therapy was used, hospital stay was short and the rate of remaining stones was low. Our therapeutic conclusions are discussed.     

Extracorporeal shock wave lithotripsy of caliceal diverticula calculi

We reviewed 10 patients with calculi in caliceal diverticula to determine whether they could be treated successfully by extracorporeal shock wave lithotripsy. Of the patients 7 required 1 and 3 required 2 treatment attempts to fragment the calculi completely. After a minimum followup of 3 months (mean 5.9 months) 2 patients (20 per cent) had passed successfully all of the stone fragments, while 3 (30 per cent) had passed more than half and 5 (50 per cent) had passed less than half of the fragments. Of the 8 patients with residual fragments only 3 had persistent symptoms indicating that symptom relief is not dependent on complete stone removal. The possibility of producing a satisfactory result (70 per cent free of symptoms) and the low morbidity of extracorporeal shock wave lithotripsy suggest that this treatment may be appropriate for calculi in caliceal diverticula.     

Extracorporeal shock wave lithotripsy monotherapy for bladder stones

This report presents our initial experience in 36 patients with bladder stones, treated by extracorporeal shock wave lithotripsy. Minute fragmentation and uncomplicated evacuation occurred in 26 patients (72%). Mean treatment duration was 55 minutes. Mean number of shock waves was 3600 and electrical discharge averaged 24 kV per shock wave. No morbidity, during or after treatment, was encountered in these patients. The treatment was performed without the use of anaesthesia on an outpatient basis.     

Extracorporeal shock wave lithotripsy of renal calculi during early pregnancy.

OBJECTIVE: To evaluate the safety of renal stone treatment by extracorporeal shock wave lithotripsy (ESWL) during pregnancy. PATIENTS AND METHODS: Data from 824 women of reproductive age who were treated by ESWL were analysed and the patients surveyed using a questionnaire about pregnancies, to which 636 (76%) responded. Of these patients, six had inadvertently undergone ESWL for renal stones during the first month of pregnancy. The stones were detected and located during ESWL using ultrasonography. RESULTS: The six patients gave birth to six children who had no detectable malformations or chromosomal anomalies. CONCLUSION: Although these results suggest that there were no adverse effects of ESWL during early pregnancy, a larger series should be assessed to confirm the safety and long-term effects of ultrasound-guided ESWL in the treatment of renal calculi during pregnancy. We do not advocate lithotripsy as a treatment for renal calculi in pregnancy, but inadvertent lithotripsy in a pregnant woman is not a cause for concern.     

Extracorporeal shock wave lithotripsy in renal calculi causing ureteral obstruction: report of 20 cases

From Dec. 1985 to July 1988, 2006 patients with renal calculi were treated with Zhongshan Hospital JT-ESWL-I and France EDAP machines. Post-treatment obstruction of ureteral street stones occurred in 20 patients (1% in this series) with large renal calculi: 10 cases occurred in the left ureter, whereas the others in the right. The length of street stones measured 3-22 cm. Among the 20 cases, 14 patients were cured by medicine, repeated ESWL, or/and endoscopical manipulation. Two patients with acute renal failure were completely free of ureteral stones after nephrostomy or placement of a ureteral catheter and irrigation. 2 patients are still under treatment. In addition, some factors of the formation, prevention and treatment of the ureteral street stones are discussed in this paper.     

Extracorporeal shock wave lithotripsy treatment of calculi in horseshoe kidneys

From June 1985 to November 1986, 17 patients with calculi in horseshoe kidneys presented to our hospital for evaluation and possible treatment with extracorporeal shock wave lithotripsy. Of these patients 14 were treated with extracorporeal shock wave lithotripsy; the calculi in 2 could not be localized and focused at the F2 focal point, and 1 was asymptomatic and has been followed conservatively. Four patients required repeat extracorporeal shock wave lithotripsy. Adjunctive procedures included preoperative retrograde catheter placement (5 patients), postoperative percutaneous nephrostolithotomy (1), ureteroscopy for ureteral fragments (2) and placement of a double pigtail stent (1). Of 14 patients 11 (79 per cent) have been rendered free of fragments with extracorporeal shock wave lithotripsy and adjunctive measures as needed. We conclude that most patients with calculi in a horseshoe kidney can be managed primarily with extracorporeal shock wave lithotripsy.     

Extracorporeal shock wave lithotripsy for lower pole calculi: Our experience

INTRODUCTION: This study was performed in order to evaluate the immediate and long-term outcome of patients undergoing extracorporeal shock wave lithotripsy (ESWL) for isolated lower pole calculi. METHODS: Three hundred and seventy renal units of 350 patients (240 men and 110 women; mean age 55 years) with isolated lower pole renal stones of smaller than 2 cm2 were studied. Follow up ranged from 1 to 52 months (mean, 15 months) to time of censorship, significant period of secondary urologic evaluation. RESULTS: Out of 370 renal units in 350 patients, 212 (57, 29%) were stone-free 1 month after ESWL and 21 (5.67%) spontaneously became stone-free within another 1-52 months (mean, 15 months). Intervention was required after 1-52 months (mean, 17.5 months) and accomplished by ESWL alone (30/350 patients 8.57%) or combined with retrograde endoscopy (10/350 patients 2.85%) while retrograde manipulation was necessary in two of the 350 patients (0.57%). CONCLUSION: Extracorporeal shock wave lithotripsy is the initial treatment of choice in patients with lower pole stones < 2 cm2, because the overall stone-free rate is acceptable and because even in the residual calculi, the risk of suffering symptomatic episodes requiring secondary intervention is low.     

Extracorporeal shock wave lithotripsy monotherapy in the treatment of staghorn calculi

From October, 1987 to September, 1989, 53 staghorn calculi of 51 patients underwent extracorporeal shock wave lithotripsy (ESWL) monotherapy by using Dornier HM3 lithotriptor. All patients were treated with double J stenting preoperatively. Mean number of shock waves was 6092 and mean number of sessions was 2.1. In 52 out of 53 kidneys (98%), the stones were disintegrated completely. Complete removal of the stone were observed in 29 kidneys (55%) 3 months after the last ESWL treatment. Complications consisted of fever attack (more than 38 degrees C) (26 patients), ileus (2), subcapsular hematoma (2) and gastrointestinal hemorrhage (1). They could be conservatively treated except one case with percutaneous nephrostomy. Supplementary procedures for the stone street were necessary in 23 patients. They consisted of ESWL (16 patients) and transuretheral lithotripsy (7). The indication of this procedure for the treatment of staghorn calculi was also discussed.     

Extracorporeal shock wave lithotripsy treatment in paraplegic patients with bladder stones

BACKGROUND: Spinal cord injury patients are at increased risk of developing urolithiasis and many will require treatment, most commonly with extracorporeal shock wave lithotripsy (ESWL). METHODS: We examined 20 consecutive spinal cord injury patients (all male) undergoing ESWL for the treatment of bladder stones between April 1992 and May 2000. The mean number of shock waves administered in these 20 patients was 3600 and the shock power was 19 kW/s. All patients were treated without anesthesia. After ESWL, the bladder was irrigated with povidone iodine solution and stone fragments were evacuated through a 22F endoscopic sheath. RESULTS: All patients became stone-free after ESWL. Stone fragments were observed in the urethra of 3 patients, which were removed by urethroscopy. No major complication was observed; however, 5 patients had minor hematuria (which subsided within 24 h) and subfebrile fever (37.2-37.5 degrees C). CONCLUSION: ESWL and transurethral bladder irrigation is a safe, effective and simple modality for the treatment of bladder stones in spinal cord injury patients.     

Extracorporeal shock wave lithotripsy for large renal calculi: the role of ureteral stents. A randomized trial

Ureteral stents reduce complications after extracorporeal shock wave lithotripsy (ESWL*) and contribute to successful stone passage. However, some reports note complications that are attributed to indwelling ureteral stents. We randomized 64 patients with large renal calculi (stone burden more than 200 mm.2) for in situ treatment or treatment with a prophylactically inserted stent. We used a 6Ch round stent with single-coiled ends or a triangular shaped stent with double-coiled ends. Patients were treated with a Siemens Lithostar lithotriptor. After 3 months we evaluated the results of treatment and post-ESWL morbidity. Of the in situ group (23 patients) treatment complications consisted of fever in 3, pyelonephritis in 1 and steinstrasse in 3. After 3 months 8 patients (35%) were free of stones. Of the stented population (41 patients) treatment complications consisted of fever in 7, pyelonephritis in 1, steinstrasse in 6 and bladder discomfort in almost half of the patients. Stent calcification and stent migration were also seen in 7 and 10 patients, respectively. Calcified stents had been in situ longer than noncalcified stents. The round stents migrated and calcified more often than the more rigid triangular stents. After 3 months 18 of the stented patients were stone-free (44%). We conclude that ureteral stents do not reduce post-ESWL complications. They are clearly associated with morbidity and do not improve stone passage markedly. Therefore, patients with a stone burden of more than 200 mm.2 should be treated in situ without auxiliary stenting.     

Extracorporeal shock wave lithotripsy for struvite renal calculi: prospective study with extended followup

To clarify the significance of retained stone particles after extracorporeal shock wave lithotripsy (ESWL) for struvite renal calculi we followed 22 otherwise healthy women for 16 to 52 months (mean 39 months). Each patient had persistent Proteus mirabilis bacteriuria before ESWL and received a standardized regimen of antimicrobial therapy in the perioperative period only. Of the 22 patients 19 (86%) were cured of the persistent bacteriuria. Of these 19 patients 16 had retained stone particles at the beginning of surveillance and 10 had retained particles at last followup. None of the particles produced symptoms or enlarged. However, 1 of the patients who was rendered stone-free had a P. mirabilis reinfection at 20 months and a new stone developed. Of the 22 patients 3 (14%) had continued persistent P. mirabilis bacteriuria after ESWL. Two patients were subsequently cured of the infection with antibiotics alone (1), and with antibiotics and extraction of a new ureteral stone (1). The remaining patient had expansion of retained stone particles after 51 months of surveillance. We conclude that a stone-free kidney is an unrealistic objective of ESWL monotherapy for struvite renal calculi. However, the treatment usually will eradicate the accompanying persistent bacteriuria and sterile stone particles will not enlarge during the first 2 to 4 years after treatment.     

Extracorporeal shock wave lithotripsy for large renal stones. To what size is extracorporeal shock wave lithotripsy alone feasible?

The complications after extracorporeal shock wave lithotripsy (ESWL) for large renal calculi could be reduced by insertion of ureteral stents. In a prospective study, the critical stone size for ESWL combined with ureteral stenting was looked for. Sixty consecutive patients entered the study, 17 patients suffered from renal calculi with a length of greater than 4 cm and a width of greater than 3 cm (group 1), and in 43 patients the calculi measured between 4 x 3 and 2.5 x 1.5 cm2 (group 2). ESWL was performed with the Dornier apparatus HM-3. A ureteral stent was placed immediately before ESWL. In group 1 with very large stones, significantly more obstructive problems were encountered. Three months after ESWL, only 6 of 14 (43%) were free of stones or with stone material likely to discharge spontaneously. In group 2, a success rate of 25 of 29 (86%) was noticed, which was considered satisfactory. For most stones greater than 4 x 3 cm2 the combination of percutaneous nephrolithotomy and ESWL seems to be the preferred treatment.     

Treatment of large renal calculi with extracorporeal shock wave lithotripsy monotherapy

One hundred and twenty patients with large renal calculi (greater than 3 cm), who had not undergone previous stone-debulking procedures, were treated with extracorporeal shock wave lithotripsy (ESWL) monotherapy using a Dornier HM3 lithotripter. Stones were divided into four categories according to Rocco's classification: 20 C2, 25 C3, 51 C4 and 24 C5. Repeated treatments were necessary in 13 patients, while planned two-stage treatments were performed in 8. Pretreatment adjunctive endourological maneuvers (except for the placement of ureteral stents for visualization of 37 contrast-negative stones) were used in 16 cases (13.3%) and posttreatment maneuvers in 20 (16.6%). Open surgery was necessary in 6 patients, including one nephrectomy. Complete elimination of all concrements was documented in 74 patients (61.6%): 63 within 3 months and 11 within 6-12 months. The stone-free rates for different categories were: 80% for C2, 64% for C3, 58.8% for C4 and 50% for C5. The stone-free rate for contrast-negative calculi was 83.7% (31/37), and for radiopaque ones 51.8% (43/83) (p less than 0.001). It is concluded that ESWL monotherapy is an adequate treatment choice for some categories of large radiopaque stones and for all radiolucent ones.     

Extracorporeal shock wave lithotripsy for renal and ureteral calculi with MPL-9000. Correlation between stone burden and shock wave energy]

Clinical results of ESWL for renal and ureteral stone with MPL-9000 were presented. We also reviewed correlation between stone burden and shock wave energy. We studied 210 cases (295 sessions) of renal stone and 109 cases (154 sessions) of ureteral stone that were treated from November 1988 till January 1989 and from November 1989 till May 1990. Of those sessions, 76 sessions of renal stone cases and 53 of ureteral stone cases were carried out ambulatorily. Successful disintegration (within 4 mm) rate was 86% of renal stones, 84% of ureteral stones, and stone free rate after 6 months was 72% of renal stones and 84% of ureteral stones. As for the complications, brain infarction occurred in one case, subcapsular hematoma of the kidney in one, and arythmia in 5. No other severe side effects were observed. Between shock wave energy (the number of shock wave shots x voltage) and stone burden (long axis x short axis of the stone), a significant correlation was found in renal stone cases, but not in ureteral stone cases. E/B (shock wave energy/stone burden) was 33,100 (kv.shots/cm2) for the renal stone and 56,000 (kv.shots/cm2) for the ureteral stone. These results suggest that there is still another unknown factor, which is not related with renal stone, for successful disintegration of ureteral stone. We also confirmed that more energy is necessary for destruction of ureteral stone than for that of renal stone.(ABSTRACT TRUNCATED AT 250 WORDS)