Prediction of success of extracorporeal shock wave lithotripsy in the treatment of ureteric stones

Objectives To define the factors that affect the success rate of extracorporeal shock wave lithotripsy (ESWL) for the treatment of ureteric stones. Patients and methods Between January 2000 and December 2003, 468 patients with ureteric stones underwent in situ ESWL using Storz SL 20 lithotriptor. The results of treatment were evaluated after 3 months of follow-up. Treatment success was defined as complete clearance of the stones. Characteristics of the patients, condition of the urinary tract and stone features were correlated to the success rate to define the significant predictors of success. Results At 3-month follow-up, the overall success rate was 394/468 (84.2%). Repeat treatment was required in 239 patients (51.1%). Post-ESWL auxiliary procedures were necessary in 58 patients (12.4%). Post-ESWL complications were observed in 11 patients (2.4%). Only three factors had a significant impact on the stone-free rate, namely stone site, stone width and the presence of a ureteral stent. The stone-free rate was highest for stones located in the lumbar ureter (159/183; 86.9%) and lowest for those in iliac ureter (28/40; 70%) (P < 0.05). Stones with a transverse diameter <8 mm were associated with a stone-free rate of 89.9% (248/276), compared to 66.7% (128/192) for those with a transverse diameter of >8 mm (P < 0.01). Non-stented patients had a stone-free rate of 89.2% (313/348), compared to 75.2% (85/113) for stented patients (P < 0.01). Conclusions The site and transverse diameter of the stone and the presence of a ureteral stent are the only significant predictors of success of ESWL therapy for ureteric stones.     

Ovarian apoptosis after shock wave lithotripsy for distal ureteral stones

The objective of this study is to identify any apoptotic effect of shock wave lithotripsy (SWL) for distal ureteral stones on ovarian tissue. Twenty-one female New Zealand White rabbits were divided into three groups of seven rabbits each: I (control), and II, III (treated and killed 14 and 28 days after SWL, respectively). The left distal ureteral segment of the anesthetized (ketamine HCl, 20 mg/kg) animals in groups II and III was exposed to 1,500 shock waves at 17 kV. Localization of the distal ureteral segments was achieved following contrast medium (Iohexol 300 mg of I/ml) injection. The animals were killed on day 14 or 28 after SWL, and the ovaries were removed. The follicle number with apoptotic changes in ovarian tissue was compared with control group. Apoptotic changes were determined by terminal deoxynucleotidyl transferase (TdT)-mediated dUTP nick end-labeling (TUNEL) method. No increased apoptosis was detected in all groups. The mean number of TUNEL-positive follicle in groups I, II and III was 9.3 ± 2.9, 8.1 ± 2.6 and 8.7 ± 2.9, respectively. There were no statistically significant differences among all groups regarding the number of TUNEL-positive follicle (P = 0.647). Also, no histomorphological change other than apoptosis was detected in the study groups. In conclusion, SWL treatment for distal ureteral stones does not induce apoptotic changes on ovarian tissue.     

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 for upper urinary tract stones using piezoelectric shock wave lithotripsy]

Between August 1999 and July 2000, 123 cases of renal stones and 52 cases of ureteral stones in 116 males and 59 females were treated with the New Piezolith 2500. The average number of sessions required for renal and ureteral stones was 2.50 and 1.48, respectively. At 3 months postoperatively, stone-free rates for renal and ureteral stones were 64.2% and 72.7%, respectively. Assessing residual stones less than 4 mm in diameter as an effective treatment outcome, the efficacy rates for renal and ureteral stones were 94.3% and 86.4%, respectively. Side effects were encountered in 5 cases (2.9%) of high fever and one case (0.57%) of renal subcapsular hematoma. New Piezolith 2500 is effective and safe for the treatment of upper urinary stones.     

The effect of calcium channel blockers on stone regrowth and recurrence after shock wave lithotripsy

We evaluated the possible effects of a calcium entry blocking agent “verapamil” on new stone formation and/or regrowth of residual fragments after shock wave lithotripsy (SWL) during long-term follow-up (>30 months) and compared the results with the success rates of adequate fluid intake. A total of 70 patients treated with SWL were randomly divided into three different groups, in the first two of which the patients received different preventive measures with respect to stone recurrence and/or regrowth. While 25 patients received a calcium channel blocking agent, verapamil hydrochloride, beginning 3 days before SWL and continued 4 weeks after the procedure, an additional 25 patients were put in an enforced fluid intake program and the remaining 20 patients received no specific medication and/or measure apart from close follow-up. Patients were followed regularly with respect to the clearance/regrowth of the residual fragments and that of new stone formation during long-term follow-up (within a mean follow-up of 30.4 months). The overall stone recurrence rate was 14% (10/70). Of the patients who became stone free (12/25, 48%) in group I, only one patient (1/12, 8.3%) showed a new stone formation during long-term follow-up. The figure was 40% (4/10) in group II patients and 55% (5/9) in group III patients receiving no specific medication. Regarding the residual stone fragments (<5 mm) after SWL, again high fluid intake was found to be the most effective on stone regrowth rates (2/13, 15.3%). Patients treated with verapamil also had acceptable regrowth rates (3/15, 20%). Finally, verapamil treatment significantly improved the clearance of residual fragments; while 7 out of 15 patients with residual fragments passed these particles successfully, (46.5%) in this group; these figures were 46% (6/13) and 18% (2/13) in the remaining groups. Residual fragments located in lower calyces demonstrated a poor clearance rate with higher regrowth rates. Verapamil administration was found to be effective enough to limit the regrowth of residual fragments and also to facilitate residual fragment clearance after SWL. Patients receiving this medication seemed to pass the retained fragments easily in a shorter time than the others.     

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     

体外冲击波碎石术治疗上尿路尿酸结石

作者采用超声定位的压电晶体式体外冲击波碎石术连续性治疗１２１例上尿路尿酸结石，观察其碎石疗效。肾结石１１２例，共１６７枚，结石长径０．５～３．５ｃｍ，平均０．８６ｃｍ；输尿管结石９例，长径０．６～１．３ｃｍ，平均０．８４ｃｍ。２例输尿管上段结石接受了重定位辅助治疗，其余均采用原位治疗。单次治愈者为８０．９９％，２次者１２．４０％，３次者４．９６％，４次者１．６５％。所有患者术后均未发生严重并发症。作者认为采用超声定位的压电晶体式碎石机治疗尿酸结石是一种较为理想的方法，并侧重探讨了尿酸结石的Ｂ超定位技术、碎石过程中的冲击方法和术后碱性药物的应用。     

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.     

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.     

Results of extracorporeal shock wave lithotripsy for the treatment of upper urinary tract stones

The treatment results of 697 renal units in 687 patients treated for upper urinary tract stones using a Piezolith 2500 at the Ageo Central General Hospital during the 5-year period between August 1999 and July 2004 were analyzed. The stone-free rate and the success rate were calculated according to the stone size and location. Univariate and multivariate logistic regression analyses were performed to estimate the effect of the patient age, sex, affected side, stone location and stone size on the stone-free rate and the success rate. Overall, the stone-free rate and the success rate at 3 months after treatment were 82.6% and 91.9%, respectively. The stone-free rates in renal and ureteral stones were 60.5% and 88.7%, respectively. The success rates for renal and ureteral stones were 93.6% and 91.6%, respectively. In a univariate logistic regression analysis, patient age and stone size were significant negative factors for both the stone-free rate and the success rate and the stone location in ureter was a significant positive factor only for the stone-free rate. In a multivariate analysis, stone location in the ureter had a positive effect on the stone-free rate, although a negative effect on the success rate. Extracorporeal shock wave lithotripsy for upper urinary tract stones was an effective and safe treatment modality. However, if pre-treatment factors indicate unfavorable outcome, the other treatment options should be considered for the first line therapy.     

Trapping of the double-J stent in the urinary tract eight years after extracorporeal shock wave lithotripsy

We report a case of the `forgotten' DJ stent in the urinary tract for eight years. In spite of years DJ stent spent in the urinary tract, and the great burden of the new-formed stones, residual renal function still exist. One year after treatment patient is stone free, infection free, with the mild renal failure. This revised version was published online in August 2006 with corrections to the Cover Date.     

术中应用利尿剂预防上尿路腔内碎石术后感染的临床研究

目的:观察和探讨术中应用利尿剂预防上尿路结石腔内碎石术后感染的临床疗效.方法:自2003年11月～2006年4月,共160例上尿路结石患者人组,随机分为利尿剂应用组(n=81)和对照组(n=79),其中行经皮肾镜治疗者62例,行输尿管硬镜治疗者71例,输尿管软镜治疗者27例.利尿剂组于解除尿路梗阻后(经皮肾镜治疗为建立经皮肾通道后;输尿管硬镜治疗为击碎结石并引流肾盂尿后;输尿管软镜治疗为置入外鞘后),静脉推注速尿20 mg;对照组术中不作特殊处理.术后两组均建立通畅的尿液引流,经皮肾镜治疗术后置双J管及肾造瘘管;输尿管硬、软镜术后置双J管,同时给予同级抗生素防治感染.分别比较各种腔内碎石术后,两组中发生全身炎症反应综合征(Systemic inflammatory reaction syndrome,SIRS)及脓毒败血症休克的情况.结果:利尿剂应用组和对照组术后SIRS的发生率分别为7.4%(6例)和17.7%(14例).其中经皮肾镜治疗后,两组SIRS的发生率分别为6.3%(2例)和16.7%(5例);输尿管硬镜治疗后为8.3%(3例)和20.0%(7例);输尿管软镜治疗后为7.7%(1例)和14.3%(2例).对照组中行经皮肾镜和输尿管硬镜碎石后,各有2例SIRS患者发展为脓毒败血症休克.结论:通过术中应用利尿剂,抑制肾小管重吸收,减少了术中灌洗致肾盂内高压而引起的细菌、细菌毒素反流和吸收,从而有效降低上尿路结石腔内碎石术后感染的发生率.     

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.     

体外冲击波碎石治疗儿童尿路结石的疗效观察(附62例报告）

目的：探讨体外冲击波碎石(ESWL)治疗儿童尿路结石的有效性和安全性。方法：采用ESWL治疗儿童尿路结石患者62例，其中肾盂肾盏结石35例，输尿管结石22例，膀胱结石4例，移植肾结石1例。结果：62例随访3个月，结石排净59例(95．2％)，结石残留2例(3．2％)，1例无效(1．6％)，改用手术治疗。结论：ESWL治疗儿童尿路结石安全、有效，是儿童尿路结石的首选治疗方法。     

Glycosaminoglycans in urine and extracorporeal shock wave lithotripsy

In 50 calcium oxalate stone-forming patients, the total excretion of glycosaminoglycans (GAGs) and of four subgroups [chondroitin-4-sulfate (CS-A), chondroitin-6-sulfate (CS-C), dermatan sulfate (DS) and hyaluronic acid (HY)] were investigated before extracorporeal shock wave lithotripsy (ESWL) and during the subsequent 5 days. The standard value was determined by reference to a group of healthy test subjects. The excretion of GAGs was significantly higher in healthy test persons than in stone-forming patients. Twenty-four hours after ESWL administration, GAG excretion was enhanced significantly but returned to normal values over the course of 3 days. ESWL had no influence on the proportional composition of GAG subgroups CS-A, CS-C, DS and HY. The increase in GAG excretion after ESWL indicates a transient injury of renal tissue or of the mucus layer lining the urothelium. This lesion, however, can be regarded as temporary with later restitutio ad integrurn.     

逐步提高冲击波能量预处理对体外冲击波碎石术肾损伤的保护作用

目的探讨逐步提高冲击波能量（GESW）预处理对体外冲击波碎石术（ESWL）肾损伤的保护作用及机制。方法制成单肾的40只雌性家兔随机等分为对照组、GESW组、ESWL组、ESWL＋GESW预处理组。GESW组肾接受300次GESW;ESWL组肾接收标准的1500次ESWL：ESWL＋GESW预处理组先按GESW组处理,然后同ESWL组处理。24h时观察肾组织超氧化物歧化酶（SOD）活性、丙二醛（MDA）含量和尿N-乙酰-β-D-氨基葡萄糖苷酶（NAG）变化,原位缺口末端标记法（TUNEL）检测凋亡细胞。结果与ESWL组比较,GESW预处理组肾组织SOD活性增高（P〈0．05）,MDA含量和细胞凋亡指数降低（P〈0．01）、尿NAG降低（P〈0．01）。与对照组比较,GESW组各项指标差异无统计学意义（P〉0．05）。结论GESW预处理可减轻ESWL所致的肾损害,与其抗氧化应激损伤、抗细胞凋亡有关。     

顺行输尿管软镜碎石术治疗尿流改道后上尿路结石分析

目的：评价顺行输尿管软镜碎石术治疗各种尿流改道后上尿路结石的临床应用价值、安全性及疗效。方法：2009年1月～2012年2月采用顺行输尿管软镜碎石术治疗尿流改道后上尿路结石患者19例,其中左侧13例,右侧5例,双侧1例;输尿管结石12例,肾结石5例,同时合并肾结石和输尿管结石2例。4例采用C臂X线引导,15例采用B超引导肾造瘘。11例一期行经皮肾造瘘＋顺行输尿管软镜碎石术;8例合并感染及急性梗阻患者一期行经皮肾造瘘,1周后二期行输尿管软镜碎石术。结果：19例患者均取得手术成功,平均手术时间为（61±21）min,平均住院时间为（5．6±3．2）d,术中出血量均〈50ml,术中及术后均未发生严重并发症。17例经历一次碎石程序即完全清除,2例经过2次碎石程序。术后4周复查CT,仅1例显示肾盂残留小片状结石,一期结石清除率达94．7％。平均随访15个月,2例患者复发,显示结石复发率为10．5％（2／19）,1例经过ESWL得到成功治疗,另1例再次顺行输尿管软镜碎石治疗成功。结论：顺行输尿管软镜是处理尿流改道后上尿路结石治疗的首选方式,具有安全性高、手术成功率高、结石清除率高、复发率低、并发症少等优点,值得临床推广应用。     

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.