Semen changes after extracorporeal shockwave lithotripsy for distal-ureteral stones

PURPOSE: To determine the effects on semen of extracorporeal shockwave lithotripsy for distal-ureteral stones. PATIENTS AND METHODS: We examined the semen of 62 patients 1 day before and 1 week and 3 months after SWL for distal-ureteral stones. The results were compared with those of 62 patients similarly treated for upper- ureteral stones. RESULTS: Sperm density and motility decreased significantly after SWL for distal-ureteral stones (P < 0.001 for both). Macroscopic hemospermia was reported by 16 patients. These changes were reversed by 3 months. No change was observed after SWL for upper-ureteral stones. CONCLUSION: Transient deterioration of semen characteristics can be expected after SWL for distal-ureteral stones, which may be attributable to damage to the seminal vesicles or ejaculatory ducts. The changes are transient, and normal semen characteristics are found by 3 months after SWL. The long-term effects in subfertile men warrant further investigation.     

Post-extracorporeal shockwave lithotripsy residual stone fragments: clinical significance and management

Although extracorporeal shockwave lithotripsy (ESWL) is one of the primary treatments for urolithiasis, very often residual fragments of the calculi are still present for a long time after the ESWL session. These fragments are usually asymptomatic and can be managed expectantly, but sometimes they can cause symptoms and require intervention. Secondary procedures are not routinely applied to all patients with residual fragments, but only to those with significant symptoms. Medical therapy may play an important role in the management of residual fragments, by correcting an underlying metabolic disorder and by preventing the growth of residual calculi and the formation of new ones.     

5-year-follow-up of patients with clinically insignificant residual fragments after extracorporeal shockwave lithotripsy

OBJECTIVES: After SWL treatment, many patients have residual fragments in the kidney or ureter. Fragments 2 stones episodes. These patients and their referring urologist received follow-up questionnaires which contained questions about stone clearance, late complications, auxillary measures and dietary or drug metaphylaxis. RESULTS: Most residual stone fragments were located within the lower calyx (17%) and the renal pyelon (14%). Stone analysis was available in 142 patients with CIRF and revealed calciumoxalate calculi in 93.6% of the cases. In 78.6%, CIRF cleared spontaneously within few weeks and did not recur within 5 years. However, residual stones led to stone recurrence and need of re-treatment in 21.4%. Renal pyelon (23%) and calices showed comparable growth of former CIRF (lower calices 26.5%, middle calices 27%, upper calices 26%). Only 48% of the patients with recurrent stone formation followed dietary metaphylaxis. However, a significant correlation between a general or specific metaphylaxis and stone growth of CIRF could not be demonstrated. CONCLUSIONS: Most of the CIRF after SWL pass spontaneously without any complications. But considering that one fifth of the patients developed new stones at the side of residual fragments, it is obvious that close follow-up is required. Although we could not demonstrate a relation between metaphylaxis and stone re-growth, it is conceivable that adequate metaphylaxis can reduce stone recurrences.     

Hepatic haematoma after shockwave lithotripsy for renal stones

Extracorporeal shock wave lithotripsy (SWL) is a non-invasive procedure for urolithiasis. Only a very small portion of patients suffer from post-SWL haematoma and most of them have perinephric haematoma formation. We present two patients who developed subcapsular hepatic haematomas after SWL, followed by a review of the literature on the condition.     

Treatment of renal stones by extracorporeal shockwave lithotripsy: an update

AIM: Despite the extensive experience with minimal invasive stone therapy, there are still different views on the ideal management of renal stones. MATERIALS AND METHODS: Analysis of the literature includes more than 14,000 patients. We have compared these data with long-term results of two major stone centers in Germany. The results have been compared concerning the anatomical kidney situation, stone size, stone localization and observation time. RESULTS: According to the importance of residual fragments following extracorporeal shock wave lithotripsy (ESWL), we have to distinguish between clinically insignificant residual fragments and clinically significant residual fragments (CIRF). 24 months following ESWL stone passage occurs as a continuous process, and if there are no clinical symptoms, any endoscopic procedure should be considered as overtreatment. According to these results, stone-free rates of patients increase in longer follow-up periods. Newer ESWL technology has increased the percentage of CIRF. CONCLUSION: We consider ESWL in most patients with renal calculi as first-line treatment, except in patients with renal calculi bigger than 30 mm in diameter.     

The fate of residual fragments after extracorporeal shock wave lithotripsy monotherapy of infection stones

We reviewed 53 patients with infection stones treated by extracorporeal shock wave lithotripsy (ESWL*) monotherapy to determine the long-term rate free of stones and the stone recurrence rate as correlated with the pre-treatment stone burden and the radiological presence of sand or fragments after the procedure. Long-term followup (mean 26.6 months) was available on 33 patients representing 38 kidneys. Although only 3 kidneys were free of stones immediately after ESWL, 20 were without stones at 3 months and 18 (47%) were stone-free at followup. Of 9 kidneys with fragments of more than 5 mm. after the final treatment 7 (78%) had residual fragments at 3 months and experienced stone progression. Of 9 kidneys with sand remaining 6 (66%) and all 3 kidneys that appeared to be free of stones after ESWL were without stones at followup. The 3-month plain film of the kidneys, ureters and bladder was a reliable indicator of eventual outcome. Of 20 kidneys that were free of stones at 3 months 16 remained without stones. Of 18 kidneys with residual stone particles at 3 months 14 showed disease progression, 2 had stable disease and 2 passed residual sand. Only 1 of 17 patients who were free of stones or had stable stone disease had a positive urine culture at followup. Patients with infection stone fragments 3 months after ESWL monotherapy have a high rate of stone progression (78%) and should undergo further treatment. ESWL monotherapy of infection stones requires close patient followup to assure that all residual fragments have passed and urine remains sterile.     

Emergency extracorporeal shockwave lithotripsy for acute renal colic caused by upper urinary-tract stones

PURPOSE: To evaluate emergency SWL for the treatment of upper urinary-tract stones causing renal colic. PATIENTS AND METHODS: Between January 1999 and June 2003, 53 patients with a mean age of 46.6 years (range 22-65 years) were enrolled. The inclusion criteria were acute renal colic, radiopaque 5-mm to 1.5-cm calculi in the ureteropelvic junction (N=10) or upper ureter (N=43), and no evidence of urinary-tract infection or acute renal failure. The mean stone size was 7.14 mm (range 5-13 mm). Patients were randomly assigned to the control (N=28) and study (N=25) groups using previously prepared cards in envelopes. Patients in the study group underwent emergency SWL, while patients in the control group underwent scheduled SWL within 30 days. Stone status was evaluated 4 weeks after lithotripsy. There was no significant difference between the control and study groups with respect to age, sex, stone location or volume, renal obstruction, or days spent in the hospital for pain control. Available fragments of stones were sent for infrared spectroscopy. Preoperative and postoperative data were compared in the two groups using SPSS 10.0 statistical software. RESULTS: The SWL treatment lasted 50+/-11 minutes. The stone-free rates were 72% and 64% and the efficiency quotients were 53% and 44% in study and control groups, respectively. Patients in the control group spent more time in the hospital (P=0.014) and in recovery at home (P=0.011). CONCLUSION: Emergency SWL for acute renal colic caused by upper-ureteral stones is a safe procedure and offers effective release from pain and obstruction. It also decreases hospitalization days and hastens return to normal activity.     

Percutaneous nephrolithotomy for renal stones following failed extracorporeal shockwave lithotripsy: different performances and morbidities

The purpose of this study is to summarize the results of percutaneous nephrolithotomy (PCNL) for renal stones following failed extracorporeal shockwave lithotripsy (SWL), and to investigate the effect of previous SWL on the performances and morbidities of subsequent PCNL. Sixty-two patients with a history of failed SWL who underwent PCNL on the same kidney (group 1) were compared to 273 patients who had received PCNL as first treatment choice (group 2). Patient demographics, stone characteristics, operative findings, and complications were documented and compared. Groups 1 and 2 had similar patient demographics and stone characteristics. Mean time to establish access was comparable in both groups (10.5 ± 4.2 vs. 9.6 ± 4.5 min, p = 0.894). Time required to remove stones and total operative time were longer in group 1 (71.5 ± 10.3 vs. 62.3 ± 8.6 min, p = 0.011 and 95.8 ± 12.0 vs. 80.6 ± 13.2 min., p = 0.018, respectively). Group 1 had lower clearance rate compared to group 2 (83.9 vs. 93.4 %, p = 0.021), while postoperative complications were similar in both groups. Scattered stone fragments buried within the tissues made the procedure more difficult for stone fragmenting and extracting, which lead to longer operative time and inferior stone free rate. However, the PCNL procedure was safe and effective in patients with failed SWL. The risk of complications was similar and clearance rate was encouraging.     

Is extracorporeal shockwave lithotripsy suitable treatment for lower ureteric stones?

Forty patients with lower ureteric calculi for which intervention was considered desirable have been treated by in situ extracorporeal shockwave lithotripsy (ESWL) on the Dornier HM3 Lithotripter using a modified technique. Stone localisation was satisfactory in all patients. Adequate disintegration was achieved in 90% of patients following one treatment; 34 patients have been followed up for at least 3 months and 27 of these are stone-free (79%). Treatment failed in 4 patients and 2 of these had dense lower ureteric stone streets as a result of previous ESWL. The retreatment rate, post-treatment auxiliary procedure rate and complication rate were minimal. It was concluded that in situ ESWL is an effective and safe method for treating certain selected lower ureteric stones and should be considered as a feasible alternative to the more conventional methods of treatment.     

Fate of residual fragments after successful extracorporeal shock wave lithotripsy

PURPOSE: The aim of the present study was to investigate the reason residual fragments from upper urinary tract calculi failed to clear after successful extracorporeal shock wave lithotripsy (ESWL). METHODS: Risk factors were analyzed in 161 patients with residual fragments (< or = 4 mm) that had remained for more than 3 months after ESWL. The factors examined in the present study were gender, a history of urolithiasis, the number, location and size of stones, hydronephrosis 3 months after ESWL and bacteriuria before ESWL. The mean follow-up period was 20.0 months (range 6-69 months). RESULTS: The overall stone-free rate was 14.3%. The stone-free rate in patients with multiple stones or hydronephrosis 3 months after ESWL was significantly lower than that in patients without these conditions (P < 0.05 and P < 0.01, respectively). The cumulative non-clearance rate in patients with hydronephrosis was significantly higher than in patients without this condition (P < 0.05). Results of Cox's proportional hazards model indicated that hydronephrosis was the most important and only significant factor for failure to clear of the seven factors investigated (P < 0.05). CONCLUSION: Hydronephrosis was most highly correlated with the fate of residual fragments after ESWL.     

Mobile extracorporeal shockwave lithotripsy

During the last 18 months, extracorporeal shockwave lithotripsy (ESWL) has been provided at Epsom District Hospital using a mobile unit containing a Dornier HM4 lithotriptor. Patients with upper ureteric and renal stones were selected for treatment, which was performed without anaesthesia or sedation as a day-case procedure; 83 patients were treated, 5 of them with bilateral stones. Seventy patients required 1 treatment session, 17 required 2 and 1 patient required 3. There were no serious complications but 3 patients needed ureteroscopy to remove obstructing stones. The overall success rate was 86%. The cost to treat each NHS patient was 253 pounds. Mobile lithotripsy as a day-case procedure is a safe and cost-effective means of treating urolithiasis and can be performed in a District General Hospital.     

Sticks and stones: use of acupuncture in extracorporeal shockwave lithotripsy

BACKGROUND AND PURPOSE: Extracorporeal shockwave lithotripsy (SWL) is an effective noninvasive, outpatient method of stone clearance. In our unit, it is performed using a combination of oral analgesia and intravenous sedation, which allows us to treat to therapeutic levels in the vast majority of our patients. However, we have encountered patients who do not tolerate various elements of the analgesia protocol and thus cannot be treated to full effect. The options for these people are currently limited to either SWL under formal sedation or epidural or general anesthetic or the use of another technique of stone clearance, such as percutaneous nephrolithotomy, which may not be as appropriate, and again necessitates an anesthetic, an inpatient stay, or both. PATIENTS AND METHODS: We describe three patients who had previously failed SWL who received acupuncture in place of standard analgesia prior to the next treatment. RESULTS: All three patients were able to tolerate the procedure better and were treated at a higher level with more shocks than in the previous session. No side effects were noted. CONCLUSIONS: We propose that acupuncture may be considered in patients unable to take standard sedoanalgesia. It is a cost-effective, safe method of inducing sedation with analgesia and had no demonstrable side effects in our series. It provides an attractive alternative to the use of general or regional anesthetics in these patients.     

Ambulatory extracorporeal shockwave lithotripsy

The Kidney Stone Center in Fort Lauderdale, Florida, is an ambulatory ESWL facility where 226 patients have been treated since July, 1985. A total of 258 kidneys were treated over a period of five months with a success rate of 99 per cent. The post-treatment admission rate, both immediate and delayed, was 14.2 per cent. Outpatient ESWL treatment of both renal and ureteral calculi is feasible, medically safe, and cost-effective.     

Effect of vibration massage therapy after extracorporeal shockwave lithotripsy in patients with lower caliceal stones

PURPOSE: To determine whether vibration massage influences the results of extracorporeal shockwave lithotripsy (SWL) in patients with lower caliceal stones. PATIENTS AND METHODS: One hundred three patients with lower caliceal stones were entered in the study. Patients were divided into two groups that received either SWL alone (Group A, N = 52) or with vibration massage (Group B, N = 51). There was no statistically significant difference between the two groups in stone size, duration of follow-up, or patient age. The complication, stone-free, and stone recurrence rates of the groups were compared. RESULTS: There was no statistically significant difference between the groups in the number of shockwaves, number of SWL sessions, or shockwave energy. The renal colic rate was higher in Group B than in Group A (P = 0.03). The stone-free rates in Group A and Group B were 60% and 80%, respectively (P = 0.003). The stone recurrence rate was higher in Group A than in Group B (P = 0.0006). CONCLUSIONS: This retrospective study demonstrates that SWL with vibration massage appears to have a beneficial effect on the passage of fragments in patients with lower caliceal stones.     

ESWL治疗肾结石排空率的预测

目的:了解影响肾结石体外冲击波碎石(Extracorporeal shock wave lithotripsy,ESWL)成功的因素,建立回归模型估计碎石后结石排空率.方法:1996年5月～2006年10月对1 254例肾结石(结石直径＜20 mm)患者进行ESWL治疗,治疗效果在3个月随访时进行评价.碎石后比较无结石率与结石的特性,患者个人情况的相关性用方差检验进行分析,然后采用多变量回归分析方法进一步分析方差检验的有意义因素.结果:3个月随访时,ESWL后结石排空率为86.6%.1.44%(18例)患者结石未碎裂,7.97%(100例)患者结石碎片未被清除,36.5%患者接受三次ESWI,治疗.方差检验分析发现患者年龄、性别、结石大小、结石位置、结石数目、结石性质、肾形状和先天不规则肾对碎石后结石的排空率均有影响.多变量分析排除了结石性质和患者性别作为影响无结石率的因素.根据这些因素,我们建立了ESWL后无结石率的回归分析模型.该模型的准确率为86.6%.结论:结石大小,位置、数目、患者年龄、肾形状和先天性不规则肾是ESWL后结石清除率的影响因素.     

Salvage extracorporeal shockwave lithotripsy after failed distal ureteroscopy

BACKGROUND AND PURPOSE: When intervention is necessary, controversy remains as to the best treatment modality for stones of the distal ureter. In general, ureteroscopy is favored over extracorporeal shockwave lithotripsy (SWL) as the treatment of choice for distal ureteral stones. Although uncommon, ureteroscopy failures have traditionally necessitated repeat ureteroscopy to retrieve retained stone fragments. We evaluated the efficacy of salvage SWL for failed primary distal ureteroscopy in the community setting. PATIENTS AND METHODS: From December 1989 to December 2000, 6099 patients underwent SWL with the Dornier HM4 lithotripter at our institution. We retrospectively identified 31 patients who had undergone the SWL after a failed distal ureteroscopy. RESULTS: The average stone size in these patients was 9.4 mm, the average time interval from ureteroscopy to SWL was 17.2 days, and the average number of shockwaves delivered was 2386. All patients had had stents placed after ureteroscopy. Twenty-seven patients (87%) had resolution of their stone burden after one SWL session. The remaining four patients underwent additional procedures. CONCLUSIONS: Ureteroscopy is an effective modality for the treatment of distal ureteral stones. However, when unsuccessful, a salvage procedure may be necessary. Extracorporeal lithotripsy is a less invasive procedure with comparable success rates in the distal ureter. This report suggests that salvage SWL is an appropriate option for patients in whom distal ureteroscopic stone extraction fails.