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.     

The role of silicone ureteral stents in extracorporeal shock wave lithotripsy of large renal calculi

Between November 1984 and December 1985 extracorporeal shock wave lithotripsy was used to treat 1,645 kidneys at our institution. A total of 646 kidneys with stone burden greater than 14 mm. was evaluated with regard to the impact of silicone ureteral stents in post-extracorporeal shock wave lithotripsy morbidity. Our results indicate that small stones were pulverized and eliminated with minimum morbidity. Larger stones frequently were associated with post-treatment ureteral obstruction by sand and fragments. Of 283 kidneys with stone burden exceeding 25 mm. pretreatment placement of silicone ureteral stents reduced complications from 26 to 7 per cent and auxiliary procedure rates from 15 to 6 per cent. Silicone ureteral stents protect the kidney from ureteral obstruction, and allow for safe and effective extracorporeal shock wave lithotripsy of large renal calculi.     

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．…     

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。     

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 versus ureteroscopy for distal ureteral calculi: a prospective randomized study

PURPOSE: We performed a prospective randomized study to determine appropriate first line treatment for distal ureteral stones. MATERIAL AND METHODS: Between January 1996 and October 1997, 80 patients with distal ureteral stones (40 smaller than 5 mm. and 40 larger than 5 mm.) were randomized and treated with extracorporeal shock wave lithotripsy or ureteroscopy with a 9.5 or 6.5F semirigid ureteroscope. RESULTS: Ureteroscopy was significantly better in terms of operative time, fluoroscopy time and time to achieve a stone-free state. The smaller the stones, the greater the difference between the 2 treatment modalities. CONCLUSIONS: For distal ureteral stones we recommend ureteroscopy as first line treatment.     

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 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.     

A randomized outcomes trial of ureteral stents for extracorporeal shock wave lithotripsy of solitary kidney or proximal ureteral stones

PURPOSE: Routine use of ureteral stents before extracorporeal shock wave lithotripsy of kidney stones between 10 and 20 mm. is controversial. We conducted a prospective randomized clinical trial to evaluate the outcome of ureteral stents for treating solitary kidney stones between 10 and 20 mm. or solitary proximal ureteral stones less than 20 mm. with shock wave lithotripsy. MATERIALS AND METHODS: A total of 97 patients who met the aforementioned criteria were randomized between March 1994 to July 1997 into group 1-no stent, group 2-a 4.7Fr multi-length stent and group 3-a 7Fr multi-length stent. The patients were treated with the Dornier HM3 lithotriptor (Dornier Medical Systems, Inc., Marietta, Georgia) and monitored for stone-free rate, number of days lost from work, number of patients requiring rehospitalization, emergency room visits, irritative voiding symptom score and pain symptom score. RESULTS: Objective outcome was obtained from 91 patients based on a followup of at least 3 months. The overall stone-free rate was 80%, with a re-treatment rate of 7%. The number of days lost from work was approximately 2, with no significant differences among individual groups or subgroups. The hospitalization rate and number of emergency room visits in group 1 (22%) were statistically higher compared to groups 2 (7%) and 3 (7%). The irritative voiding symptom score was statistically higher in the stented groups 2 and 3 compared to the nonstented group 1. CONCLUSIONS: Although ureteral stents are associated with more irritative symptoms, their use resulted in fewer hospital readmissions and emergency room visits compared to when no stent was used to treat solitary kidney stones of 10 to 20 mm. or solitary proximal ureteral stones less than 20 mm. Size 4.7Fr stents may be preferable over 7Fr stents when used in conjunction with shock wave lithotripsy.     

Prospective randomized trial comparing shock wave lithotripsy and ureteroscopy for management of distal ureteral calculi

PURPOSE: We compared the efficacy of shock wave lithotripsy and ureteroscopy for treatment of distal ureteral calculi. MATERIALS AND METHODS: A total of 64 patients with solitary, radiopaque distal ureteral calculi 15 mm. or less in largest diameter were randomized to treatment with shock wave lithotripsy (32) using an HM3 lithotriptor (Dornier MedTech, Kennesaw, Georgia) or ureteroscopy (32). Patient and stone characteristics, treatment parameters, clinical outcomes, patient satisfaction and cost were assessed for each group. RESULTS: The 2 groups were comparable in regard to patient age, sex, body mass index, stone size, degree of hydronephrosis and time to treatment. Procedural and operating room times were statistically significantly shorter for the shock wave lithotripsy compared to the ureteroscopy group (34 and 72 versus 65 and 97 minutes, respectively). In addition, 94% of patients who underwent shock wave lithotripsy versus 75% who underwent ureteroscopy were discharged home the day of procedure. At a mean followup of 21 and 24 days for shock wave lithotripsy and ureteroscopy, respectively, 91% of patients in each group had undergone imaging with a plain abdominal radiograph, and all studies showed resolution of the target stone. Minor complications occurred in 9% and 25% of the shock wave lithotripsy and ureteroscopy groups, respectively (p value was not significant). No ureteral perforation or stricture occurred in the ureteroscopy group. Postoperative flank pain and dysuria were more severe in the ureteroscopy than shock wave lithotripsy group, although the differences were not statistically significant. Patient satisfaction was high, including 94% for shock wave lithotripsy and 87% for ureteroscopy (p value not significant). Cost favored ureteroscopy by $1,255 if outpatient treatment for both modalities was assumed. CONCLUSIONS: Ureteroscopy and shock wave lithotripsy were associated with high success and low complication rates. However, shock wave lithotripsy required significantly less operating time, was more often performed on an outpatient basis, and showed a trend towards less flank pain and dysuria, fewer complications and quicker convalescence. Patient satisfaction was uniformly high in both groups. Although ureteroscopy and shock wave lithotripsy are highly effective for treatment of distal ureteral stones, we believe that HM3 shock wave lithotripsy, albeit slightly more costly, is preferable to manipulation with ureteroscopy since it is equally efficacious, more efficient and less morbid.     

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)     

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 for distal ureteral calculi: what a powerful machine can achieve

PURPOSE: We assessed the efficacy of extracorporeal shock wave lithotripsy (ESWL, Dornier Medical Systems, Inc., Marietta, Georgia) for distal ureteral calculi with the HM3 (Dornier Medical Systems, Inc.) lithotriptor. MATERIALS AND METHODS: A total of 585 consecutive patients with distal ureteral calculi were treated with ESWL using an unmodified HM3 lithotriptor. Of these patients 67 referred for treatment only for whom no followup was available were excluded from further analysis. The remaining 518 cases were followed until they were radiologically documented to be stone-free or considered treatment failures. Before ESWL additional procedures were performed in 144 patients, including stone push back, ureteral catheter or Double-J (Medical Engineering Corp., New York, New York) stent placement, percutaneous nephrostomy, ureteral endoscopic maneuvers or stone basket manipulation. A total of 374 patients needed no preliminary treatment before ESWL. RESULTS: Of the 518 patients 469 (91%) were successfully treated with 1 ESWL session, while 49 (9%) needed 2 or 3. Manipulation after ESWL was performed in 22 cases, including stent placement, percutaneous nephrostomy, ureteral endoscopic stone removal and a stone basket procedure. On day 1 after ESWL 327 patients (63%) were stone-free, 158 (30%) had less than 5 mm. fragments and 33 (7%) had more than 5 mm. fragments. At 3 months the stone-free rate increased to 97%. CONCLUSIONS: These data show that ESWL for distal ureteral calculi with the powerful unmodified HM3 lithotriptor has a high success rate with a low rate of minimally traumatic manipulations before and after intervention. Results in terms of the re-treatment and stone-free rates are superior to those of any other second or third generation lithotriptor and comparable to the results of the best ureteroscopic series.