A new transportable shock-wave lithotripsy machine for managing urinary stones: a single-centre experience with a dual-focus lithotripter

OBJECTIVE: To assess the efficacy and safety of a transportable extracorporeal shock wave lithotripsy (ESWL) machine, the Modulith SLX-F2(TM) (Storz Medical Italia, Rome, Italy), in the management of solitary urinary calculi. PATIENTS AND METHODS: The study included 233 patients (mean age 51 years; 172 male, 61 female) with symptomatic solitary renal (group A, 170, mean diameter 15.5 mm) or ureteric stones (group B, 63, mean diameter 9.5 mm) treated in a tertiary care institution. Exclusion criteria for the analysis were: pelvi-ureteric junction obstruction, multiple stones, stone diameter >2 cm, stones in a lower calyx with unfavourable anatomy, active infection, or impacted ureteric stones. Selected patients had ureteric stenting before treatment, and all patients were treated with no anaesthesia. Hospitalization, complications and subsequent auxiliary procedures were evaluated. Patients were assessed after a single ESWL session and after 3 months by a plain abdominal film and renal ultrasonography. Stone-free status was defined as no evidence of calculi, and clinical success as the presence of stone fragments of <4 mm. An efficiency quotient (EQ) was calculated for the ESWL treatment. Pain was assessed using a visual analogue scale. RESULTS: The mean number of shocks used was 3779 and the mean (range) treatment time was 35 (5-55) min. The overall clinical success rate after one ESWL session was 83.7% and 82.5% for renal and ureteric stones, respectively, and the overall 3-month stone-free rate was 77% and 74.6%, respectively; the overall EQ was 0.64. When risk factors for persistent calculi were analysed simultaneously in a logistic regression model, only stones of >1 cm were statistically significant (P < 0.05). Most patients reported that pain during ESWL was mild to moderate and easily tolerated. Only minor complications occurred, with an overall complication rate of 3.8%. CONCLUSIONS: This transportable lithotripter is a safe and effective device for managing solitary stones throughout the urinary tract. Its main advantage is represented by the dual-focus system. Moreover, it shares with other contemporary machines several important features such as outpatient setting, no need for anaesthesia, easy patient positioning, and the capability of ancillary procedures.     

Clinical experience and results of ESWL treatment for 3,093 urinary calculi with the Storz Modulith SL 20 lithotripter at the Singapore general hospital

We study the outcome of 2,700 patients treated for 3,093 urinary calculi over a period of 60 months. All patients underwent Extracorporeal Shock Wave Lithotripsy (ESWL) treatment using the Storz Modulith SL20, predominantly on an outpatient basis (99.9% using intravenous pethidine for analgesia). The treatment outcome of 1,666 renal calculi and 1,427 ureteric calculi were analysed and stratified according to size and site. Follow-up status at 3 months was available for 91.8% of patients. For renal calculi, the overall success rate was 81% (re-treatment rate 29.7%). The majority of failures were stones larger than 2 cm and those situated in the lower pole of the renal calyces. The overall success rate for ureteric calculi is 85% with similar clearance rates throughout the ureter (re-treatment rate 22.8%). Failures were predominantly with stones larger than 2 cm. For the entire series, the morbidity rate requiring hospital admission was 2.9%, there was no mortality. The commonest cause for admission was for pain control (1.8%). To our knowledge, our experience with this lithotriptor is the largest to date. We have demonstrated that ESWL with Storz Modulith SL20 is safe, well tolerated and highly effective for the treatment of urolithiasis.     

Extracorporeal shockwave lithotripsy of 2000 urinary calculi with the modulith SL-20: success and failure according to size and location of stones

PURPOSE: We analyzed the successes and failures of SWL in the treatment of 2016 urinary calculi stratified according to size and position in the urinary tract. METHODS: All the patients were treated with a Modulith SL-20 (Storz Medical). RESULTS: The overall stone-free rate, regardless of the size and position of the stone, was 87.4%. The rate was different for kidney and ureteral stones. The stone-free rate observed for the different positions of the calculi within the kidney was upper calix 89.2%, middle calix 90.5% lower calix 84.8%, and renal pelvis 86.0%. For staghorn calculi, the stone-free rate was 60.0%. The stone-free rate for the different positions of calculi within the ureter was: upper ureter 84.3%, iliac ureter 82.4%, and pelvic ureter 91.0%. For calculi >24 mm, the retreatment rate increased, and the success rate dropped sharply. CONCLUSION: Extracorporal shockwave lithotripsy should be the first therapeutic option for urinary calculi of <24 mm regardless of their position in the urinary tract.     

Factors affecting the success rate of extracorporeal shock wave lithotripsy for renal calculi in children

The aim of the study was to analyse factors affecting the success rate of extracorporeal shock wave lithotripsy (ESWL) in children with renal calculi. We performed a retrospective analysis reviewing records of 85 (40 female, 45 male) children (89 renal units) subjected to ESWL for treatment of renal calculi during 1990–2005 in our department. As 4 patients had bilateral calculi and 19 children (21 renal units) had renal stones at more than one different site, each location was analysed separately for convenience. The mean age of the patients was 10.3±4.6 (2–16) years. The stone-free rates for renal pelvis, lower, middle and upper caliceal calculi were 70, 62, 50 and 73%, respectively. A higher rate (33%) of insignificant fragments (≤4 mm) was noted for lower pole calculi. Increased stone diameter (P=0.0001) and burden (P=0.04) were found as the most significant factors that adversely affect the stone-free rate for pelvis renalis calculi, whereas an acutely oriented infundibulum and/or a long lower infundibulum (P=0.005) were unfavourable factors for clearance of lower caliceal stones. The stone-free rate in children with multiple calculi was 48%, while 29% of the renal units had retained fragments. ESWL is a good initial option for treatment of most of the renal calculi <2 cm except in the presence of unfavourable lower caliceal anatomy. Increased stone burden, multiple stones, staghorn calculi, narrow lower infundibulopelvic angle and long lower infundibulum are factors that adversely affect the clearance rate.     

Extracorporeal piezoelectric lithotripsy for all renal stones: effectiveness and limitations

An unselected group of patients with renal stones was treated with extracorporeal piezoelectric lithotripsy (EPL) monotherapy. The results showed that this minimally invasive treatment was very effective for patients with stones smaller than 20 mm. After a minimum follow-up of 1 month, 65% of these patients were stone-free and 22% of the remainder had only small fragments. Patients with larger stones (20 mm or larger) required multiple treatment sessions (mean 5.8) and had less favourable results. One month or more after treatment, only 46% of these patients were free of stone and 21% required secondary operative procedures for obstructing ureteric fragments. Most of these patients are better treated initially by percutaneous nephrolithotomy.     

Pediatric urolithiasis: 15 years of local experience with minimally invasive endourological management of pediatric calculi

PURPOSE: We sought to identify whether changes in technology and local practice have improved outcomes in the minimally invasive management of pediatric stone disease. MATERIALS AND METHODS: We reviewed retrospectively case notes and imaging from 1988 to 2003, noting treatment modality, stone-free rates, ancillary therapy and complications. RESULTS: A total of 122 children (140 renal units) with a mean age of 7.7 years underwent 209 extracorporeal shock wave lithotripsy (SWL) sessions. Stone size ranged from 6 to 110 mm. Stone-free rates were 84% for cases involving stones smaller than 20 mm, and 54% for those involving stones 20 mm or greater. For complex calculi 40% of patients were stone-free and 45% required ancillary procedures, with an overall complication rate of 26%. A total of 37 children (43 renal units) with a mean age of 6.4 years underwent 46 percutaneous nephrolithotomies (PCNLs). Stone size ranged from 8 to 155 mm. The overall stone-free rate was 79%. Of these patients 34% required ancillary procedures, with a major complication rate of 6%. A total of 35 children (35 renal units) with a mean age of 5.9 years underwent 53 ureteroscopies. Holmium laser was the most effective treatment modality in this group, with a 100% stone-free rate and no complications. CONCLUSIONS: For most renal stones smaller than 20 mm SWL was the most effective primary treatment modality. There was no statistical difference between the 2 lithotriptors for stone-free or ancillary procedure rate. The stone-free rate was dependent on stone size rather than type of lithotriptor. For renal stones 20 mm or greater and staghorn calculi we switched from SWL to PCNL as primary treatment, as stone-free rates were higher and the ancillary procedure and re-treatment rates were lower with PCNL. Electrohydraulic lithotripsy and pulse dye laser were initially used to treat ureteral stones. However, with the introduction of holmium laser technology we achieved higher stone-free rates and lower complication rates. Holmium laser lithotripsy is now used as a primary treatment modality for ureteral stones.     

Flexible ureterorenoscopy for the treatment of refractory upper urinary tract stones.

OBJECTIVE: To report our experience of using flexible ureterorenoscopy for upper urinary tract stones. PATIENTS AND METHODS: Thirty-seven patients (13 females, 24 males, mean age 48 years, range 10-76) with upper urinary tract stones not responding to other treatments had their residual symptomatic stones treated through a 9.3 F flexible ureterorenoscope. Electrohydraulic lithotripsy (EHL) was used to fragment the stones and a basket or a grasper used to retrieve the fragments. RESULTS: Twenty-three patients were completely freed of stone and a further five had asymptomatic residual fragments of < 5 mm. Of 15 patients with ureteric stones, 14 were rendered stone-free at the end of the procedure and 14 of the 22 patients with kidney stones were treated successfully; 80% of the lower calyceal stones were treated successfully and a firm decision was possible on the further management of the remaining stones. There were no major complications. CONCLUSION: Flexible ureterorenoscopy should be considered in patients with symptomatic upper ureteric or renal stones refractory to other treatments, but the instrumentation is expensive and delicate, and its use should be reserved for such cases.     

Extracorporeal lithotripsy of ureteric calculi using the Dornier HM-3 lithotriptor.

Over a 5-year period (November 1984-November 1989), we treated 356 patients with ureteric calculi; 170 were treated by extracorporeal shock wave lithotripsy (ESWL) on a Dornier HM-3 lithotriptor. The calculi (n = 176) were uniformly distributed along the length of the ureter: 44 were just below the pelviureteric junction, 59 were lumbo-iliac, 42 were in the upper bony pelvis and 32 in the lower bony pelvis. The mean diameter of the upper ureteric calculi was 10 mm and for the others it was 8 mm. Thirty-four patients with acute obstructive pyelonephritis required pre-ESWL drainage of the urine. X-ray localisation required intravenous urography during lithotripsy in 52 cases (30%). On plain X-ray the following day 170 stones (96%) were judged to have disintegrated. The 6 patients whose stones were not fragmented received further treatment (ureterotomy (4) and ureteroscopy (2)). Five patients required additional treatment because of pain or fever (catheterisation (3) and ureterotomy (2)) and 2 patients had a second lithotripsy owing to insufficient fragmentation. Four patients were lost to follow-up. In 153 patients (90%) the fragments were eliminated completely, 146 in the first month and the remainder before the sixth month. No serious sequelae were observed. In addition to the 5 patients who required supplementary treatment. 11 patients with pain or fever needed medical treatment. We recommend first intention in situ ESWL for all ureteric calculi.     

The Dornier Compact Delta lithotripter: the first 500 renal calculi

BACKGROUND AND PURPOSE: Extracorporeal Shockwave Lithotripsy (SWL) is now the best noninvasive treatment for renal calculi, rendering many patients stone free. This prospective study was performed to evaluate the short-term results of patients undergoing SWL with the Dornier Compact Delta lithotripter for all renal calculi. PATIENTS AND METHODS: Between April 1999 and May 2000, there were 500 renal calculi treated in 166 female and 334 male patients with a mean age of 53 +/- 15 years. All patients who completed treatment were entered in the study and assessed at 1 and 3 months with a plain film of the kidneys, ureters, and bladder. Stone-free rate and final outcome have been evaluated. Final outcome is defined as stone free or residual fragments 4 mm or less. Analysis has been made according to stone size, location, number of treatments per stone, and number of shocks per stone. The analgesia requirements during each treatment and complications have also been analyzed. RESULTS: The overall stone-free rate for stones <10 mm was 62% at 1 month and 76% at 3 months. For stones 10 to 20 mm, these rates were 53% and 66%, while the rates for stones >20 mm were 41% and 47%, respectively. The final outcome for stones <10 mm was 90% at 1 month and 93% at 3 months, for stones 10 to 20 mm 73% and 84%, and for stones >20 mm 57% and 67%, respectively. The effectiveness quotient for calculi <10 mm was 60%. For calculi 10 to 20 mm, it was 51%, and for those >20 mm, it was 31%. Oral analgesia was given routinely; however, additional intravenous analgesia was necessary in 22% of treatments. No serious complications have been seen. CONCLUSIONS: These results show that with proper patient selection, good results at 1 and 3 months can be achieved with minimal anesthesia during treatment and low retreatment rates. We do not recommend SWL as primary therapy for stones >20 mm.     

输尿管软镜下钬激光碎石处理直径〉2cm肾结石

目的 探讨输尿管软镜下钬激光碎石术处理直径〉2 cm肾结石的安全性和可行性.方法 2010年2月～2013年4月,采用输尿管软镜下钬激光碎石术处理经选择的直径〉2 cm的肾结石35例.先用F8.0/9.8输尿管硬镜探查、扩张患侧输尿管,置入导丝后留置输尿管软镜鞘,引入输尿管软镜进行钬激光碎石,较大、影响视野的结石碎屑用套石网篮取出.结果 一次进镜成功率94.2%（33/35）.手术时间35~95 min,平均45 min.4例因术后残留较大体积结石再次输尿管镜下钬激光碎石.术后4例出现高热,经积极抗感染治疗后好转,无一例出现术中严重并发症.术后住院1~5 d,平均3 d.术后8周随访,结石清除率90.9%（30/33）;2例少量残留结石碎片停留于输尿管中下段,拔除内支架管时同时取出;1例孤立肾结石术后18周随访（术后8周已拔除内支架管）,仍有结石碎片在输尿管下段未排出,局麻下输尿管镜钳夹取出.结论 输尿管软镜碎石术治疗经选择的直径〉2 cm肾结石,安全、有效,特别对于术后复发的肾结石患者可以避免再次肾脏手术损伤.     

Clinical application of Modulith SL20 on extracorporeal shock wave lithotripsy for upper urinary tract calculi]

Thirty-nine patients, 27 males and 12 females with renal and ureteral stones, were treated using the Modulith SL 20 between October 1990 and January 1991. Thirty-three of the 39 cases had a single session of extracorporeal shockwave lithotripsy (ESWL) and the other six cases had two sessions. The pulverization rate of ESWL by this device was 84.6%. According to the X-rays taken 21 days after ESWL, of the 37 cases, 14 (37.8%) were stone-free, 18 (48.7%) had residual sandy stones less than 4 mm in diameter, five (13.5%) had residual stone fragments larger than 4.1 mm in diameter, and two cases were not clear. Using the criterion of cases which can be expected to have spontaneous passage, in other words, residual stones less than 4 mm in diameter, lithotripsy with the Modulith SL 20 was regarded as "effective" in 32 of the 37 cases (86.5%). As side effects of this treatment, hematuria was observed for several days after ESWL in all patients, but not other serious complications were observed. Among the 37 cases in which the grade could be evaluated the evaluation for 24 (64.9%) was "useful" and that for 13 (35.1%) "useful to some extent". Therefore, ESWL was performed very successfully.     

Is the conservative management of ureteric calculi of > 4 mm safe?

OBJECTIVE: To determine the safety of the conservative management of ureteric calculi of > 4 mm in diameter, using mercapto-acetyltriglycine (MAG3) radioisotope renography to monitor renal parenchymal function. PATIENTS AND METHODS: Patients with symptomatic unilateral ureteric calculi were recruited prospectively. After confirming the position of the stone using contrast urography, a MAG3 radioisotope renogram was taken within 48 h of admission and again 1 month after the patients became stone-free. The indications for intervention were ipsilateral loss of function (>/= 5% loss), infection, pain or any combination of these factors. The recovery of function was determined by follow-up renography. RESULTS: In all, 54 patients were recruited; 18 were initially allocated to conservative treatment although four later required intervention for pain. The remainder required early intervention for pain (eight), diminished function only (15) or diminished function with infection (13). Of the 54 patients, 28% had 'silent' loss of renal function at presentation. No calculi of > 7 mm diameter passed without intervention. The mode of initial management was determined according to individual clinical need. The upper tracts of all patients were relieved of obstruction and all patients were rendered stone-free. Intervention for reduced function only (at 相似文献   

Extracorporeal shock wave lithotripsy in the management of pediatric urolithiasis

The main objective of this paper was to evaluate the efficacy and safety of the management of pediatric urolithiasis by extracorporeal shock wave lithotripsy (ESWL). Between November 1988 and July 2000, 165 renal stones, 53 ureteral stones, and 5 bladder stones were treated in 126 pediatric patients using Siemens Lithostar lithotriptor. The ESWL treatments ranging from 1 to 7 were needed per patient (mean: 2.1). One ESWL session was performed for 49.6% of stones, two for 24.6%, three for 13.0 %, four for 5.6% and > 4 for 8.2%. The success rate for renal stone units (asymptomatic fragments less than 4 mm) was 88.2%, stone-free rate was 49.0%. The stone-free rate for ureteral stone units was 87.5%, but was 75% for bladder stones. The overall results of ESWL treatment in 126 children was satisfactory: the success rate was 90.5%, stone-free rate was 51.6%, residual fragments > 4 mm were 9.5%. General anesthesia was required in 65 children (136 treatments) under the age of 10, and only in 18 children (40 treatments) in the age 11–14. Auxiliary procedures, such as double J stent and percutaneous nephrostomy (PCN) were used in 19 and 7 patients, respectively. Perirenal hematoma in one patient and hematomas in enteric wall in another one patient were the only major complications managed conservatively without consequences. Low energy lithotripsy with the Siemens Lithostar in our series of pediatric patients was safe and relatively effective.     

倒置排石床在肾下盏结石治疗中的应用

目的 探讨倒置排石床在治疗肾下盏结石中的作用.方法 2006年3月至2008年9月,收治的36例肾下盏结石患者,其中结石直径>4 mm且<2 cm者13例,进行体外冲击波碎石术(ESWL)同时配合倒置排石床治疗,直径≤4 mm且≥2 mm的单纯肾下盏结石或输尿管镜钬激光碎石术及后下盏残石23例,仅进行倒置排石床治疗.3个月后复查尿路平片,了解结石排尽情况.结果 所有36例患者均顺利完成排石床排石治疗,倒置排石过程中未出现严重的心脑血管意外,3个月复查结石排净率83.3%(30/36),残石率16.7%(6/36).结论 采用倒置排石床可以提高肾下盏结石排石率,可作为结石微创治疗的辅助手段.     

Holmium:YAG laser for urinary stones

OBJECTIVE: To evaluate the results of Holmium:YAG (Ho:YAG) laser lithotripsy in the treatment of urinary stones. MATERIAL AND METHODS: Between 1993 and 1997, 59 patients with 85 urinary stones were treated with the Ho:YAG laser lithotripsy. Retrospective evaluation was done on the 64 procedures available, comprising 53 ureteric, 8 bladder, and 2 renal calculi, and one stone in a ureterocele. RESULTS: The Ho:YAG laser fragmented all types of calculi. Of 38 patients, 29 (76%) with ureteric stones were stone-free and 7 (18%) had stone fragments smaller than 2 mm left 1-3 months after the lithotripsy, resulting in a total clinical success rate of 95%. The procedure caused four ureteric perforations. One ureteric stricture, after repeated treatments for a Steinstrasse formation, led to nephrectomy. CONCLUSIONS: The Ho:YAG laser was reliable and effective for most of the urinary stones. The largest stones in any location, and stones of hard composition, however, were treated with combined disintegration methods. Four minor ureteric perforations and one ureteric stricture were related to laser use.     

Lithotripsy in the treatment of urinary lithiasis

Based on an extensive review of the literature and on our own clinical experience, this article attempts to present clear guidelines for the management of various kidney stones, particularly regarding the extracorporeal shock waves lithotripsy (ESWL) treatment nowadays. Few technical developments have changed medicine more within a short period of time than ESWL. Fifteen years after the first clinical application, ESWL has gained world-wide acceptance as first choice therapy for most forms of urolithiasis. Ninety-eight per cent of stones can be successfully fragmented by the application of shock-waves, but the ability of the kidney and ureter to clear the resulting fragments is far more important in terms of successful treatment outcome. Increasing experience with new ultrasound-guided lithotriptors has shown that there are some advantages: cost reduction, permanent monitoring and lack of exposure to ionising radiations. ESWL is a safe procedure for the treatment of urolithiasis; nevertheless some problems remain. In ureteric stones, ureteroscopy (rigid or flexible device) allows a rate of stone-free patients better than ESWL. For treatment of large staghorn calculi combined approach of PCNL and ESWL is preferred. For stones located at lower calyx, the stone-free rate in patients treated by ESWL fell to 50%, when unfavourable anatomy is present. The potential long-term renal damage, associated with ESWL in children, have delayed the acceptance of shock-waves into paediatric practice. Recent reports suggest that the renal damage, including the potential risk of hypertension induced by ESWL, is mild and transient. A subgroup of patients (e.g. solitary kidney, impaired renal function, children) required further attention. The fate of residual fragments is unclear. In some cases residual lithiasis tend to result in regrowth and further progression, although ESWL itself does not increase the recurrence rate of urolithiasis. Nevertheless follow-up of stone patients after ESWL is mandatory and the ultimate goal of treating stones by whatever means is to get the patient stone-free and prevent recurrence.     

The effect of intracalyceal distribution on the clearance of renal stones of > or = 20 mm in children after extracorporeal lithotripsy

OBJECTIVES: To determine the effect of the intracalyceal distribution of renal stones on clearance rates after treating paediatric nephrolithiasis with extracorporeal shock wave lithotripsy (ESWL). PATIENTS AND METHODS: We assessed a retrospective case series of children (aged < or = 14 years) undergoing lithotripsy on an MPL 9000 (Dornier GmbH, Germany) echo-guided lithotripter. Patients were identified using an international coding and indexing system and ESWL registry. In all, 125 children were treated during 1990-2003, but 21 had stones of > or = 20 mm. Stone clearance was assessed at 1 and 3 months, the stone-free state being defined as no radiological evidence of stone or fragments of < or = 3 mm. Failed treatments were analysed to identify any correlation with stone site. RESULTS: The overall stone-free rate was 81%; in four children the treatment failed (all girls) and subsequently they required ancillary procedures. Nineteen patients (90%) received up to three sessions of ESWL; two required four or more sessions. Of the four children in whom treatment failed, two had JJ stents; the stones were in the lower pole calyx in two, and the renal pelvis and lower pole calyx in two. The mean stone size in those where treatment failed was 25 mm, vs 21 mm in the stone-free group. The complication rate was 19%, but only one child required admission to hospital. CONCLUSIONS: ESWL is very effective for renal stones in children, with minimal morbidity. Lower pole and partial staghorn stones with a major component in the lower pole calyx should preferably be treated by a percutaneous approach.     

Prognostic factors for extracorporeal shock-wave lithotripsy of ureteric stones--a multivariate analysis study

OBJECTIVE: To define factors that have a significant impact on the stone-free rate after extracorporeal shock-wave lithotripsy (ESWL) of ureteric stones using multivariate analysis. MATERIAL AND METHODS: Between February 1992 and February 2002, a total of 938 patients with ureteric stones were treated with in situ ESWL using the Dornier MFL 5000 lithotripter. The outcome of treatment was evaluated after 3 months and failure was defined as the presence of any residual stones. The stone-free rate was correlated with patient characteristics (age, sex and radiological renal picture) and stone features (site, side, length, width, nature, opacity and the presence of ureteral stents). Factors with a significant impact on the stone-free rate using the chi (2) test were further analyzed using multivariate analysis. RESULTS: Overall, the stone-free rate was 88.7%. Repeat treatment was required in 50.4% of cases. Post-ESWL complications were observed in 32 cases (3.4%), including static steinstrasse in 19 (2%). Auxiliary procedures were needed in 28 cases (3%). Using the chi (2) test, only three factors had a significant impact on the stone-free rate, namely stone site, the transverse diameter of the stone and the presence of a ureteral stent. The stone-free rate was highest for stones located in the lumbar ureter (436/470; 92.8%) and lowest for those located in the pelvic ureter (268/324; 82.7%) (p = 0.0017). Stones with a transverse diameter of < or =1 cm were associated with a stone-free rate of 89.7% (715/797), compared to 83% (114/141) for those with a transverse diameter of >1 cm (p = 0.017). Non-stented patients had a stone-free rate of 89.8% (732/815), compared to 81.3% (100/123) for stented patients (p = 0.006). On multivariate analysis, these three factors maintained their statistical significance. A logistic regression model was designed to estimate the probability of stone-free status after ESWL. CONCLUSION: 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.     

Extracorporeal shockwave lithotripsy, endourology and open surgery: the management and follow-up of 200 patients with urinary calculi

The management and follow up of 200 consecutive patients with renal and ureteric calculi are presented. The primary treatment of 185 (92.5%) was by extracorporeal shockwave lithotripsy (ESWL), of whom three (1.6)%) with large calculi underwent percutaneous nephrolithotripsy (PCNL) prior to ESWL as a planned combined procedure. Twelve (6%) were treated by PCNL or ureterorenoscopy (URS) as their definitive treatment and three (1.5%) by conventional open renal and ureteric surgery. The average in-patient stay was 3.8 days and most returned to normal activity within one day of discharge. Of the 185 patients 102 (55%) required no analgesia after treatment by ESWL, 29 (15.6%) required parenteral analgesia and the rest were comfortable with oral non-narcotic medication. Thirty (16%) required auxillary treatment by percutaneous nephrostomy (PCN), PCNL and URS following ESWL for obstructive complications from stone particles. Two required further ESWL and one PCNL at three months for large fragments. Overall, open surgery was required for only 1% of renal calculi and 13% of ureteric stones. These results are consistant with the extensive West German experience confirming that most urinary calculi are now best managed by ESWL and endoscopic techniques. Where these facilities are available open surgery should only be necessary for less than 5% of upper urinary tract stones.     

经后中组肾盏径路行微创经皮肾取石治疗复杂性肾结石

目的：评价经后中组肾盏径路行微创经皮肾取石(MPCNL)术处理复杂性肾结石的疗效。方法：从2002年6月-2004年7月采用经后中组肾盏径路行MPCNL处理复杂性肾结石患者152例。结果：术后结石清除率为86．18％(131／152例,包括一期多次取石)。一期结石完全清除率达65．28％。仅15例(9．87％)接受辅助的ESWL治疗,6例(3．95％)需要重建另一通道再行MPCNL治疗。结论：经后中组肾盏径路行MPCNL治疗复杂性肾结石安全高效,有很高的结石清除率;残留结石可联合ESWL来提高疗效。