Efficacy of X-ray localization in ESWL (report of 15 019 cases in 23 years)

Abstract

Objective To summarize the experience of management of upper urinary tract calculi by Extracorporeal Shock Wave Lithotripsy (ESWL) in our department in order to improve the gravel success rate and decrease the incidence of complications.Methods 15 019 patients with upper urinary calculi from October 1988 to September 2011 treated by ESWL with X-ray localization were analyzed retrospectively.The maximum diameter of the stones ranged from 0.8 cm to 3.2 cm,with 1 3 794 cases with maximum stone diameter less than 2 cm (guoup A),and with 1225 cases with maximum stone diameter more than 2 cm (guoup B).All patients had normal or nearly normal renal function,and 56.0％ patients (8 410/15 019)had varying degrees of hydronephrosis.Results The effective rate of first ESWL was 84.5％ ( 12 691/15 019) and the effective rate of second ESWL was 12.0％ (1 802/15 019),and 313 cases need a third ESWL.The clearance rate in group A was 90.2％ ( 12 443/13 794 ),in group B was 50.9％ (623/1225),and the overall stone clearance rate within three months was 87.0％ ( 13 066/15 019).The majority of patients ( about 93％ ) had postoperative gross hematuria,which disappeared after drinking lots of water.46cases (0.3％) of patients had postoperative fever,which returned to normal after usage of antibiotics.There were no serious complications such as kidney hematoma,continuous high fever,continuous hematuria,ureteral stones jams.Conclusions ESWL.with X-ray localization had the advantage of low energy,minor injury,easy localization,uniform stone fragment,because of which it could reduce the complications such as continuity fever,ureter stone james,continuious hematuria.ESWL with X-ray localization could be preferred treatment for upper urinary calculi with diameters between 10 to 20 mm. Key words: X-ray; Extracorporeal shock wave lithotripsy; Upper urinary calculus