The Development And Status Of Extracorporeal Shock Wave Lithotripsy

Abstract

Urinary calculi shall afflict people for decades. People invented many devices for treatment of calculi. Extracorporeal shock wave lithotripsy because of its relative safety, less trauma, low cost, good treatment effect, has soon become a preferred method in the treatment of urinary calculi. With the development of ESWL, variety and quality of lithotripter are improved. But some problems still exit. History of Lithotripsy Urinary calculi are one of the most common urological diseases. Not only that, it is a very old disease, and shall afflict people for decades. As a result, many thousands of years ago people had been willing to risk their lives for treatment to relieve the pain. In the absence of anesthesia, through perineum incision surgery is not only a terrible process for patients, also can leave sequela and associated with high mortality [1] . Patients required recovery time for three months or more, many of whom have erectile dysfunction, incontinence and other sequelae, and some patients even died of sepsis. Through a cannula dilating the urethra, Egyptians had smaller calculi taken out successful. Some forms of lithotripsy using a catheter can be traced back to the 9th century during Byzantine period [2] . In the 18th century, with the development of chemical technology, people have tried to dissolve calculi by chemical means, but all failed. People began to consider again with a more direct treatment of urinary calculi. The 18th century, Haller suggested that if a stone was too big to extract, it could be drilled. The lithotrites was based on Haller’s view as the first basic principle. In 1824, Percy reported to the Academy of Sciences in Paris about a monk of Citreaux who crushed his bladder calculi by himself. The monks moved a metal catheter into the bladder, and then steel rod with an end cut into chisel through the catheter was moved into his bladder. A hammer hit the other end of the steel rod and calculi were cut into small pieces. The calculi finally were excreted in the urine. The monks took about a year to discharge all gravel. He is the first person who have destroyed calculi mechanically [3,4] . In the early 19th century, Gruithusisen designed a lithotripter. The calculi were located at the end of the hollow straight tube, and put a drill bit into the tube to destroy stones [5] . Civiale invented a instrument called trilabe. The trilabe was made up of two tubes. The external tube was mounted on the hinged arm to grab calculi and the inner tubes with a drill bit or other grinding tools to destroy the calculi [6-8] . In 1824 Civiale used his improved lithotripter to destroy calculi in a living subject successfully. Although Gruithusisen’s and Civiale’s instruments promoted the development of lithotripsy, and for the patients lithotripsy have higher security than 5th International Conference on Education, Management, Information and Medicine (EMIM 2015) © 2015. The authors Published by Atlantis Press 1171 invasive surgery, surgeons believed invasive surgery is more reliable than blind lithotripsy. So the invasive surgery was still preferred in the early 19th century. In the 1870s, Bigelow of Boston invented a new type of surgery. In the procedure, a rubber ball was used to suck out calculi fragments from another large diameter catheter. The surgery made it possible that all fragments can be removed in one time. In 1877, Max Nitze invented the first cystoscope, and in 1886 an improvement was made to it. It was the first time that the urologist had the vision of the surgery in patients’ bladder [9] . In 1908, Young of Baltimore invented the first lithotriptoscope [10] . The invention and integration of cystoscope and lithotriptoscope promoted the development of modern lithotrites. With the development of technology, many kinds of new type of lithotrites were designed to be invented. Goodfiend designed ultrasonic probe in 1973. As the probe can't bend and is not easy to heat dissipation, it is limited in application [11] . In 1976, Mauermayer and Hartung designed a punch lithotrite, which can keep conditions of the good visibility [12] . The pneumatic lithotrite was successfully developed in lausanne, Switzerland, 1990. The device uses compressed air to activate a solid probe in a manner similar to that of a jackhammer [13] . At present, electrohydraulic and laser shock wave lithotrite is also used in the treatment of calculi. Now the safety and the success rate of lithotrite has been greatly improved.