Use of Intravenous Contrast Material During in Situ Extracorporeal Shock Wave Lithotripsy of Ureteral Calculi

Abstract

We prospectively studied the usefulness of contrast material to facilitate extracorporeal shock wave lithotripsy (ESWL) of ureteral calculi in situ. Followup was available for 67 consecutive patients with ureteral calculi treated in situ (without ureteral catheterization) on an unmodified Dornier HM-3 lithotriptor. In 30 patients radiographic contrast material was administered to facilitate targeting of calculi. Intraoperative obstruction was determined by the lack of passage of contrast material beyond the calculus during treatment. Immediate postoperative obstruction was defined as prolonged retention of contrast material on a postoperative radiograph. Passage of contrast material beyond the calculus was not noted in 9 of 26 evaluable patients, 5 of whom appeared to have obstruction on postoperative radiography. Of these 5 patients 3 required immediate hospitalization for pain control, compared to none of those without intraoperative obstruction. The stone-free rates after ESWL, including success following adjunctive measures or repeat ESWL, were 83, 100 and 87% for calculi in the proximal, middle and distal ureter, respectively. Neither use of contrast material, nor intraoperative or postoperative obstruction altered the eventual success of ESWL. The administration of intravenous contrast material during ESWL allows for effective treatment of ureteral calculi that otherwise could not be imaged adequately without ureteral catheterization, and provides information valuable for short-term prognosis.