External Shock Wave Lithotripsy Research Articles

Five historical innovations that have shaped modern urological surgery.

Throughout history, many innovations have contributed to the development of modern urological surgery, improving patient outcomes and expanding the range of treatment options available to patients. This article explores five key historical innovations that have shaped modern urological surgery: External shockwave lithotripsy, transurethral resection of prostate, cystoscope, perioperative prostate-specific antigen and robotic surgery. The selection of innovations for inclusion in this article was meticulously determined through expert consensus and an extensive literature review. We will review the development, impact and significance of each innovation, highlighting their contributions to the field of urological surgery and their ongoing relevance in contemporary and perioperative practice.

Shockwave Lithotripsy for De-Novo Urolithiasis after Kidney Transplantation: A Systematic Review of the Literature.

Allograft urolithiasis is an uncommon, challenging, and potentially dangerous clinical problem. Treatment of allograft stones includes external shockwave lithotripsy (SWL), flexible ureteroscopy and lasertripsy (fURSL), or percutaneous nephrolithotomy (PCNL). A gap in the literature and guidelines exists regarding the treatment of patients in this setting. The aim of this systematic review was to collect preoperative and treatment characteristics and evaluate the outcomes of post-transplant SWL for stone disease. A systematic search in the literature was performed, including articles up to March 2023. Only original English articles were selected. Eight articles (81 patients) were included in the review. Patients were mainly male, with a mean age of 41.9 years (±7.07). The mean stone size was 13.18 mm (±2.28 mm). Stones were predominantly located in the kidney (n = 18, 62%). The overall stone-free rate and complication rates were 81% (range: 50-100%) and 17.2% (14/81), respectively, with only one major complication reported. A pre-operative drainage was placed in eleven (13.5%) patients. Five patients (6.71%) required a second treatment for residual fragments. SWL is a safe and effective option to treat de novo stones after transplantation. Larger studies are needed to better address allograft urolithiasis management.

Percutaneous nephrolithotomy in a patient with a ureterosigmoidostomy diversion

In patients with bladder cancer, ureterosigmoidostomy has been used as a form of urinary diversion, and urinary lithiasis has been reported as a complication. A patient with a large bilateral kidney stone and ureterosigmoidostomy diversion is described. In 2012, a 61-year-old man had a cystectomy due to bladder cancer. He was lost to follow-up after presenting to the emergency department in 2016 with right flank pain and fever. Computed tomography (CT) scan reveals bilateral staghorn calculus. A bilateral percutaneous nephrostomy was performed. The patient was planned for bilateral percutaneous nephrolithotomy (PCNL). He declined, therefore we proposed External Shock Wave Lithotripsy (ESWL). The right kidney stone was removed, but the left kidney stone did not alter after 7 ESWL sessions, thus PCNL was scheduled. The middle calyx was punctured under fluoroscopic guidance through the nephrostomy in Valdivia’s modified position. Two 0.035” hydrophilic guide wires were passed down the renal pelvis and ureter until it ureterosigmoidostomy union was reached. Dilation was carried out with Nephromax. An Amplatz 30 Ch was placed. The holed stone was then fragmented with Laser Holmium. PCNL tubeless was performed. He was discharged two days after surgery. PCNL tubeless was performed. The hospital stay was two days. CT control two months later: Lower pole 5 cm hematoma, the residual stone of 4 mm in the upper calyx. After resolving the renal hematoma, the residual stone will be dealt with ESWL.

The effect of the phytocomplex Renotineх® on postoperative period after external shock wave lithotripsy in patients with urolithiasis

INTRODUCTION: Phytopreparations are one of the leading medicines used as preoperative preparation and postoperative management in patients with urolithiasis.
 THE AIM of the study was to evaluate the nephroprotective effect of Renotinex in patients with urolithiasis after extracorporeal shock wave lithotripsy (ESWL).
 MATERIALS AND METHODS: The study included 86 patients (43 in the main and the comparison group) with urolithiasis with localization of the stone in the renal pelvis without disturbing the outflow of urine. All patients underwent extracorporeal shock wave lithotripsy (ESWL). After ESWL patients in both groups received spasmodic, anti-inflammatory, antibacterial therapy. Patients of the main group additionally received Renotinex 2 capsules 3 times a day for 14 days before and 14 days after surgery.
 RESULTS: During the observation a more effective discharge of calculus fragments was noted in patients of the main group while taking the phytocomplex Renotinex, as well as less pronounced damage and faster recovery of the renal parenchyma after ESWL according to the level of enzimuria.
 CONCLUSION: The results of the study indicate the feasibility of prescribing the phytocomplex Renotinex for nephroprotective and lithokinetic therapy in patients after ESWL.

Surgical Management of Urolithiasis of the Upper Tract - Current Trend of Endourology in Africa.

Urolithiasis is a global pathology with increasing prevalence rate. The lifetime recurrence of urolithiasis ranges from 10–75% creating a public health crisis in affected regions. The epidemiology of urolithiasis in most parts of Africa and Asia remains poorly documented as incidence and prevalence rates in these settings are extrapolated from hospital admissions. The surgical management of kidney and ureteral stones is based on the stone location, size, the patient’s preference and the institutional capacity. To date, the available modalities in the management of urolithiasis includes external shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), ureterorenoscopy (URS) including flexible and semirigid ureteroscopy. However, regarding the lack of endourological equipment and expertise in most parts of Sub-Saharan Africa (SSA), most urological centers in these regions still consider open surgery for kidney and ureteral stones. This review explores the current trend and surgical management of upper tract urolithiasis in SSA with insight on the available clinical guidelines.

P141 - The use of a virtual reality device (HypnoVR®) during external shock wave lithotripsy for treatment of urinary stones: Initial results from a feasibility study

P141 - The use of a virtual reality device (HypnoVR®) during external shock wave lithotripsy for treatment of urinary stones: Initial results from a feasibility study

Stone Cone® in ureteroscopic ballistic lithotripsy of proximal ureteral stones

Stone Cone® (Microvasive-Boston Scientific Corp, USA) is a device which prevents retrograde calculus migration during endoscopic ureterolithotripsy. We have studied the safety and efficacy of this device in endoscopic ureterolithotripsy with ballistic energy in proximal ureteral stones. MATERIALS AND METHODS. From 01/02/2006 to 01/02/2008 we carried out 36 ureterorenoscopies (URS) for proximal ureteral stones (average age: 46, range: 15-73). A ballistic energy was used for stones fragmentation. In 18 patients (Group A) we carried out URS with the aid of Stone Cone®, which was not used in the other 18 patients (Group B). Semirigid 8 Ch or 10 Ch Storz ureteroscope and ballistic lithotriptor Swiss Lithoclast Master EMS® were used. In cases of migration, edema, and ureteral damage, a ureteral stent was used. RESULTS. In Group B patients (URS performed without Stone Cone®) the migration of the whole stone, or of clinically significant fragments, occurred 8 times (45%). All of these patients underwent external shockwave lithotripsy (ESWL) at a center equipped with a lithotriptor. A ureteral stent was placed in 14 cases (78%). In Group A, the migration of a stone requiring ESWL treatment occurred only once (5%). The ureteral stent was placed 8 times (45%). We had no significant complications during the procedure. CONCLUSIONS. The Stone Cone® is a safe and easy-to-use device. The cost of this device can be balanced by the reduction of postoperative ESWL treatments for lithiasic fragments pushing up into the kidneys (p<0.01), and of ureteral stent applications at the end of the procedure (p<0.05).

In the era of flexible ureteroscopy is there still a place for Shock-wave lithotripsy?: Opinion: NO

Flexible ureteroscopy will replace almost completely ESWL for the treatment of renal stones in few years, even in developing countries. This process is already ongoing and probably is irreversible. Let s try to understand how and why this phenomenon is happening. Since the development of the External Shockwave Lithotripsy (ESWL) in the late 70’s (1), it has been the standard treatment for small renal stones (2). However, recent years have seen a significant shift towards endoscopic therapies (3). This can be attributed to the evolving surgical experience in the use of these techniques, but even more to major improvement in the technical equipment. The question of if the flexible ureteroscopy will substitute ESWL as the choice therapy for renal stones is controversial. First of all, they are not totally comparable, since ESWL is a non-invasive method. If ESWL is not an option no more, we lose a noninvasive method of treatment of renal stones. Otherwise, a non-invasive method doesn’t means that it is not harmful, because its association with late development of diabetes and hypertension is still controversial, while a link between ESWL and phosphate calcium stones is possible (4). However, as flexible ureteroscopy has higher success rates, it can be justified, since the complications rates are low. Regarding the cost, in some services the flexible ureteroscopy is cost effective compared to ESWL (5). If we see this issue from a current point of view only, it sounds almost absurd to state that ESWL will disappear. Almost 60% of renal stones today are treatment by ESWL, at low cost and low complications rates. No one should close an ESWL service that is established and working properly. The urological guidelines support the use of ESWL for renal and ureteral stones (2, 6). However, we are discussing the future of renal stones treatment, what includes search for better treatments, with lower costs, higher success rates and low complications rates, with a high acceptance and satisfaction of the patients. Vol. 41 (1): 203-206, January February, 2015

PTH-099 External Shockwave Lithotripsy (eswl) Of Pancreatic Calculi Improves Pain Related To Chronic Calcific Pancreatitis

IntroductionChronic calcific pancreatitis is associated with the development of pancreatic ductal calculi. The calculi can lead to the blockage of the pancreatic duct which can increase the pressure in the...

Flexible Ureteroscopy and Laser Lithotripsy for Bilateral Multiple Intrarenal Stones: Is This a Valuable Choice?

To demonstrate the safety and efficacy of flexible ureteroscopy (FURS) and holmium laser lithotripsy as a valuable treatment of bilateral multiple intrarenal stones and stratify the efficacy by stone burdens ≤ 20 and >20 mm. Twenty-five patients with bilateral multiple intrarenal stones were treated with FURS and holmium lithotripsy at a single clinic. The operative time, stone-free rates (SFRs) per renal unit, stone compositions, number of procedures, serum creatinine, and complications were evaluated. The SFRs were evaluated with computed tomography and plain X-rays of the kidneys, ureters, and bladder. Renal ultrasound was performed 30 days after double-J stent removal to identify hydronephrosis and absence of stones. We defined a stone-free status as the absence of fragments in the kidney or fragments of <1 mm. The total stone number was 128 with a mean stone burden per patient of 24 ± 5 (range 17-37 mm). The overall SFRs per renal unit after 1, 2, and 3 procedures were 70.0%, 92.0%, and 92.0%, respectively. The overall SFRs per renal unit for patients with a preoperative stone burden ≤ 20 and >20 mm were 100% and 85.7%, respectively. No major intraoperative or postoperative complications occurred. There were only 4 minor postoperative complications (16%). Our study results firmly suggest that FURS with holmium laser lithotripsy represents a favorable alternative to external shock wave lithotripsy or percutaneous nephrolithotomy for select patients with bilateral multiple intrarenal stones, which have a satisfactory efficacy and low morbidity.

Topical EMLA for pain control during extracorporeal shock wave lithotripsy: prospective, comparative, randomized, double-blind study

Patient collaboration in external shock wave lithotripsy (ESWL) is critical for its correct application, making proper analgesic selection indispensable. The aim of this study was to evaluate the efficacy of combined application of EMLA and intravenous (i.v.) pethidine compared with pethidine plus placebo cream in patients undergoing ESWL for ureteral and/or renal lithiasis. Prospective, controlled, randomized, double-blind study was conducted in patients receiving ESWL for renal and/or ureterolithiasis. The patients were randomly assigned to receive i.v. pethidine plus either EMLA cream (group A) or placebo hydrating cream (group B). Evaluated were type, location, and size of lithiasis, patient's sex, age, body mass index, comorbidity, Visual Analogue Scale (VAS) score of pain, and degree of lithiasis fragmentation. EMLA cream provided significantly better pain relief and lithiasis fragmentation and more completed ESWL treatment. Topical application of EMLA cream combined with i.v. pethidine improved VAS scores and lithiasis fragmentation and decreased the rate of withdrawal from ESWL procedure versus i.v. pethidine plus placebo therapy.

Stone Cone® in ureteroscopic ballistic lithotripsy of proximal ureteral stones

Stone Cone® (Microvasive-Boston Scientific Corp, USA) is a device which prevents retrograde calculus migration during endoscopic ureterolithotripsy. We have studied the safety and efficacy of this device in endoscopic ureterolithotripsy with ballistic energy in proximal ureteral stones. Materials and Methods. From 01/02/2006 to 01/02/2008 we carried out 36 ureterorenoscopies (URS) for proximal ureteral stones (average age: 46, range: 15–73). A ballistic energy was used for stones fragmentation. In 18 patients (Group A) we carried out URS with the aid of Stone Cone®, which was not used in the other 18 patients (Group B). Semirigid 8 Ch or 10 Ch Storz ureteroscope and ballistic lithotriptor Swiss Lithoclast Master EMS® were used. In cases of migration, edema, and ureteral damage, a ureteral stent was used. Results. In Group B patients (URS performed without Stone Cone®) the migration of the whole stone, or of clinically significant fragments, occurred 8 times (45%). All of these patients underwent external shockwave lithotripsy (ESWL) at a center equipped with a lithotriptor. A ureteral stent was placed in 14 cases (78%). In Group A, the migration of a stone requiring ESWL treatment occurred only once (5%). The ureteral stent was placed 8 times (45%). We had no significant complications during the procedure. Conclusions. The Stone Cone® is a safe and easy-to-use device. The cost of this device can be balanced by the reduction of postoperative ESWL treatments for lithiasic fragments pushing up into the kidneys (p&lt;0.01), and of ureteral stent applications at the end of the procedure (p&lt;0.05).

Incidencia y tratamiento de la litiasis urinaria en el injerto renal

Urinary calculi is an uncommon complication in kidney transplantation; several stone risk factors are found in transplanted patients, but in most cases there is not a relationship between these risk factors and stone formation. The treatment of these patients is complex due to their both immunosuppressive status and border-line renal function. From 1980 to February 2000, 1198 kidney transplant have been performed in our institution. We describe our series consisting in 22 urinary calculi (15 in the graft, 3 in the urether and 4 in the bladder) in 18 patients, including 7 stones detected in cadaveric donor patients. We performed external shock wave lithotripsy in 7 patients, bench surgery in 4, endoscopic mechanic lithotripsy in 5, open surgery in 1 and observation in 6. Calcium oxalate (mono and dihidrate) was found in 9 of 13 calculi. Metabolic changes were found in 15 of the 18 patients, the most common was hiperuricemia. There were not complications of every treatment applied and 9% of them needed a savage treatment. We found recurrence in 4 cases (22.2%). Now 12 of the patients are stone-free (66.7%) and three have non-significative stones (83.3% without symptoms). Detection of renal calculi in cadaveric renal donors is not a reason to refuse the graft for further transplantation. In both renal calculi up to 2 cm and uretheric calculi surgical treatment is assessed as first option. In caliceal stones smaller than 5 mm observations is the best treatment.

Endoscopic transpapillary catheterization of the gallbladder followed by external shock wave lithotripsy and solvent infusion for the treatment of gallstone disease

Herein we describe the techniques and early results of attempted endoscopic transpapillary catheterization of the gallbladder (ETCG) in combination with external shock wave lithotripsy (ESWL) and solvent infusion in the treatment of 23 consecutive, symptomatic patients with gallstones. Despite anticipated difficulty in advancing wires and catheters through the cystic duct, impeded by tortuosity of its lumen, ETCG was successfully accomplished in 20 of the 23 patients (86.9%). Through an indwelling catheter, obstructed gallbladders were drained in 4 patients and combined treatment with ESWL and infused solvents was carried out in 18 patients. Combined treatment resulted in elimination of gallstones from the gallbladders of 14 of 18 patients (77.7%). Treatment was complicated by mild pancreatitis in only 1 of 20 successfully catheterized patients; there was no mortality.

Use of external shock wave lithotripsy and adjunt urodial for treatment of radiolucent stones

Use of external shock wave lithotripsy and adjunt urodial for treatment of radiolucent stones