Piezoelectric Extracorporeal Shock Wave Lithotripsy Research Articles

Langzeiterfahrungen mit der extrakorporalen piezoelektrischen Stoßwellenbehandlung von Steinen der Glandula parotis

To evaluate prospectively the recently developed method of extracorporeal shock-wave treatment of stones of the parotid gland. 76 patients with symptomatic, sonographically proven, solitary stones of the parotid gland (36 females, 40 males; aged 2-80 years) were treated with extracorporeal piezoelectric shock-wave lithotripsy (ESWL) after failed conservative management (sialagogues, gland massage, duct bougie dilation). Parotid stones were no longer demonstrable after a mean follow-up time of 48 (6-71) months in 38 of the 76 patients; they were symptom-free and no new stones had formed. A residual, but symptom-free, stone was found in another 20 patients (26%) of whom 13 (17%) reported marked improvement after ESWL. No change from pretreatment symptoms occurred in five patients (7%) so that operative removal had to be performed. The success rate of the lithotripsy was independent of size and site of the stone. ESWL is the method of first choice in the treatment of parotid gland stones after unsuccessful conservative treatment and obviates operative gland removal in most cases.

Extracorporeal piezoelectric lithotripsy of intra- and extrahepatic bile duct stones

64 patients (27 men, 37 women; mean age 71 [27-90] years) with intra- or extrahepatic biliary stones, which could not be extracted endoscopically, underwent extracorporeal piezoelectric shock-wave lithotripsy (ESWL). The piezoelectric lithotripter which was used localizes the stones sonographically and the shock-waves are produced by a self-focusing sound generator consisting of 3,000 ceramic elements. The sonographic localization of the stones was successful in 57 patients (89%) and complete removal of stones was achieved in 49 (77%), after an average of 7,595 (1,000-30,800) shock-waves per patient. Spontaneous elimination of stone fragments occurred in 7 patients, while in 42 further endoscopic procedures (balloon catheter, Dormia basket, mechanical lithotripsy) were needed to remove stone fragments from the biliary tract. The only severe complication was cholangitis in two cases. It probably resulted from the associated lysis treatment. There was no case of pancreatitis and no death at 30 days. These data indicate that piezoelectric ESWL with sonographic stone localization is an effective method with few side effects for treating problematic biliary tract stones.

Piezoelectric extracorporeal shockwave lithotripsy for bile duct stone formation after choledochal cyst excision

We report a case of bile duct stones in which piezoelectric extracorporeal shockwave lithotripsy (ESWL) was highly effective for the clearance of stones. A 16-year-old girl, who had undergone excision of a choledochal cyst when she was 3 years old, presented a spiking fever and colic abdominal pain. Radiological investigations showed two large stones incarcerating to the proximal end of hepatico-jejunostomy anastomosis. Massive debris was also present in intrahepatic bile duct proximal to the anastomosis. She underwent piezoelectric ESWL with an EDAP LT02 lithotripter. An average of 40 min ESWL session was repeated at intervals of 2 or 3 days. Neither anesthetic nor sedative treatment was required. By the end of the sixth session, the stones incarcerated were fragmented and the debris in the intrahepatic bile duct was completely eliminated. We conclude that piezoelectric ESWL is a less invasive, effective and repeatable method, therefore, it could be a treatment of choice for bile duct stone formation after choledochal cyst excision.

Rapid Extracorporeal Shock Wave Lithotripsy for Proximal Ureteral Calculi in Colic versus Noncolic Patients

ObjectivesIn delayed extracorporeal shock wave lithotripsy (ESWL) treatment, increasing stone impaction is associated with delayed stone clearance. Whether colic patients treated by rapid ESWL have the same time to stone clearance as noncolic patients, which supports the thesis that stones in both groups are nonimpacted, has not been investigated yet, and was the objective of this study. MethodsA total of 82 patients were prospectively enrolled and treated with piezoelectric ESWL for a solitary proximal ureteral stone. Of these, 56 patients experienced at least one colic episode compared with 26 noncolic patients. Hydronephrosis has been assessed with the use of ultrasound and intravenous urography (IVU). Time to stone clearance after the first ESWL and stone-free rates after a follow-up period of 3 mo were recorded. ResultsIn colic and noncolic patients, mean stone size was 7.8mm (p=0.7). Ultrasound-detected hydronephrosis was present in 88% versus 39% (p<0.0001), whereas IVU-detected hydronephrosis was present in 60% versus 7.7% (p=0.0001). Mean number of impulses applied was 8000±4000 versus 6700±3400 (p=0.1). Mean time to stone clearance was 9.5±12.1 d versus 4.6±3.8 d (p=0.1). Colic and noncolic patients were considered as treatment success in 83% and 81% after 3 mo of follow-up (p=0.9). ConclusionsTreatment outcome and time to stone clearance after rapid ESWL in colic patients compared with noncolic patients is comparable and independent of concomitant hydronephrosis. This finding suggests an absence of significant impaction in proximal ureteral stones treated within 24h after a first colic episode, enforcing the concept of performing rapid ESWL in patients harbouring proximal ureteral stones.

Ten years experience with piezoelectric extracorporeal shockwave lithotripsy of gallbladder stones

A critical review of the experience with extracorporeal shockwave lithotripsy (ESWL) of gallbladder stones is needed to clarify whether this method should continue to be applied to patients. Patients with symptomatic gallbladder stones were treated by piezoelectric ESWL according to a prospective protocol between 1988 and 1997. ESWL treatment was limited to a maximum of three (solitary stones <20 mm diameter) to five sessions (larger solitary or multiple stones) and 3000 pulses per session. Univariate and multivariate analyses of pretreatment and treatment variables were performed to investigate their impact on fragmentation efficacy and stone clearance. A tree-based analysis was used to identify prognostically homogenous subgroups of individuals with maximum benefit from ESWL. Four hundred and eight patients, 76% female and 24% male, with a mean age of 46 (SD, 13) years, were selected for evaluation. Cox regression analysis identified three pretreatment variables with significant prognostic impact: (1) number of gallstones >1 (relative risk, 2.6 (95% CI, 1.9-3.5)), (2) size of stones >17 mm (1.7 (1.4-2.2)), and (3) computed tomography (CT) density of stones >55 Hounsfield units (H) (1.4 (1.1-1.8)). According to tree-based analysis, the stone clearance rate after 1 year was 85% (95% CI, 75-91%) for solitary stones <16 mm, 79% (70-86%) for solitary stones > or =16 mm with a CT density <84 H, 45% (32-55%) for solitary stones > or =16 mm with a CT density > or =84 H, and 42% (30-51%) for multiple stones. Five years after stone clearance, recurrence occurred in 43% of patients (95% CI, 39-47%). ESWL treatment showed an acceptable stone clearance in the case of small solitary gallbladder stones (<16 mm) or larger solitary stones with a CT density <84 H, but a very low success rate in the case of multiple stones. The poor long-term success, however, is an important argument against the use of ESWL of gallbladder stones.

Pancreatic duct stones in chronic pancreatitis: Criteria for treatment intensity and success

Background: The aim of the study was to evaluate interventional endoscopic management of pancreatic duct stones in patients with chronic pancreatitis by describing therapeutic methods and defining factors that predict technical success. Methods: Records were retrospectively analyzed for 125 patients with symptoms caused by chronic pancreatitis with pancreatic duct stones (single 43, multiple 82) treated by interventional endoscopy, including extracorporeal shockwave lithotripsy. Results: Technical success was achieved in 85% of patients (11 patients by mechanical lithotripsy, 114 by piezoelectric extracorporeal shockwave lithotripsy). There were no serious complications from lithotripsy. Univariate analysis disclosed a statistically significant association between treatment success and patient age as well as prepapillary location of stones. A greater therapeutic effort was necessary in patients with stones located in the tail of the pancreas, 2 or more stones, a stone 12 mm or more in diameter, or who have had a longer duration (>8 years) of the disease. However, with exception of the last parameter, correction for multiple testing of data removed statistical significance. Conclusions: Extracorporeal shockwave lithotripsy enhances endoscopic measures for treatment of pancreatic duct stones when mechanical lithotripsy fails. Middle-aged patients in the early stages of chronic pancreatitis with stones in a prepapillary location proved to be the best candidates for successful treatment. Unfavorable patient-related or morphologic factors can be compensated for through more intense efforts at therapy. (Gastrointest Endosc 2002;56:501-6.)

Extracorporeal Shock Wave Lithotripsy in Children

Extracorporeal Shock Wave Lithotripsy in Children

Ultrasound-guided piezoelectric extracorporeal shock wave lithotripsy of parotid gland calculi.

The introduction of piezoelectric extracorporeal shock wave lithotripsy (ESWL) has changed therapy for salivary calculi. This method seems especially suitable for treating calculi in the parotid gland. The purpose of this study was to evaluate ESWL in patients with such calculi. From November 1990 to November 1999, all patients with sialolithiasis of the parotid gland were treated with piezoelectric ESWL. Three different lithotriptors were used over the 9-year study period. Results were analyzed according to both the patients' clinical status and follow-up sonograms. In total, 42 patients (21 women, 21 men; mean age, 59 years) were treated with ESWL. The mean follow-up period for all patients was 63 months (range, 7-96 months). After ESWL had been performed, 71% of the patients were completely free of symptoms, and 21% had marked improvement of their symptoms. Sixty-seven percent were completely free of calculi, and 27% had a marked reduction in the size of their calculi. Adverse effects of ESWL included temporary glandular swelling (4 patients), blood-tinged salivary secretions (9 patients), petechiae on the skin surface (3 patients), and parotid abscess (1 patient). ESWL is an outpatient procedure that can be performed without anesthesia and with scarcely any discomfort for patients. Conventional surgical procedures such as subtotal parotidectomy may be almost entirely replaced by ESWL because of the excellent treatment results and a very low rate of complications associated with ESWL. ESWL should be considered the treatment of choice for parotid calculi.

Piezoelectric extracorporeal shockwave lithotripsy of distal ureteric calculi: assessment of shockwave focusing with unenhanced spiral computed tomography.

To assess the effects of the interposition of pelvic bones and abdominal gas in the shockwave pathway during piezoelectric extracorporeal shock wave lithotripsy (ESWL) of distal ureteric stones. The study included 35 patients who were evaluated with unenhanced spiral computed tomography (CT), used according to their positioning during ESWL. The shockwave pathway was simulated on the sagittal and coronal views crossing the ureteric calculi, allowing a theoretical evaluation of the effective shockwave focusing (with no bone or gas interference). Vertical and oblique approaches were statistically compared for bone and gas interposition. Overall, the effective shockwave focusing during in situ piezoelectric ESWL of distal ureteric stones was 71% of the theoretical area. The interposition of bone and gas was significantly lower for an oblique access than for a vertical approach in the sagittal plane (P < 0.001 and 0.03 on the sagittal and coronal views, respectively). Using stepwise logistic regression, the difference between vertical and oblique accesses in the sagittal plane was mainly affected by the bladder volume (P < 0.001). On the coronal views, the interposition of bone and gas affected 31 patients (89%). Such interference was eliminated in 73% of the patients with a contralateral inclination of the shockwave axis in the coronal plane. The interposition of pelvic bones and abdominal gas in the shockwave pathway can affect the performance of piezoelectric ESWL of distal ureteric stones. While awaiting clinical confirmation of these theoretical data, we recommend that patients are treated with the bladder full and that the shockwave generator is inclined in both the coronal and sagittal planes.

4691 Shock wave lithotripsy with a piezo-electric lithotriptor in the management of chronic pancreatitis.

Aim: pancreatic stones are frequently reported to be a factor of failure of endoscopic treatment of chronic pancreatitis. Our series tried to evaluate the efficacy of extracorporeal piezoelectric shock wave lithotripsy (ESWL) to disintegrate pancreatic stones in the main pancreatic duct. Methods- Patients: 51 patients (40 men, 11 women) with a mean age of 51 years, presenting with chronic pancreatitis, have been treated between May 1995 to January 1990. The mean number of sessions of lithotripsy was 4.96 per patient with the piezoelectric lithotriptor EDAP LT02. The mean cumul (power (%) x time (sec) x frequency (shock/sec.) /160) per patient was 70,5 +/- 40,5. The total or uncomplete success was defined by the feasibility ofpancreatic stenting. Results: The fragmentation of stones in the main pancreaticduct was achieved in 83,3 % of cases. The total success was achievedin 25 patients (49%), an uncomplete succcess in 11 patients (21%) and atotal failure in 15 patients (29%). Pancreatic stenting failed in 3/33patients after the ESWL and 10/33 patients before the ESWL. Pain disappearedin 72% of the cases after ESWL. There was a significant relationbetween the fragmentation of stones and the disappearance of pain. A significantrelationship was shown between the cumul value and the fragmentationrate. Conclusion: ESWL with the piezoelectric lithotriptor provides satisfactory results on the disappearance of the pain and on the fragmentation. ESWL seems helpful in the endoscopic treatment of chronic pancreatitis.

SHOCK WAVE LITHOTRIPSY DURING PREGNANCY: A SUCCESSFUL CLINICAL EXPERIMENT

During the last 15 years extracorporeal shock wave lithotripsy (ESWL*) has been used in the treatment of urolithiasis with pregnancy considered a strict contraindication.' There is lack of knowledge concerning the possible effects of shock wave therapy on the development of a human embryo or fetus. We report a case of successful experimental piezoelectric shock wave lithotripsy of an obstructing ureteral stone in an advanced pregnancy. CASE REPORT A 28-year-old multigravid woman presented with severe left flank pain during week 25 of gestation. Ultrasound demonstrated dilatation of the left renal collecting system, including the proximal ureter, due to a 16 x 5 mm. ureteral calculus obstructing the upper ureter (part A of figure). Since pushing or passing the stone by ureteral stents was not successful and recurrent attacks of colic were not relieved by parenteral narcotics, percutaneous nephrostomy was recommended. However, when the patient was confronted with the risks of bleeding, infection, tube displacement and occlusion, and the prospect of urinary diversion with an external appliance for the remainder of the pregnancy, she specifically requested shock wave treatment modalities. After consideration of what is known about the physical properties and biological effects of shock wave application, we ascertained that there was sufficient distance (11 cm.) between the stone./ focus and the uterus, and extracorporeal piezoelectric shock wave lithotripsy was performed. The patient was fully informed about the experimental nature of the treatment modality and gave written, informed consent. Lithotripsy was performed with an ultrasound guided Piezolith 2300,t which provides a small focal zone of 6 mm. in radial and 10 mm. in axial diameter (part B of figure). We delivered 1,600 impulses (focal energy 750 bar) with simultaneous monitoring of the fetus by a second ultrasound scanner and intermittent cardiotocography. No drugs were administered. Alterations of cardiotocography were not seen and no unusual fetal movements were registered. The stone was disintegrated and fragments were discharged spontaneously without further colic. To avoid a steinstrasse, we inserted without difficulty a Double-JS ureteral stent for 3 weeks. X-ray diffraction analysis of the fragments revealed a mixture of two-thirds apatite and one-third struvite. Despite the latter component, no urinary tract infection occurred during gestation. The patient recovered promptly after lithotripsy, and the remainder of the pregnancy and childbirth were free of complications. The female newborn was mature, normally developed, and showed normal size and Apgar score. There have been no adverse sequelae from the intrauterine ESWL at 6-year followup.

Piezoelectric Extracorporeal Shock-Wave Lithotripsy of Lower Pole Nephrolithiasis

To evaluate the efficacy of the EDAP LT 02 lithotriptor for the treatment of lower pole nephrolithiasis. From January 1994 to September 1995, 91 patients presenting with solitary radiopaque calculi of the lower pole calix were treated by piezoelectric extracorporeal shock-wave lithotripsy (ESWL) with the EDAP LT 02. Among them, 82 were available for follow-up. The stones' largest diameter of these patients varied from 5 to 15 mm (mean = 8.1). Indications for ESWL were pain in 63 (77%), hematuria in 5 (6%), associated infection in 6 (7.5%) and stone size in 8 (10%) asymptomatic patients. Stone localization was assessed as very easy in 74 cases (90%) and difficult in 8 cases (10%) but no intraoperative IVP was needed. ESWL sessions were performed with intravenous sedo-analgesia in 69 cases (80%) and general anesthesia in 17 cases (20%). After ESWL we advised patients to combine a diuresis with postural drainage. Most patients were treated with one session of ESWL: none required more that two (mean = 1.05). The mean hospital stay for one session was 1.2 +/- 0.7 days. Obstructive complication rate was 11% and auxiliary treatments were necessary in 6%. The stone-free rate of in situ piezoelectric ESWL monotherapy was overall 84%, and 95% of patients with pain were cured. In the absence of abnormality of the upper urinary tract, the vast majority of small lower pole caliceal stones can be completely removed by piezoelectric ESWL without recourse to more invasive methods.

Childhood urolithiasis: urological management of upper tract calculi in the era of extracorporeal shock-wave lithotripsy.

To evaluate the management of urolithiasis in children since the development of extracorporeal shock-wave lithotripsy (ESWL). Between 1988 and 1994, 37 children, aged from 2 to 15 years (mean 10), with upper tract urolithiasis were evaluated and treated. Lithogenic metabolic disorders or anomalies of the urinary tract were present in 11 children (30%) Urolithiasis was multiple in 9 cases and bilateral in 2 cases. A total of 47 renal (30) or ureteral (17) stones were managed, of which 5 were partial or complete staghorn calculi. Initial treatment was surgery in 4 cases (1 nephrectomy, partial nephrectomy and 2 pyelolithotomies) and piezoelectric ESWL in 43 cases. The overall ESWL success rate was 82.2%, with auxillary endoscopic procedures in 3 cases. ESWL failures required surgical stone removal in 5 cases, endoscopic ureterolithotripsy in 1 case and electrohydraulic ESWL in 1 case. Residual fragments after pyelolithotomies were also treated by ESWL. ESWL is the mainstay of treatment of childhood upper tract urolithiasis, but other therapeutic methods retain specific indications. Its application requires great vigilance and its long-term effects are uncertain. It is therefore important to rule out any underlying pathology and where possible to prevent further stone formation.

In situ piezoelectric extracorporeal shock wave lithotripsy of ureteric stones.

To evaluate the efficacy of the EDAP LT 02 lithotripter for the in situ treatment of ureteric calculi. One hundred consecutive patients presenting with ureteric calculi were treated with in situ piezoelectric extracorporeal shock wave lithotripsy (ESWL) using the EDAP LT 02 lithotripter. There were 49 patients with upper, nine with mid and 42 with lower ureteric stones. The largest diameter of the stones varied from 7 to 21 mm (mean 9.6 mm). Mild or severe hydronephrosis was present in 53 cases. Mid and lower ureteric stones were treated with the patients in the prone position, with no anaesthesia or pre-medication, and upper ureteric stones in the supine position, with intravenous sedation in 44 cases. Localization of the stones was easy in 81 cases and more difficult in 19, but an intravenous pyelogram was only necessary in three cases. The number of sessions per patient varied from 1 to 3 (mean 1.17). Complete success rate was achieved in 75% of patients and partial success (residual stones < or = 3 mm) in 6%. The stone-free rate was statistically affected by stone size but was independent of stone localization or the degree of obstruction. The rate of infective and obstructive complications was 14% and auxiliary treatments were necessary in 5% of patients. In situ piezoelectric ESWL with the EDAP LT 02 device is a convenient and efficient method for the treatment of ureteric stones.

Cardiac Dysrhythmias Related to Extracorporeal Shock Wave Lithotripsy Using a Piezoelectric Lithotriptor in Patients with Kidney Stones

Shock waves delivered by a spark-gap generator during extracorporeal shock wave lithotripsy (ESWL) for kidney stones frequently cause cardiac arrhythmias. However, detailed data about the arrythmogenicity of this therapy using a piezoelectric lithotriptor are not available even though this type of machine is generally not considered to induce cardiac arrhythmias. The prevalence and nature of cardiac dysrhythmias during piezoelectric ESWL were assessed in 34 patients with kidney stones in whom cardiac disease other than dysrhythmias had been excluded. Each patient underwent 24-hour ambulatory electrocardiography (ECG) recording 2 to 3 days before ESWL. On the day of ESWL, ECG was performed continuously from 4 hours before and throughout the procedure. The relationship between ESWL-related dysrhythmias and autonomic neural activity was also evaluated by heart rate spectral analysis. Piezoelectric ESWL was found to elicit new or worsened tachyarrhythmia originating from the atria or ventricles or both in 20 patients (59%), atrial premature contractions in 4, ventricular premature contractions in 7, both types in 7, atrial and ventricular premature contractions plus extreme sinus bradycardia in 1, and neurally mediated sinus bradycardia and hypotension in 1. However, piezoelectric ESWL-related dysrhythmias were not related to the dysrhythmias seen in the usual life. Heart rate spectral analysis suggested that changes in autonomic neural activity were involved in the mechanism(s) of ESWL-related dysrhythmia. Although lethal dysrhythmias have not yet been encountered at our institution, patients at risk of sustained life-threatening cardiac dysrhythmias should be monitored closely even if ESWL for kidney stones is undertaken using a piezoelectric lithotriptor.

Extracorporeal piezoelectric shock wave lithotripsy as mono and multiple therapy of large renal calculi including staghorn stones in unanaesthetized patients under semi-ambulant conditions.

To examine the effectiveness and complication rate of extracorporeal piezoelectric shock wave lithotripsy (EPL) as monotherapy for the treatment of large renal calculi. Treatment consisted of semiambulant EPL as monotherapy combined with protective ureteric stenting in 84 patients. Three groups were established according to stone volume (borderline-stone, partial and complete staghorn). An average of 18,230 shock waves was applied in 3.76 sessions to each patient. No major complications were observed but there were minor complications in 33% of patients. Invasive auxiliary methods were necessary in only 12%. After a mean follow-up of 9 months (n = 72), 54% of patients were stone-free and in 22% the fragments passed spontaneously. Thus the success rate was 76%. Analysis of the three groups showed no difference in stone status during follow-up. There was no relation between the outcome of treatment and stone volume. Analysis of the patients who failed to respond to treatment showed that they were treated for longer than the stone-free group, with significantly fewer sessions per week (0.71 vs 1.28 sessions/week). It appears that higher rates of stone removal can be achieved with more frequent treatment sessions at shorter intervals. We consider semi-ambulant EPL monotherapy to be a minimally invasive alternative treatment in patients with large renal calculi, including staghorn stones.

The management of upper urinary tract calculi by piezoelectric extracorporeal shock wave lithotripsy in spinal cord injury patients

From May 1988 to September 1994, 15 spinal cord injury patients were treated by piezoelectric extracorporeal shock wave lithotripsy. Aged from 23 to 71 years (mean = 39), they presented with a total of 23 stones, of which 18 were located in the calyces, three in the renal pelvis and two in the proximal ureter. The maximum dimensions of calculi varied from 5 to 35 mm (mean = 11). Patients were placed in a dorsal decubitus position during the sessions, three being sedated with diazepam, while the other 12 remained unsedated. All were treated routinely with systemic antibiotics. Auxiliary procedures consisted of two pyelocalyceal flushings, three double J ureteral stenting and three ureteroscopies with fragment removal with a Dormia basket. No episode of autonomic dysreflexia was observed. Short term side effects were limited to a few cases of gross haematuria which regressed spontaneously. Overall, eight successes (53%), and seven failures (47%), were registered. Of the failures, one was the result of a partial fragmentation, while six were related to intrarenal retention of residual fragments resulting in four cases in rapid recurrences. Extracorporeal shock wave lithotripsy can be easily applied to spinal cord injury patients. Its usefulness and limitations need to be well understood and a global consideration must be applied to the prevention and early detection of the upper urinary calculi in this exposed population of patients.

Effect of Controlled Sound Pressure Field on Fragmentation in Piezoelectric Extracorporeal Shock Wave Lithotripsy

A method for changing a sound pressure field by electronic driving control of individual piezoceramic elements is studied so that extracorporeal shock wave lithotripsy may become a more effective and safer therapeutic method. First, we examine this method with respect to the field of a shock wave. At 1 kV driving voltage, the focal zone can be changed from 2.2 mm×7.1 mm to 2.8 mm×34.0 mm, and the peak pressure can be decreased to 64% of the original value. The change of fragmentation ability in this method is shown by measuring the number of shots required to break a model stone. The fragmentation is the most intense at a point 10 mm in front of the focal point, and the fragmentation ability remains as effective even if peak pressure is decreased. This method can decrease the peak pressure while maintaining the fragmentation effect.

Treatment of 150 ureteric calculi with the Lithoclast.

From May 1992 to October 1993, 150 ureteral stones, impervious to piezoelectric extracorporeal shock wave lithotripsy (ESWL) with ultrasound localization (EDAP LT.01), were treated with the Lithoclast. The maximum dimensions varied from 5 to 25 mm with a mean of 11 mm. 46 calculi were situated in the pelvic ureter, 82 in the abdominal ureter, and 22 were stuck in the ureteropelvic junction. There was no complete failure of fragmentation, but 39 abdominal calculi (48%) required additional treatment by ESWL due to migration of the fragments into the calyces. Apart from a few needle-sized perforations, ureteral tissue was not damaged by the Lithoclast. The use of this endoscopic lithotripter, which is highly efficient and painless, is, however, limited by the significant effect of retrograde propulsion of very mobile stones or fragments in the urinary tract.

Inpatient piezoelectric extracorporeal shock-wave lithotripsy cost more than open cholecystectomy for symptomatic patients

Source Citation Nicholl JP, Brazier JE, Milner PC, et al. Randomised controlled trial of cost-effectiveness of lithotripsy and open cholecystectomy as treatments for gallbladder stones. Lancet. 1992 Oct 3;340:801-7.