Outcome Of Extracorporeal Shock Wave Lithotripsy Research Articles

Extracorporeal shock wave lithotripsy in anomalous kidneys: 11-year experience with two second-generation lithotripters

Objectives To present our experience with extracorporeal shock wave lithotripsy (ESWL) in patients with anomalous kidneys and to determine the factors that may influence the stone-free rate in such patients. Methods From February 1989 to February 2000, 198 patients were treated for urolithiasis in anomalous kidneys using ESWL. The mean patient age (SD) was 40.48 (11.53) years. The kidneys were horseshoe in 49 (24.7%), malrotated in 120 (60.6%), and duplex in 29 (14.7%). All patients were treated on an outpatient basis using two second-generation lithotripters (Dornier MFL 5000 and Toshiba Echolith). Pretreatment auxiliary measures were required in 6 patients (3%). Follow-up data were recorded at 3 months. The statistical analysis was performed using the chi-square and Mann-Whitney U tests, with differences considered statistically significant if P <0.05. Results The mean stone length (SD) was 13.54 (5.49) mm. The stones were single in 148 (74.7%), of new onset in 155 (78.3%), and on the right side in 82 (41.4%). All stones, but 5 (2.5%), were radiopaque. The overall stone-free rate was 72.2%. Neither the type of renal anomaly nor the type of lithotripter had any impact on the stone-free rate ( P >0.05). Stone burden (length and number) had a significant influence on the stone-free rate ( P <0.05). No extraordinary complications were recorded. Steinstrasse developed in 7 patients (3.5%). No deterioration of renal function or configuration was detected. Conclusions ESWL is safe and reliable for treatment of urolithiasis in anomalous kidneys. It should be the primary therapy when the stones are less than 20 mm. The ESWL outcome is comparable for normal and anomalous kidneys when the calculus size is considered.

Extracorporeal shockwave lithotripsy in the management of salivary calculi.

The aim was to investigate the results of extracorporeal shockwave lithotripsy in the management of salivary calculi using a dedicated sialolithotriptor. Some 122 salivary calculi (84 submandibular and 38 parotid) were treated in an experimental study using a sialolithotriptor. Complete success was achieved in 40 procedures (33 per cent), 27 of 84 submandibular and 13 of 38 parotid calculi. A further 43 patients (35 per cent) were rendered asymptomatic although some stone debris remained in the duct (26 submandibular and 17 parotid). Failure (retention of stone debris and continued symptoms) occurred in 39 patients (32 per cent), 30 submandibular and eight parotid glands. The chance of failure increased with the size of the calculus and increasing duration of symptoms. Extracorporeal shockwave lithotripsy provides a useful option for the management of salivary calculi, particularly for stones less than 7 mm in diameter.

In Situ Extracorporeal Shock-Wave Lithotripsy as a Primary Treatment for Ureteral Stones

The aim of the study was to evaluate the results of extracorporeal shock-wave lithotripsy (ESWL) as a primary treatment for ureteral calculi at different levels. We treated 166 consecutive patients with solitary ureteral stones (73 at the upper, 4 at the middle, and 89 at the lower ureter) by primary in situ ESWL on an outpatient basis. A maximum of three treatments were give individually before adopting ureteroscopy as an alternative treatment. The success rate was calculated on the basis of complete stone clearance and resolution of any associated obstruction. Re-treatment rates, complications and time to complete stone clearance were recorded. Complete stone clearance was achieved in 152 patients (91.6%) after an average of 10.2 days (range 1280. The average treatment rate was 1.3 sessions per patient. As a whole groups, lower ureteral stones required more treatment sessions than those in the upper ureter, and the difference was statistically significant. However the differences in the final success rate and time to stone clearance were statistically nonsignificant. When stratified according to size, the success rate was lowest for lower ureteral stones >1 cm in diameter. We believe ESWL is a safe and simple non-invasive option of choice for most ureteral calculi at different levels. Ureteroscopy represents an alternative choice in case of ESWL failure, or in cases of larger stones in the lower ureter when it might be the first option.

A litotripsia extracorpórea no tratamento de cálculos urinários em crianças

Urinary lithiasis affects between five and 10% of the human population during their lifetime, only 2-3% of whom are children. Therapy of urolithiasis in the pediatric age group with minimally invasive methodology represents an attractive alternative. This study presents results of extracorporeal shockwave lithotripsy, a minimally invasive methodology, for the treatment of urinary lithiasis in children. In the period between September 1991 and September 2000, 87 children were submitted to extracorporeal shockwave lithotripsy; as six of them presented with two calculi 93 urinary calculi were treated over that period. The Dornier-Philips lithotriptor was used in the procedures. Pelvic, superior and medium caliceal calculi were fragmented and eliminated in 87.7% and 77.8% of cases, respectively. Inferior caliceal stones were eliminated in 64.7% of cases. Only one of the three patients with staghorn calculi became stone-free after therapy (33.3%). All patients with ureteral calculi were stone-free after therapy. Bladder stones were fragmented and eliminated in 60% of cases. Extracorporeal shockwave lithotripsy is a safe and effective treatment for pelvic, caliceal, ureteral and bladder urolithiasis in children. Staghorn calculi have not shown satisfactory results when treated by this method. Extracorporeal shockwave lithotripsy results were influenced in our experience by the position and size of the treated calculi.

Extracorporeal shock wave lithotripsy produces a lower stone-free rate in patients with stones and renal cysts.

Renal cysts have a space-occupying effect and therefore can distort the pelvicalyceal anatomy. This distortion often produces abnormalities in normal urinary drainage. In the same way, it may effect the ability of the kidneys to become stone free after extracorporeal shock wave lithotripsy (ESWL). The purpose of the current study is to evaluate the effect of renal cysts on the outcome of ESWL. We studied 15 patients who had renal stones and coexistent renal cysts. Four patients had polycystic disease, five patients had multiple cysts and six patients has solitary ones. All cysts produced a distortion to the calyceal system of the kidneys, a fact confirmed by intravenous urography (IVU) and computed tomography (CT). All patients underwent ESWL and their stone-free status was evaluated 1 month later by ultrasound and plain kidney ureter bladder (KUB) X-ray. We had a total 60% (9/15) stone-free patients in our study group and a stone fragmentation rate of 100%. Patients with more cysts had lower stone-free rates. Patients with polycystic kidneys had a 25% (1/4) stone-free rate, while patients with multiple cysts and solitary cysts had, 60% (3/5) and 83.3% (5/6), respectively. These results are lower than the rates reported in patients without renal cysts. We believe that renal cysts may interfere with the passage of stone fragments, due to the impediment of drainage and urinary stasis from the stretching and distortion of the calyceal system by the renal cysts.

Pelvicalyceal stone load: a factor affecting the outcome of extracorporeal shockwave lithotripsy for renal pelvic calculi.

To determine the effect of variations in pelvicalyceal volume on the results of extracorporeal shock wave lithotripsy (ESWL) and the relationship of stone load to estimated pelvicalyceal volume in patients with renal pelvic stones. In all, 204 patients with renal pelvic stones were treated primarily by ESWL. Exclusion criteria were radiolucent stones, dilatation of the renal collecting system, JJ stent insertion before ESWL and an inadequate follow-up. The surface area of the stones and the renal collecting system were measured using a grid of 1 mm2 divisions. The pelvicalyceal volume was calculated as 0.6 (area)1.27. To evaluate the treatment results a pelvicalyceal stone load (PSL) index, describing the relationship of stone load to total estimated pelvicalyceal volume, was defined as stone volume/renal collecting system volume. The mean (range) pelvicalyceal volume of the patients was 13.24 (4.12-28.47) mm3 and the mean PSL index was 26.2%. The cumulative success rates according to the PSL decreased from 97% to 90% with increasing PSL, but remained at > 95% in patients with a PSL index of < 50%. In all, 184 sessions were applied and the session/patient ratio increased from 1.41 to 3.0 with increasing PSL. Complications were acute pyelonephritis in three and steinstrasse in five patients. The PSL index appears to be a more accurate and reproducible method for predicting the outcome of ESWL, and has the advantage of considering the effect of pelvicalyceal anatomy.

Prospective Evaluation of Morphology, Function, and Quality of Life After Extracorporeal Shockwave Lithotripsy and Endoscopic Treatment of Chronic Calcific Pancreatitis

Therapeutic endoscopy may be effective in selected patients with chronic calcific pancreatitis (CCP). We prospectively evaluated the early outcome of extracorporeal shockwave lithotripsy (ESWL) in combination with interventional endoscopy, using broad inclusion criteria. A total of 48 consecutive patients (35 male, 13 female) were recruited for ESWL and endoscopic therapy of symptomatic CCP. Symptoms, quality of life, pancreatic morphology and function were assessed before and after. Multiple stones (n = 43), strictures (n = 34), and pancreas divisum (n = 11) were found. A median of 13 ESWL sessions (range 2-74) with a median of 22,100 shockwaves (1,700-150,900) were required. Endoscopic pancreatic sphincterotomy (n = 48), stricture dilation (n = 12), and/or stenting (n = 27) were performed. After therapy, drainage of the pancreatic duct system was achieved in 36, complete stone clearance in 21 patients. Follow-up (n = 38) at 7 months (range 5-9) showed a significant decrease in pancreatic duct diameter (p < 0.001) and pain score (p < 0.0001) whereas complete pain relief was observed in 45% of cases. Several quality of life scores improved significantly. Weight gain occurred in 68% of patients. Normalization of fasting blood glucose and HbA1c levels were observed in four patients, without modifying their treatment. Improvement in pain score correlated with weight gain and decrease in pancreatic duct diameter. Nonalcoholic etiology was associated with a better chance for improvement in pain score and decrease in pancreatic duct diameter. The presence of strictures did not deteriorate the clinical outcome. Besides pain relief, ESWL in combination with interventional endoscopy resulted in pancreatic ductal decompression, weight gain, and improvement in quality of life in a considerable number of patients with advanced CCP.

Prospective evaluation of morphology, function, and quality of life after extracorporeal shockwave lithotripsy and endoscopic treatment of chronic calcific pancreatitis

OBJECTIVE: Therapeutic endoscopy may be effective in selected patients with chronic calcific pancreatitis (CCP). We prospectively evaluated the early outcome of extracorporeal shockwave lithotripsy (ESWL) in combination with interventional endoscopy, using broad inclusion criteria. METHODS: A total of 48 consecutive patients (35 male, 13 female) were recruited for ESWL and endoscopic therapy of symptomatic CCP. Symptoms, quality of life, pancreatic morphology and function were assessed before and after ESWL. RESULTS: Multiple stones (n = 43), strictures (n = 34), and pancreas divisum (n = 11) were found. A median of 13 ESWL sessions (range 2–74) with a median of 22,100 shockwaves (1,700–150,900) were required. Endoscopic pancreatic sphincterotomy (n = 48), stricture dilation (n = 12), and/or stenting (n = 27) were performed. After therapy, drainage of the pancreatic duct system was achieved in 36, complete stone clearance in 21 patients. Follow-up (n = 38) at 7 months (range 5–9) showed a significant decrease in pancreatic duct diameter ( p < 0.001) and pain score ( p < 0.0001) whereas complete pain relief was observed in 45% of cases. Several quality of life scores improved significantly. Weight gain occurred in 68% of patients. Normalization of fasting blood glucose and HbA1c levels were observed in four patients, without modifying their treatment. Improvement in pain score correlated with weight gain and decrease in pancreatic duct diameter. Nonalcoholic etiology was associated with a better chance for improvement in pain score and decrease in pancreatic duct diameter. The presence of strictures did not deteriorate the clinical outcome. CONCLUSIONS: Besides pain relief, ESWL in combination with interventional endoscopy resulted in pancreatic ductal decompression, weight gain, and improvement in quality of life in a considerable number of patients with advanced CCP.

2000 AD: still a role for the intravenous urogram in stone management?

The intravenous urogram (IVU) remains a useful investigation in the assessment of upper urinary tract calculi. Helical computed tomography scanning appears to have superseded the IVU in the diagnosis of acute flank pain due to a higher sensitivity in diagnosis. Results of extracorporeal shockwave lithotripsy (ESWL) for lower calyceal stones are generally disappointing. Recent studies using the intravenous urogram have demonstrated that an acute infundibulopelvic angle may be a significant indicator of the likelihood of failure of ESWL. A prospective evaluation of the role of spatial anatomy in the clearance of lower calyceal stones by ESWL is needed. In future this parameter may be used to determine treatment protocols for lower calyceal stones. Future imaging methods may make the IVU redundant, but for the time being it remains an essential part of the urologist's armamentarium.

Extracorporeal Shockwave Lithotripsy for Ureterolithiasis in Patients with Urinary Bilharziasis: Efficacy and Variables That Influence Treatment Outcome

Objectives: Schistosomiasis affecting the ureter is commonly accompanied by ureteric dilatation with or without ureteric stricture and altered ureteric wall motility that can influence extracorporeal shockwave lithotripsy (ESWL) results. This study attempts to identify variables that may influence the outcome of ESWL in the treatment of ureterolithiasis in patients with urinary bilharziasis.Patients and Methods: Forty–three patients with urinary schistosomiasis and ureterolithiasis treated with ESWL were reviewed. The study data include characteristics of patients, stones, urinary tract treated and details of ESWL treatment.Results: Thirty–five patients (81.3%) were stone–free at 3 months. Multivariate analysis with logistic regression identified two significant variables that influenced treatment outcome, namely the presence of ureteric stricture (p = 0.004) and the ESWL voltage (p = 0.003). Ten ureteric strictures were encountered in 9 patients (21%), the majority of these were diagnosed post–ESWL when patients failed to pass well–fragmented stones in spite of pre–ESWL evaluation.Conclusions: In situ ESWL is a safe and effective first line of treatment for urinary stones in bilharzial ureters. The presence of concomitant bilharzial stricture is a significant variable which affects the treatment outcome. Every effort should be made to rule out and deal with possible complicating factors such as ureteric strictures in the pretreatment period.

Effect of vibration massage therapy after extracorporeal shockwave lithotripsy in patients with lower caliceal stones.

To determine whether vibration massage influences the results of extracorporeal shockwave lithotripsy (SWL) in patients with lower caliceal stones. One hundred three patients with lower caliceal stones were entered in the study. Patients were divided into two groups that received either SWL alone (Group A, N = 52) or with vibration massage (Group B, N = 51). There was no statistically significant difference between the two groups in stone size, duration of follow-up, or patient age. The complication, stone-free, and stone recurrence rates of the groups were compared. There was no statistically significant difference between the groups in the number of shockwaves, number of SWL sessions, or shockwave energy. The renal colic rate was higher in Group B than in Group A (P = 0.03). The stone-free rates in Group A and Group B were 60% and 80%, respectively (P = 0.003). The stone recurrence rate was higher in Group A than in Group B (P = 0.0006). This retrospective study demonstrates that SWL with vibration massage appears to have a beneficial effect on the passage of fragments in patients with lower caliceal stones.

Pediatric urolithiasis: To cut or not to cut

Urolithiasis is a major source of morbidity in children of the third world. Since its advent in 1982 and despite uncertainties about the long-term effects on the kidney, extracorporeal shock wave lithotripsy (ESWL) has rapidly replaced traditional surgery in the management of this condition. A retrospective study was conducted to compare the outcome of ESWL with that of open surgery in the management of paediatric urolithiasis in a single institution between November 1988 and December 1991. Emphasis was placed on the rate of stone clearance, complications, duration of follow-up, and cost of treatment of each modality. A total of 83 patients under 14 years of age underwent management of 101 stones; the stones were located in the kidneys (63), ureters (13), or bladder (25). Thirty-one patients who enrolled directly through the Lithotripsy Clinic underwent a total of 65 ESWL sessions for 44 calculi (mean, 2.1 sessions per patient). The overall stone clearance rate was 82%, with an 83% clearance rate for renal stones. There were three failures. Nine patients did not return after the first ESWL session, and by the end of 6 months, 93.5% were lost to follow-up. The cost of ESWL ranged from $600 to $1,000 (mean, $780). Fifty-two children were managed through the Pediatric Surgery Clinic and underwent open surgery (57 stones). The overall stone clearance rate was 96%, with a clearance of 88% for renal calculi. There were two wound infections and no deaths. All patients returned for the first follow-up visit, but by the end of 6 months, only 34.5% were available for follow-up. The total cost of treatment ranged from $520 to $900 (mean, $580). The authors believe that with the present level of knowledge, use of the lithotriptor should be restricted to children with small stones and/or those for whom long-term follow-up is possible.

A Report on Extracorporeal Shock Wave Lithotripsy Results on 1,569 Renal Units in an Outpatient Clinic

We report our experience with extracorporeal shock wave lithotripsy (ESWL**Dornier Medical Systems, Inc., Marietta, Georgia.) treatment of 1,569 renal units in an outpatient clinic with a small focused piezoelectric lithotriptor. A stone-free rate of 93% was achieved. In 3.6% of the patients, mainly those with a history of surgery and/or anatomical caliceal deformations, fragments smaller than 3mm. in diameter remained despite multiple ESWL sessions and intensive upside down physiotherapy. Of the cases 3.4%, including those without sufficient data, were considered unsuccessful. We treated 58 renal units in children 14 years old and younger, 55 patients had a single kidney and 7 had a horseshoe kidney.

Extracorporeal Shock-Wave Lithotripsy for Small Symptomatic Renal Calculi: Is It Effective?

Renal calculi with a diameter of less than 5 mm can pass spontaneously. However, some patients have small symptomatic renal calculi for more than 3 months. We evaluated the results of extracorporeal shock-wave lithotripsy in 38 patients with such stones. Patients presented with loin pain, hematuria, infection, or a combination of complaints. Average stone size was 18 mm2. After a wait of 3 months for spontaneous evacuation without success, all patients were treated with a Siemens Lithostar. Three months after treatment, 19 patients (50%) were completely free of stones, but 7 still had complaints; of the 19 patients with residual fragments, 8 (42%) were free of complaints. Both evacuation and resolution of complaints were achieved in only 12 of the 38 patients (32%). We conclude that one should be reluctant to treat small renal calculi, because spontaneous evacuation occurs in about 80% and the results of treatment are restricted.

Results of Extracorporeal Shockwave Lithotripsy: a Review of 83 Patients Treated at the Robert Packer Hospital

Results of Extracorporeal Shockwave Lithotripsy: a Review of 83 Patients Treated at the Robert Packer Hospital

Outcome of Extracorporeal Shock Wave Lithotripsy in Western Region of Nepal

Background: Extracorporeal shock wave lithotripsy (ESWL) is an effective non-invasive method for management of urinary tract stones. It was introduced for the first time in Pokhara 1 year back. This study aims to study the efficacy of ESWL in removal of renal and ureteric calculus in relation to the stone size and location and potential adverse effect of the procedure. Methods: It is a prospective observational study carried out in 112 cases undergoing elective ESWL for solitary urolithiasis during a period of 1 year (August 2010- August 2011). Number of sessions required for successful fragmentation and clearance of stones were studied according to their size and position along with the complications encountered. Results: The success rate of ESWL was found to be 91.1% for solitary urolithiasis. The mean number of sessions required for success was found to increase according to increase in size of the stones whereas it was almost similar for various locations. Complications were encountered in 25% of cases. Conclusion: Stone size was found to be the most important predictor in successful outcome of ESWL and the procedure is quite favorable for stones less than 20 mm. Keywords: ESWL; renal stones; ureteric stones DOI: http://dx.doi.org/10.3126/njms.v1i1.5787 Nepal Journal of Medical Sciences. 2012; 1(1): 3-6

Physiological factors affecting compensatory renal hyperplasia in the rat.

Journal of Experimental ZoologyVolume 145, Issue 3 p. 209-216 Article Physiological factors affecting compensatory renal hyperplasia in the rat† Richard J. Goss, Richard J. Goss Department of Biology, Brown University, Providence, Rhode IslandSearch for more papers by this authorMarsha Rankin, Marsha Rankin Department of Biology, Brown University, Providence, Rhode IslandSearch for more papers by this author Richard J. Goss, Richard J. Goss Department of Biology, Brown University, Providence, Rhode IslandSearch for more papers by this authorMarsha Rankin, Marsha Rankin Department of Biology, Brown University, Providence, Rhode IslandSearch for more papers by this author First published: December 1960 https://doi.org/10.1002/jez.1401450304Citations: 48 † This investigation was supported by grant B-923 from the National Institutes of Health. AboutRelatedInformationPDFPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessClose modalShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume145, Issue3December 1960Pages 209-216 RelatedInformation RecommendedRenal pelvic stonesAnthony Blacker, Top Tips in Urology, [1]Reaching stones in the kidney during flexible ureterorenoscopy with a large renal pelvisGerald Rix, Top Tips in Urology, [1]Pelvicalyceal stone load: a factor affecting the outcome of extracorporeal shockwave lithotripsy for renal pelvic calculiB. Küpeli, L. Tunç, T. Alkibay, Ü. Karaoglan, I. Bozkirli, BJU InternationalCompensatory renal hypertrophy in hypophysectomized ratsS. E. Dicker, A. L. Greenbaum, Christine A. Morris, The Journal of PhysiologyTHE EFFECT OF GROWTH AND LACTOGENIC HORMONES ON RENAL COMPENSATORY HYPERTROPHY IN HYPO‐PHYSECTOMIZED RATSTalib Astarabadi, Quarterly Journal of Experimental Physiology and Cognate Medical Sciences