Extracorporeal Shock Wave Lithotripsy Sessions Research Articles

Pulverisation of calcified and non-calcified gall bladder stones: extracorporeal shock wave lithotripsy used alone.

Using a modified electromagnetic lithotripter (Siemens), extracorporeal shock wave lithotripsy (ESWL) was performed in 260 patients with gall bladder stones. Exclusion criteria for treatment were a non-functioning gall bladder, subcostal gall bladder location, and multiple stones occupying more than three quarters of the gall bladder volume. Stone pulverisation was the end point of ESWL. The number of shock wave discharges and sessions was not limited. Pulverisation was achieved in 250 patients (96.1%) after a median of three ESWL sessions (range 1-21). The number of sessions required depended upon stone composition and burden. More than three sessions were required in 60.2% of patients with calcified stones compared with 35.9% of patients with non-calcified stones (p < 0.001). 65.8% of patients with stones measuring more than 30 mm in total diameter required more than three sessions compared with 42.9% of patients with a stone burden less than 30 mm (p < 0.01). At 18-24 (8-12) months follow up, stone clearance was achieved in 94.3% (80.4%) of patients with non-calcified stones, compared with 89.5% (76.8%) in patients with calcified stones and in 75% (71.4%) of patients with a total stone diameter more than 30 mm compared with 95.7% (80.4%) for patients with a total stone diameter less than 30 mm (p < 0.05). ESWL related complications (gross haematuria) occurred in three patients. Thirty six (13.8%) patients experienced biliary colic; four had cholecystectomy, and five endoscopic papillotomy because of common bile duct obstruction. Stone recurrence was seen in 5.3% of patients over a follow up period of up to two years (median 16.6 months).

Evaluation of the results of one session of extracorporeal shock-wave lithotripsy (ESWL) for a single urinary tract stone

Fourteen hundred seventeen patients with a single stone under either general or epidural anesthesia were treated by one session of ESWL using the Dornier HM3 while 255 cases by one session of ESWL using the Dornier MPL9000 under no anesthesia but only with some analgesics, with 3 months' follow up available in all patients. The ratio of stone location in the kidney vs ureter was 7 to 3 in the Dornier HM3 and 5 vs 6 in the Dornier MPL9000. The overall success rate (stone free and residual stone fragments of less than 4 mm, 3 months after ESWL) was 58% (591 cases/1016 cases) for kidney stones with the Dornier HM3 and 35% (41/117) with the Dornier MPL9000. On the other hand, the overall success rate for ureter stones was 61% (245/401) with the Dornier HM3 and 70% (96/138) with the Dornier MPL9000. The overall success rate for stones of more than 10 mm, was poor when treated by the Dornier MPL9000 compared with the Dornier HM3.

In situ Extracorporeal Shockwave Lithotripsy of Distal Ureteral Stones: Parameters for Therapeutic Success

Between January and December 1989, 123 patients with distal ureteral stones were treated with in situ extracorporeal shockwave lithotripsy (ESWL) using a modified HM3 Dornier lithotriptor. One hundred and three patients (83.7%) were stone-free, 20 patients (16.3%) had small residual stones (< 1 mm2) that passed spontaneously. In situ ESWL treatment alone was successful in 88 of the 103 stone-free patients (85.4%). Fifty-six (54.4%) needed 1 ESWL session, 26 (25.2%) needed 2 ESWL sessions. Nineteen of the 123 patients (15.4%) needed auxiliary endourological measures. The results of ESWL treatment were correlated to pretherapeutically identified parameters such as stone size, radiopacity, outer contour, shape, inner structure, biochemical analysis of the stones and grade of dilatation of the upper urinary tract. The results prove that size (> or = 75 mm2), radiopacity and grade of dilatation have a direct correlation to the difficulty to disintegrate ureteral stones.

Prognosis after Extracorporeal Shock Wave Lithotripsy of Radiopaque Renal Calculi: A Multivariate Analysis

To obtain a better understanding of the prognostic factors influencing treatment outcome after extracorporeal shock wave lithotripsy (ESWL), a multivariate logistic analysis of the data from 246 patients has been undertaken. All of the patients were treated with the Dornier lithotriptor HM-3 for radiopaque renal calculi. Treatment success was defined as stone-free within 3 months of one ESWL session and without adjuvant measures after ESWL. In a first analysis, 210 patients with solitary and multiple calculi without adjuvant measures before ESWL were studied. Of 210 patients, 141 (67%) were free from stones after 3 months). Significant influences on the success rate were body mass index and stone number. In a second analysis only those 160 patients with solitary calculi were considered. In this group, age, body mass index, stone location, stone burden and serum calcium significantly influenced the prognosis. When patients with adjuvant measures were added to the analysis an increasing prognostic importance of the stone burden was seen. In patients with a small to medium stone burden (< 4.0 cm3), the number of stones seemed to be more important than the stone burden. Patients appear to have the best chance for successful ESWL when their body mass index is between 20 and 28, their age is between 40 and 60 years, their stones are in the renal pelvis and solitary, the stone burden is < 1.0 cm3, and when their serum calcium is normal.

Extracorporeal Shock Wave Lithotripsy for Ureteral Stones Using the Dornier Lithotriptor MFL5000

A total of 157 ureteral stones in 150 patients were treated by extracorporeal shock wave lithotripsy (ESWL) using the Dornier lithotriptor MFL5000. Stones were treated in situ in 149 cases and with a double-J ureteral stent bypass in 8 cases due to large stone burden or failure of the preceding in situ ESWL. The average number of ESWL sessions and shock waves were 1.6 and 4,446, respectively. Multiple sessions were required in 58 cases (36.9%) for satisfactory fragmentation. At a 3-month follow-up, 91.7% of the cases treated by in situ ESWL and 50% of those treated with a stent bypass were rendered stone-free, achieving an overall stone-free rate of 89.4%. Ureteroscopic extraction or open ureterolithotomy was performed in 4 cases with an impacted stone for the removal of the residual fragments. No serious complications related to ESWL were observed. In situ ESWL is an effective and noninvasive method of treating ureteral stones. Large and/or impacted stones can also be successfully treated by ESWL with or without a stent bypass, but ureteroscopic or surgical procedures may be necessary to salvage fragments packed in the ureteral edema.

Extracorporeal shockwave lithotripsy in the treatment of gallbladder lithiasis. The first 109 patients

The AA report their 15-month experience with extracorporeal shock-wave lithotripsy (ESWL) in the treatment of gallbladder stones (GS). The selection criteria included symptomatic patients, with 1 to 3 radiolucent stones in a functioning gallbladder. All patients were put on adjuvant therapy with 10 mg/Kg weight/day of ursodeoxycholic acid (ursodiol). ESWL sessions were performed in an ambulatory setting, using high-energy shock-waves (mean: 23 Kv) until fragments < or = 4mm were obtained, if possible. By the end of December 1992, 109 patients had completed the ESWL protocol, undergoing a total of 265 sessions (mean: 2.4 sessions per patient, variation 1-5). The stone-free (SF) rates and respective 95% confidence intervals were 31% (22%-43%) at 6 months and 59% (38%-76%) at 1 year of follow-up. For the subset of patients with a single stone < or = 2 cm (n = 59), were 47% (33%-63%) at 6 months and 77% (40%-95%) at 1 year. The most significant complication was acute biliary pancreatitis, of which we report 4 cases (4%). They were always mild and non-complicated. There was no mortality. The AA conclude that ESWL is a safe and effective treatment for selected patients with GS.

A Case of Pancreatolithiasis Treated by a Combination of Endoscopic Extraction and Extracorporeal Shock Wave Lithotripsy

Abstract:We report on the case of a 50‐year‐old woman with idiopathic chronic calcifying pancreatitis and diabetes. An endoscopic retrograde pancreatography showed a stone with a diameter of 23 mm and multiple small stones in the head of the pancreas. An endoscopic pancreatic sphincterotomy was performed. However, the stone could not be removed endoscopically. So we performed an extracorporeal shock wave lithotripsy (ESWL) using a Tripter X1. The stone was located in the shock wave focus by fluoroscopy. Under intravenous sedation, the patient received 5 ESWL sessions (a total of 11700 shock waves with an energy of 18kv). ESWL permitted stone disintegration and successful endoscopic extraction of the fragments. Complete clearance in the main pancreatic duct was achieved. No severe complications were observed. After treatment, an improvement in the PFD test was seen. ESWL is an effective method for treatment of endoscopically unextractable pancreatic ductal stones.

Extracorporeal shock wave lithotripsy of bile duct stones: a single institution experience.

Extracorporeal shock wave lithotripsy treatment with Dornier HM3 or MPL 9000 machines was applied in 37 patients with problematic bile duct stones. General anaesthesia was not required. After one extracorporeal shock wave lithotripsy session 14/37 patients (38%) were spontaneously stone free, and additional endoscopic extraction (eight of 37) and retreatments with extracorporeal shock wave lithotripsy (seven cases) increased the stone free rate to 29/37 (78%). In three patients with intrahepatic stones, the bile ducts could not be evaluated decisively at cholangiography and ultrasonography, but they were all symptom free at 15 to 38 months follow up. If these three patients are added to the radiologically stone free patients, the overall clinical success rate was 32/37 (86%). There were no serious complications, hospital admissions, or 30 day mortality as a result of extracorporeal shock wave lithotripsy or endoscopic procedures. It is concluded that extracorporeal shock wave lithotripsy is a valuable adjunct to the non-surgical treatment of bile duct stones.

Evaluation of Extracorporeal Shock Wave Lithotripsy Without Anesthesia Using a Dornier HM3 Lithotriptor Without Technical Modifications

In 210 patients with urolithiasis extracorporeal shock wave lithotripsy was performed without regional, general or infiltration anesthesia by means of a technically unmodified Dornier HM3 lithotriptor. The stone burden varied from small ureteral stones to complete staghorn stones. All patients were given premedication with pethidine and diazepam, and a lidocaine-prilocaine-contain-ing cream was applied on the skin at the entry site of the shock wave. Energy usually varied between 14 and 16 kv. More than 90% of the patients reported the pain to be at most of moderate intensity and acceptable. Less than 3% found the treatment unpleasant. The results were compared to those obtained in 250 patients treated with anesthesia according to the original procedure, with a generator voltage of 18 to 23 kv.The number of extracorporeal shock wave lithotripsy sessions for ureteral and large stones was somewhat higher with the low energy method than with the original procedure. However, the therapeutic result in terms of renal units without stones after 4 weeks was similar to that recorded for patients treated with the anesthesia method. According to these promising results we believe that extracorporeal shock wave lithotripsy without anesthesia in an unmodified Dornier HM3 lithotriptor can be performed successfully in a majority of patients and is an attractive alternative to other technical modifications of the equipment. (J. Urol., 142: 1189–1192, 1989)

Extracorporeal Shock Wave Lithotripsy Monotherapy: Experience with Piezoelectric Second Generation Lithotriptor in 642 Patients

Extracorporeal shock wave lithotripsy monotherapy was performed in 642 patients for 1 year with an EDAP-LT01 piezoelectric lithotriptor. Of 642 patients 398 completed extracorporeal shock wave lithotripsy treatment and 244 still are undergoing multiple extracorporeal shock wave lithotripsy sessions. The 398 patients had renal (64.6 per cent) or ureteral (35.4 per cent) stones 0.6 to 4.8cm. in diameter (mean 1.4cm.). No general or regional anesthesia was required except in 7 children. Among 398 patients who completed extracorporeal shock wave lithotripsy the rate free of stones was 73.4 per cent and the rate of clinically insignificant residual fragments was 12.8 per cent. The success rate (rate free of calculi plus that of clinically insignificant renal fragments) ranged from 95.6 per cent for stones 0.6 to 1.0cm. in diameter to 52.6 per cent for stones larger than 3.0cm. (mean 86.2 per cent). The number of treatment sessions in 343 patients with successful results increased in accordance with the stone size, with an average of 1.6 sessions. Double-J⁎⁎Medical Engineering Corp., New York, New York. stents were placed in 7 patients and ureteral catheterization was performed in 11 as post-extracorporeal shock wave lithotripsy adjunctive measures. The steinstrasse phenomenon was noted in 14 patients, of whom only 1 required Double-J stenting. There were no significant complications. Therefore, extracorporeal shock wave lithotripsy monotherapy with the piezoelectric lithotriptor is considered to be a safe and efficient outpatient procedure for the initial treatment of urinary stones regardless of stone sizes.

Long-Term Results of Extracorporeal Shock Wave Lithotripsy in Children

Extracorporeal shock wave lithotripsy was performed for treatment of calculi of the upper urinary tract in 73 children. All patients were treated with the standard HM3 Dornier lithotriptor. A total of 138 calculi in 86 renal units was treated, requiring 111 extracorporeal shock wave lithotripsy sessions. After therapy no serious complications were encountered. Six months after treatment 79 per cent of the patients were free of stones and 17 per cent had small residual fragments (less than 3mm.), while extracorporeal shock wave lithotripsy was considered to be unsuccessful in 3 children, although disintegration could be obtained in all patients. During a median followup of 24 months (range 13 to 40 months) growth of residual fragments was noted in 33 per cent of the patients and the recurrence rate was 10 per cent.

Hypertension after Extracorporeal Shock Wave Lithotripsy: A False Alarm

Among 200 normotensive patients who had a solitary stone fragmented by extracorporeal shock wave lithotripsy (ESWL) with 1100 to 1900 (mean 1380) shock waves at 18 to 22 kV on a Dornier HM3 lithotripter, only three had hypertension at follow-up, a figure that can be accounted for by the expected rate of new onset of hypertension in persons of the same age. Moreover, in 100 other patients having two ESWL sessions, the basal diastolic pressure did not differ significantly between the two sessions, and in 10 patients 25 to 41 years old, plasma renin activity was no higher 60, 120, and 240 minutes after receipt of 1000 to 1500 shock waves than before ESWL. At present, no relation between ESWL and hypertension can be postulated, and warning patients of any such danger is unjustified.

Second-generation lithotripsy: a safe, noninvasive, ambulatory procedure.

A total of 600 patients underwent 696 treatments of extracorporeal shockwave lithotripsy (ESWL) during the period between June and November 1987. Our progressively increasing experience with the second-generation device shows that this new unit is as effective as the conventional one, and reveals several advantages. The focusing of the stone is easier; therapy time is shorter; general or regional anesthesia is no longer necessary; distal ureteral stones can be disintegrated, and adjuvant procedures are easily performed during the ESWL session. Of the last 400 patients of our series, 76% were treated on an outpatient basis without any major complications.

Clinical application of Sonolith 2000 on Extracorporeal Shock Wave Lithotripsy for renal and ureteral calculi

The collaborate studies of clinical application of Extracorporeal Shock Wave Lithotripsy (ESWL) using Sonolith 2000, performed at Departments of Urology of Nara Medical University, the University of Tokai School of Medicine and Wakayama Medical College between March and August 1987, were reported. In total 155 ESWL sessions were carried out on 111 patients suffering from in total 119 upper urinary tract stones. The localization system using ultrasound imaging with a computer assisted multiarticulated arm were evaluated as excellent or effective in 117 cases (98.3%). The stone fragmentations were evaluated as excellent (less than or equal to 3 mm) or effective (less than or equal to 5 mm) in 101 cases (84.9%). On the X-ray film obtained six weeks after the final ESWL treatments, 61 cases (51.3%) were free from stone fragments, 20 cases (16.8%) had sand-like fragments and 18 cases (15.1%) had stone fragments less than 5 mm. 99 cases (83.2%) without stone or with stone fragments less than 5 mm were considered to be with satisfactory results. No serious adverse effect was observed, but petchia on the flanks where shock wave penetrated and mild hematuria were observed in all cases. It is concluded that ESWL treatment using Sonolith 2000 is applicable in the managements of patients with the upper urinary tract stones without serious adverse effects.

Extracorporeal shock-wave lithotripsy in the management of bile duct stones.

Extracorporeal shock-wave lithotripsy (ESWL) was performed in 16 patients with bile duct stones. Dornier HM3 water-bath equipment (Dornier Medical Systems, Marietta, GA) was used in all procedures. All patients had either a T-tube or a nasobiliary, cholecystostomy, or transhepatic biliary drainage tube in place at the time of the lithotripsy. In 12 patients, the indication for ESWL was the failure of or anticipated difficulty with basket extraction of the stones, either via a T-tube tract or by means of endoscopic sphincterotomy. In the other four patients, ESWL was performed immediately after retained stones were found on a postoperative cholangiogram, even though no difficulty was anticipated in removing the stones by means of basket extraction. In 15 (94%) of the 16 patients, the stones were successfully fragmented. The fragments passed spontaneously in nine patients but had to be removed by basket in five patients. In one patient, the fragments could not be extracted by basket. The number of ESWL shocks used in a single session ranged from 525 to 3200. Three patients had two ESWL sessions. No significant complications were observed. ESWL is a successful method for the management of patients with bile duct stones when used in conjunction with other nonsurgical techniques. It was also the only treatment required in 56% of our patients.

Extracorporeal shock wave lithotripsy of proximal and distal ureteral stones.

Extracorporeal shock wave lithotripsy (ESWL) was used for treatment of 105 patients with ureteral stones. There were 77 stones in the upper part of the ureter, i.e. above the pelvic brim, and 28 in the lower part, i.e. below the sacroiliac joint. Successful fragmentation was attained in 101 (96%). In 93% of the patients with stones in the upper ureter and in 100% with stones in the lower ureter the fragments were eliminated completely. In 87% of the patients with stones in the upper ureter, a ureteral catheter was introduced under local anesthesia but without fluoroscopic control. It was thereby possible to remove 30% of the stones from the ureter to the kidney. For the remaining stones, saline was infused through the catheter during ESWL. For patients with stones in the lower part of the ureter, a ureteral catheter was passed in 79% and saline infused during treatment. Whereas some form of anesthesia was used for treatment of all upper ureteral stones, 89% of the treatments for lower ureteral stones were performed without anesthesia. Auxiliary procedures after ESWL were limited to four ureteral catheter manipulations for distal stones. Four proximal stones which remained unaffected by ESWL had to be treated by open surgery (3 stones) or percutaneous surgery (1 stone). Of 82 ureteric stones treated in situ the success fragmentation rate was 95%. The average number of ESWL sessions was 1.04 for both proximal and distal ureteral stones.

Extracorporeal Shock-Wave Lithotripsy for Upper Urinary Tract Calculi

Four hundred sixty-seven patients with symptomatic upper urinary tract calculi underwent extracorporeal shock-wave lithotripsy (ESWL) at The New York Hospital-Cornell Medical Center during the first year. Ninety-five percent of stones were completely treated with one ESWL session. An analysis of 300 treatments revealed that the overall stone-free rate (success) three months after treatment was 75%. The stone-free rate for patients with renal pelvic calculi less than or equal to 20 mm in diameter was 91%. Individual patient stone-free rates depended on stone size (burden), position, composition, and quality of disintegration. Two percent of treatments failed to disintegrate the targeted stone. Complications were minimal. Seven percent of treatments were followed by a secondary endoscopic procedure to facilitate complete stone passage, and 23% of treatments were preceded by cystoscopy with ureteral stent placement of manipulation of stones. Combined therapy utilizing percutaneous surgery or multiple sequential ESWL treatments is necessary for complex stones, and ureteroscopy or basket extraction remains the treatment of choice for distal ureteral calculi.