Extracorporeal Shock Wave Lithotripsy For Stones Research Articles

Extracorporeal shock wave lithotripsy: Prematurely falling out of favour? A 7year retrospective study from an Australian high-volume centre.

The aim of this study is to audit 7years of data with a 3year follow up from a high-volume stone centre performing extracorporeal shock wave lithotripsy (ESWL) to evaluate efficacy in stone clearance compared to existing knowledge and understand reasons for this performance. Patients who received ESWL treatment for renal or proximal ureteric stones at a single centre between January 2012 and January 2019 (to allow minimum 3year follow up) were retrieved. A retrospective analysis was performed cross referencing for stone size, location, treatment and need for further procedures. Ethical approval was granted through Metro North HHS HREC, Queensland, Australia. A total of 1930 patients met inclusion criteria. Fifty-seven percent (n = 1100) underwent left-sided ESWL, compared to 43% (n = 830) on the right. Stone size and location were both statistically significant to treatment outcome. Small stones (<1cm) had an overall clearance rate of 81.9%, medium stones (1-2cm) had a clearance rate of 60.6% and stones (>2cm) had a clearance rate of 31.3%. Small stones in an upper calyx had the highest clearance rate (87.5%, n = 120). Allowing for two procedures, 89% of stones were treated successfully. ESWL remains a legitimate option for the treatment of small and medium sized renal calculi. ESWL stone clearance rates at our centre are higher than published elsewhere and serve as proof to its efficacy. X-ray imaging on the day of the procedure, heavy consultant input and frequent intra-operative imaging are cited as key reasons for success. Further research is warranted to elucidate factors affecting stone clearance rate and to enable more standardised outcomes. Further investment may be required into ESWL provisions in most Australian states and especially in Queensland to enable its continued use in contrast to developing endourological techniques.

Effectiveness of Extracorporeal Shockwave Lithotripsy in Removing Small and Large Stones

Objective: To examined the efficacy of extracorporeal shockwave lithotripsy in the removal of small and large stones. Study Design: Observational prospective study. Place and Duration of Study: Department of Urology, Liaquat University of Medical and Health Sciences, Jamshoro from 1st January 2018 to 31st January 2019. Methodology: Two hundred patients, 139 males and 61 females, who underwent extracorporeal shockwave lithotripsy for stones were enrolled. The participants were separated into two groups based on stone size group A (stones measuring between 1.5 to 2.0 cm) and group B (stones measuring between 2.0 and 2.5 cm). Patients who were pediatric or had co-morbidities were excluded. The number of extracorporeal shockwave lithotripsy sessions and the number of beams per session were determined based on the clearance of the stones, if the radiology report indicated that the stones were completely cleared or if fragments smaller than 2 mm in diameter were present. Results: In group A, only 26 patients had partial clearance while in group B only 2 patients had partial clearance. The majority of the patients in both groups did not report any complications. The most common complaint was isolated haematuria, with 9 (4.5%) patients in the one session group, 16 (8%) in the two session group, and 5 (2.5%) in the three or more session group reporting this symptom Two patients in group A had hematoma along with haematuria, one patient in group A had massive haematuria that required transfusion, and one patient in each group reported having steintrasse with haematuria. In addition, one patient in group A had an isolated hematoma. Conclusion: Extracorporeal shockwave lithotripsy is effective and first-line treatment option for small renal stones. For ureteric stones, the location of stones should be taken into account, as this can have an effect on the stone-free rate and efficacy of extracorporeal shockwave lithotripsy. Keywords: Extracorporeal shockwave lithotripsy (ESWL), Stone removal, Ureteric Stones, Haematuria

Relative benefits of extracorporeal shockwave lithotripsy (ESWL) compared to observation in acute renal colic

Miss Catherine Lovegrove1,2Mandy Spencer1Prof Ben Turney1,2Ms Naomi Neal1&#x0D; 1 Department of Urology, Oxford University Hospitals NHS Trust, Oxford, Oxfordshire, UK2 University of Oxford Nuffield Department of Surgical Sciences, Oxford, Oxfordshire, UK&#x0D; &#x0D; Background NICE guidance recommends patients with renal colic be offered surgical treatment, including extracorporeal shockwave lithotripsy (ESWL), within 48 hours if pain is uncontrolled or stones unlikely to pass. We compared outcomes for ureteric stone passage after ESWL with those of observation to ascertain the relative benefits of ESWL.&#x0D; Methods We collected data on stone location, size and number of ESWL treatments required prospectively over 18 months. Stone passage was confirmed radiologically. Data were compared with MIMIC, a multi-centre collaborative study examining spontaneous stone passage after observation alone.&#x0D; Results 166 patients had ESWL for ureteric stones. Median size was 6.5mm (IQR 5.0-8.0mm). 57.2% (N=95) were proximal stones. Smaller stones required fewer treatments (P=0.003). Patients with a ureteric stone &lt;5mm required median 1.0 ESWL treatments (IQR 1.0-2.0). Ureteric stones 5-7mm had median 1.0 treatments (IQR 1.0-2.0) and stones &gt;7mm median 2.0 treatments (IQR 1.0-2.0). Compared to MIMIC, patients with ESWL for stones &lt;5mm were 11% more likely to achieve stone clearance (100.0% vs 89.0%, P=0.001). ESWL for 5-7mm stones had 28.1% greater clearance compared to observation (77.1% vs. 49.0%, P&lt;0.001) and ESWL for stones &gt;7mm 21% greater likelihood of clearance (50.0% vs. 29.0%, P&lt;0.001). Proximal ureteric stones were 16.4% more likely to pass with ESWL than observation (68.4% vs 52%, P=0.02). Distal stones showed similar passage with ESWL (77.5%) and observation (83.0%), P=0.43.&#x0D; Conclusions Proximal ureteric stones and those &gt;5mm stones benefit most from ESWL. Results aid identification of patients whose stones are less likely to pass and warrant urgent review to consider ESWL.

327 Relative Benefits of Extracorporeal Shockwave Lithotripsy (ESWL) Compared to Observation in Acute Renal Colic

Abstract Aim NICE guidance recommends patients with renal colic be offered surgical treatment, including extracorporeal shockwave lithotripsy (ESWL), within 48 hours if pain is uncontrolled or stones unlikely to pass. We compared outcomes for ureteric stone passage after ESWL with those of observation to ascertain the relative benefits of ESWL. Method We collected data on stone location, size, and number of ESWL treatments required prospectively over 18 months. Stone passage was confirmed radiologically. Data were compared with MIMIC, a multi-centre collaborative study examining spontaneous stone passage after observation alone. Results 166 patients had ESWL for ureteric stones. Median size was 6.5mm (IQR 5.0-8.0mm). 57.2% (N = 95) were proximal stones. Smaller stones required fewer treatments (P = 0.003). Patients with a ureteric stone &amp;lt;5mm required median 1.0 ESWL treatments (IQR 1.0-2.0). Ureteric stones 5-7mm had median 1.0 treatments (IQR 1.0-2.0) and stones &amp;gt;7mm median 2.0 treatments (IQR 1.0-2.0). Compared to MIMIC, patients with ESWL for stones &amp;lt;5mm were 11% more likely to achieve stone clearance (100.0% vs 89.0%, P = 0.001). ESWL for 5-7mm stones had 28.1% greater clearance compared to observation (77.1% vs. 49.0%, P &amp;lt; 0.001) and ESWL for stones &amp;gt;7mm 21% greater likelihood of clearance (50.0% vs. 29.0%, P &amp;lt; 0.001). Proximal ureteric stones were 16.4% more likely to pass with ESWL than observation (68.4% vs 52%, P = 0.02). Distal stones showed similar passage with ESWL (77.5%) and observation (83.0%), P = 0.43. Conclusions Proximal ureteric stones and those &amp;gt;5mm stones benefit most from ESWL. Results aid identification of patients whose stones are less likely to pass and warrant urgent review to consider ESWL.

Contralateral Coupling During Extracorporeal Shockwave Lithotripsy for Stones in Ectopic Kidney: Is It Feasible?

Purpose: Extracorporeal shockwave lithotripsy (SWL) results in a lower stone-free rate (SFR) for ectopic kidneys when using the standard technique, directing the shock wave from the same side of the stone; however, this may not be the optimal approach when the ectopic kidney is located more medial and anterior than the normally positioned kidney. Thus, contralateral coupling where waves come from the opposite direction may result in a better outcome. We tested the feasibility and outcome of contralateral coupling during SWL for stone in ectopic kidney. Materials and Methods: We prospectively recruited 20 patients with simple renal ectopia, who presented with renal stones that were amenable for SWL in the period between 2014 and 2018 at outpatient clinic of urology department, Minia University. Patients received SWL in Private Nile SWL Center were included to benefit from the ability of the electromagnetic SWL lithotripter. We did SWL in a supine position, and then contralateral coupling was performed from the opposite side of the affected kidney, rather than using the standard ipsilateral coupling approach. The SFR and various pre-, intra-, and postprocedural SWL variables were assessed, including stone characteristics, body habitus, shock wave numbers, and auxiliary measures. Count and percentages were calculated. Results: The mean stone radius was 14.7 mm with a mean S.T.O.N.E. (size, topography, obstructions, number of stones, and evaluation of HUs) of 9.6 points. Effective SWL was achieved in 80% of cases, 65% of them were stone free with effective single SWL session in 56% of cases. Hematuria, infection, and obstruction occurred in 50%, 20%, and 15% cases, respectively. One case required ureteral stent insertion. Conclusions: SWL applied through contralateral coupling is feasible, with comparable safety profile to the standard ipsilateral approach. Better SFR was achieved with the contralateral approach, in fewer sessions. However, the recruitment of more cases is necessary.

Is extracorporeal shockwave lithotripsy a risk factor for the development of diabetes mellitus? A population-based study.

To determine if patients treated with extracorporeal shockwave lithotripsy (ESWL) are at a greater risk of developing diabetes mellitus (DM) than those treated with ureteroscopy (URS). A retrospective population-based cohort study was performed of all ESWL and URS stone treatments done in Ontario between January 1994 and March 2014, utilising linked encoded healthcare databases. The primary outcome was the development of DM >90days after treatment. TheKaplan-Meier method was used for unadjusted survivalanalysis and multivariable analysis with Cox proportional hazards regression was used to assess the risk of DM between the ESWL and URS groups whilst controlling for age, gender, region of residence, income quintile, year of treatment, and comorbidity index. A sensitivity analysis with a subset of ESWL patients treatedfor left renal or proximal ureteric stones was completed. We identified 106963 patients who underwent ESWL or URS over the study period with a median follow-up of 6.6years (ESWL 8.5years, URS 5.6years). Unadjusted survival analysis showed an increased risk of developing DM in the ESWL group compared to the URS group (P<0.001); however, multivariable analysis showed no increased risk of DM in the ESWL cohort (hazard ratio [HR] 0.97, 95% confidence interval [CI] 0.91-1.02; P=0.25). Similarly, sensitivity analysis showed no increased risk of DM in the left renal/proximal ureteric stone ESWL cohort compared to the URS cohort (HR 1.04, 95% CI 0.96-1.13; P=0.35). Our population-based cohort study demonstrated no increased risk of DM in patients undergoing ESWL compared to URS.

STONE FREE RATES OF KIDNEY STONE WAS LOWER THAN THE ONE OF URETER STONE PATIENTS MANAGED BY ESWL AND THE ONE OF URETER STONE MANAGED BY URETEROLITHOTRIPSY

Objective: To evaluate the stone free rates of kidney and ureter stone patients managed by Extracorporeal Shockwave Lithotripsy (ESWL), and the ureter stone free rate managed by ureterolithotripsy. Material &amp; method: We reviewed the medical records of kidney and ureter stone patients managed by ESWL and ureter stone patients managed by ureterolithotripsy in Arifin Achmad Regional General Hospital Pekanbaru Riau Province, Indonesia, from January 2010 - December 2016. ESWL and ureterolithotripsy stone free rates were examined by the control of KUB röngents. Results: There were 891 kidney and ureter stone patients consisting of 325 (36.5%) were kidney stone patients and 566 (63.5%) were ureter stone patients. The pyelum stones were the most (78.2%) in kidney stones and the lower ureter stones were the most (57.2%) in ureter stones. There were more male patients than the female ones in which most of the patients were in the group age of 49-59 years. The amount of patients increased each year. The kidney stone free rate managed by ESWL was lower (71.7%) than ureter stone free rate (84.1%) by ESWL, while the stone free rate of ureter stone patients managed by ureterolithotripsy was 100%. Conclusion: The ESWL stone free rate of the kidney stone patients was lower than the one in ureter stone patients while the ureterolithotripsy stone free rate was 100%.

EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY;

Background: Urolithiasis is a common ailment that costs billions of Dollars everyyear. Recurrent urinary tract obstruction or urolithiasis may stimulate the fibrogenic flow, whichis responsible for the definite functional loss of renal parenchyma. In the few past years, themanagement of urinary calculi undertook a remarkable modification. Open surgery for stonesis nearly replaced by minimal or non-invasive operative procedures like ureterorenoscopy,percutaneous nephrolitholapaxy and extracorporeal shock wave lithotripsy (ESWL). StudyDesign: Randomized Controlled Trial. Setting: Department of Urology Services HospitalLahore. Duration of Study: 1st January -30th December 2016. Material and methods: Thecomparative study of 60 cases through Non probability convenient sampling was conducted toevaluate the outcome of ESWL in patients with single lithiasis of lower pole calyx with differentinfundibulopelvic angles as measured on pre-treatment IVU. Results: The mean age of all thepatients was 33.70±10.72 years. Out of 60 Patients 32(53.3%) were males while 28(46.7%)were females with 1.14 male to female ratio. In group A, the mean LIPA was 78.83±4.71o andin group B, was 100.53±5.73o. The overall mean LIPA of the patients was 89.68±12.11o.Stoneclearance was noted in 39 (65%) patients. 15 patients (38.46%) and 24 patients (61.53%) ingroup A and B respectively. p-value=0.015. After ESWL stone clearance was more in patientshaving IPA ≥ 90°as compared to IPA 70-90o. Conclusion: Stone clearance is significantlyhigher with IPA&gt;90o as compared to IPA70-90o.In future now we are able to implement the useof IPA&gt;90o instead of using &lt;90o that is more successful in achieving stone clearance.

Advantages of the supine transgluteal approach for distal ureteral stone extracorporeal shock wave lithotripsy: outcomes based on CT characteristics.

Extracorporeal shock wave lithotripsy (ESWL) for distal ureteral stones can be performed in prone or supine position. The aim of this study was to investigate the advantages brought by the supine transgluteal ESWL approach for distal ureteral stones treatment using real-time ultrasound (US), and to show how computerized tomography (CT) scan parameters may be related to the outcomes. Seventy consecutive supine transgluteal ESWL of distal ureteral stones were performed. All patients had a pre-treatment CT scan. The following parameter were evaluated: stone size, Hounsfield Units, skin-to-stone distance, sciaticum majus foramen width, stone to ureteral ostium distance, fragmentation and expulsion perception during the treatment, and the stone-free status. Stone focusing was obtained US, which allows a real-time visualization of stone location and fragmentation. Follow-up included a kidney ureter bladder (KUB) film and US examination at 2-3 weeks after treatment (median time: 18 days). Stone-free condition was defined as the complete absence of stone fragments. A linear regression analysis was used to assess the possible variables mostly related to stone-free status. P<0.05 was considered as significant. Median number of SWL sessions for patient was 1 (IQR: 1-1), mean 1.2±0.5. The re-treatment rate for stone-free patients was 18.3%. Stone-free rate was 85.7%. A clear and real time US stone fragmentation was perceived by the surgeon during the treatment in 42/70 (60%) of patients and correlated to the definitive stone-free status (P=0.04). Stone to ureteral ostium distance was the only variable affecting the stone-free condition (P=0.01). Supine transgluteal SWL of distal ureteral stones provide satisfactory outcomes in terms of stone-free rate. The distance of the stone to the ureteral ostium, measured by CT, appeared to be the only significant variable connected to SWL success.

MP54-09 COMPARISON OF EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY FOR UROLITHIASIS BETWEEN CHILDREN AND ADULTS: A SINGLE CENTRE STUDY.

INTRODUCTION AND OBJECTIVES: To retrospectively evaluate the effectiveness of extracorporeal shock wave lithotripsy (ESWL) for urolithiasis and compare the results between children and adults. METHODS: From January 2011 to January 2015, ESWL was performed in 102 children and 605 adults for urolithiasis. We used Modulith SL X lithotripter 4th generation Storz medical equipment for ESWL. The stone free rates, number of ESWL sessions required, complication rates and auxiliary procedures used were evaluated in a comparative manner. RESULTS: Mean Stone size was 1.28 61 cm in adults while 1.08 0.59cm in children. Post ESWL stone clearance was 86.60% for children and 69% for the adults. In children group second session was required in 19 (23.5%) patients and third session was required in 3 (3.7%) patients while in adult group 2 sessions in 122 (20.1%) and 3 sessions in 48(7.9%) patients. In adults complications included steinstrasse in 12 patients (1.98%), fever in 30(4.95%), hematuria in 38(6.28%) and sepsis in 12(1.98%) patients while in children steinstrausse in 2 patients (2.5%), mild fever in 2 patients (2.5%), hematuria in 6 patients (7.4%) and sepsis was seen in 4 patients (4.9%). Complication rates were almost similar in both groups. In ancilliary procedures including DJ stent was used in 13 patients (16.04%) in children while in 29% of adults. CONCLUSIONS: The results of ESWL for urolithiasis in adults remains inferior to that of children. Children can achieve high stone-free rates. Complication rates were almost similar in both children and adult ESWL group in our study.

The success of extracorporeal shock-wave lithotripsy based on the stone-attenuation value from non-contrast computed tomography

ObjectiveTo determine the utility of the urinary stone-attenuation value (SAV, in Hounsfield units, HU) from non-contrast computed tomography (NCCT) for predicting the success of extracorporeal shock-wave lithotripsy (ESWL). Patients and methodsThe study included 305 patients with renal calculi of ⩽30mm and upper ureteric calculi of ⩽20mm. The SAV was measured using NCCT. Numerical variables were compared using a one-way analysis of variance with posthoc multiple two-group comparisons. Univariate and multivariate regression analysis models were used to test the preferential effect of the independent variable(s) on the success of ESWL. ResultsPatients were grouped according to the SAV as group 1 (⩽500 HU, 81 patients), group 2 (501–1000 HU, 141 patients) and group 3 (>1000 HU, 83 patients). ESWL was successful in 253 patients (83%). The rate of stone clearance was 100% in group 1, 95.7% (135/141) in group 2 and 44.6% (37/83) in group 3 (P=0.001). ConclusionsThe SAV value is an independent predictor of the success of ESWL and a useful tool for planning stone treatment. Patients with a SAV ⩾956 HU are not ideal candidates for ESWL. The inclusion criteria for ESWL of stones with a SAV <500 HU can be expanded with regard to stone size, site, age, renal function and coagulation profile. In patients with a SAV of 500–1000 HU, factors like a body mass index of >30kg/m2 and a lower calyceal location make them less ideal for ESWL.

Is there a place for ESWL in the treatment of complicated proximal ureteral stones?

Although recently the minimal invasive urological and endourological methods have been substantially improved, concerns remain about the optimal management of proximal ureteral stones. Even the European Association of Urology Guidelines are not fully clear and leave the choice of treatment method to the urologist's discretion. Both extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy (URS) are accepted methods of the proximal ureteral stones management. ESWL is very often used as a first–line procedure because of its minimal invasiveness. It is proper for ureteral stones in all locations, but especially suitable for proximal (lumbar) localization because URS is considered more difficult in the upper part of the ureter. Authors of the paper published in this issue of Central European Journal of Urology have discussed the impact of a double–J stent for the results of ESWL in ureteral lumbar stones [1]. A lot of predictors have been reported to influence ESWL outcome in the management of ureteral calculi [2]. One of them is a double–J stent. As the authors have pointed, there are conflicting opinions on the ESWL effects in the management of ureteral stones in pre–stented patients. There is a quite popular theory that the indwelling stent creates expansion space thus facilitating effects of ESWL. On the other hand many authors stress that a stent can absorb energy of shock waves, impede their propagation and energy transmission thus lowering fragmentation rate. Also, while some suggest that catheters aid fragments passage by passive dilatation of the ureter [3] others point out that double–J stents can cause uretheral oedema, irritation and diminished peristalsis delaying clearance [4]. Results reported by Pettenati et al. show that presence of a double–J stent adversely affect the results of ESWL for stones >8 mm. The main limitation of this study is its retrospective design. However, some prospective studies have also reported that pre–stenting before ESWL does not improve the procedure results. In the recent prospective randomized trial stenting prior ESWL provided no additional advantage over in–situ ESWL. There was no statistical significant difference in stone–free rates between stented and non–stented patients with upper impacted ureteral stones measuring ≤2 cm treated with ESWL (90% vs. 86.7% respectively; p = 0.346) [5]. In another prospective randomized study pre–stenting limited stone–free rates in the ESWL management 4 to 10 mm ureteral stones (68.6% vs. 83.7% for stented and non–stented groups respectively; p = 0.026) and was responsible for higher post–ESWL morbidity and lower quality of live [6]. Therefore routine stenting before ESWL for ureteral lithiasis is not recommended, but in case of complicated lithiasis (sepsis, acute obstructive pyelonephritis, renal insufficiency, severe pain) urgent decompression with a double J stent is often necessary before implementation of definitive treatment. What should be the next step in the management of ureteral stones after recovery from sepsis or any other emergency case? Should we perform ESWL or rather ureteroscopy as a definitive treatment following the double J stent placement? The choice is controversial. Decision should be individual for each patient with a ureteral stone, especially if complicating factors co–exist. However, in my opinion Pettenati's study and other publications support the use of URS as a preferred first–line procedure in complicated lumbar ureteral stones previously managed with a double J stent. Pre–stenting makes ureteroscopy easier, improves stone–free rates and reduces complications risk [7]. With uncomplicated URS there is a higher probability of definitive stone clearance with just one procedure and the stent can be removed earlier. That is an important advantage as lower urinary tract symptoms caused by indwelling stent are noticed in up to 80% of patients. Stent–related complaints interfere with daily activities and are responsible for quality of life deterioration [3]. Patients treated with ESWL are usually not immediately stone–free and very often there is a need for repeated ESWL sessions or other additional procedures which delay definitive treatment, thus lowering the patient's quality of live and increasing costs.

Prise en charge des calculs du rein (hors coralliforme et calice inférieur)

The management of renal stones needs a recent and good quality imaging. Contrast medium injection is optional. Extracorporeal shockwave lithotripsy (ESWL) is the most common treatment of renal stones. ESWL is indicated as first line treatment for less than 1.5cm stones. The stone-free (SF) rate at 3 months of ESWL is 70-80%. Results of ESWL for stones with more than 1000UH density or located in the lower calyx are poor. Flexible ureteroscopy (URS) is indicated in case of ESWL failure or for hyperdense, 1-2cm stones. The SF rate of flexible is 80%. Percutaneous nephrolithotomy is indicated for complex or more than 2cm stones. Asymptomatic and non infected stones, especially if located in the lower calyx, do not need urological treatment but must be followed up. In all cases, renal stones needs a metabolic evaluation and treatment, and annual follow-up.

The Effect of Tamsulosin on Expulsion of Ureteral Stones after Extracorporeal Shock Wave Lithotripsy

Purpose: The aim of this study was to evaluate the effect of tamsulosin on expulsion of ureteral stones after extracorporeal shock wave lithotripsy (ESWL). Materials and Methods: Seventy-six patients (39 with upper ureteral stones and 37 with lower ureteral stones) treated with ESWL for stones <10mm were randomly divided into two groups. Tamsulosin (0.2mg orally once daily) was administered to group 1; group 2 received no medications. All patients were evaluated with respect to the number of episodes of ureteral colic, the expulsion rates of stones after ESWL, and the mean number of sessions of ESWL until complete expulsion of stones. Results: The complete expulsion rates of upper and lower ureteral stones did not differ significantly between groups 1 and 2 during each session of ESWL; however, the mean session of ESWL was lower in group 1 than in group 2. For upper ureteral stones, 1.8 sessions were necessary per patient in group 1, while 2.3 sessions were required for the patients in group 2 (p=0.039). For lower ureteral stones, 2.0 sessions were necessary per patient in group 1, while 2.9 sessions were required for the patients in group 2 (p=0.032). There were significant decreases in the number of episodes of pain in group 1 with lower ureteral stones (p=0.014). There were no side effects associated with tamsulosin. Conclusions: The use of tamsulosin in the treatment of upper and lower ureteral stones after ESWL can decrease the mean number of sessions of ESWL and the number of episodes of pain, but cannot improve the expulsion rate. Further research regarding the cost-effectiveness of tamsulosin after ESWL is needed. (Korean J Urol 2008;49:1100-1104) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Endoscopic vs. Surgical Drainage for Chronic Pancreatitis

Pancreatic-duct (PD) obstruction is an important etiologic factor for pain in chronic pancreatitis (CP) patients; thus, PD decompression is an appropriate treatment for symptomatic patients with markedly dilated PDs. To compare outcomes of endoscopic and surgical drainage, researchers from Amsterdam enrolled 39 patients with CP, obstruction of the PD (due to strictures, stones, or both), dilation of the PD (≥5 mm proximal to stenosis), and severe recurrent pancreatic pain (not relieved by non-narcotic analgesics). Patients were randomized to endoscopic therapy, consisting of sphincterotomy, pancreatic stone removal (extracorporeal shockwave lithotripsy for stones …

Extracorporeal Shock Wave Lithotripsy for Large Ureteral Stones Using HM3 Lithotriptor

We assessed the efficacy of extracorporeal shock wave lithotripsy for large (more than 10 mm) ureteral calculi with the unmodified Dornier HM3 lithotriptor. A total of 96 consecutive patients with large ureteral stones were treated with shock wave lithotripsy using an unmodified HM3 lithotriptor. Patients, stone characteristics, preliminary treatment before shock wave lithotripsy, additional procedures after shock wave lithotripsy, complications and clinical outcomes were assessed. Between 2000 and 2003 a total of 96 patients (75 males, 21 females, mean age 51 years [range 16 to 81]) with large ureteral stones underwent shock wave lithotripsy. Average stone size was 14 mm (range 10 to 22), 90 stones were calcified, and 66 stones were located in the upper ureter, 20 in the mid ureter and 10 in the distal ureter. A total of 77 (80.2%) patients underwent a single shock wave lithotripsy session, 18 (18.7%) underwent 2 sessions and 1 (1.1%) patient underwent 3 sessions. The overall stone-free rate was 86.5% (83 patients). Complications occurred in 10 (10.4%) patients. Shock wave lithotripsy failed in 13 (13.5%) patients who were successfully treated with ureteroscopy. Our data show that shock wave lithotripsy for large ureteral stones along the entire ureter with the unmodified HM3 lithotriptor has a high success rate with minimal morbidity. We recommend it as first line treatment.

307 Recurrence, retreatment and subsequent recurrences after initially successful gallbladder stone extra-corporeal shock wave lithotripsy (ESWL)

307 Recurrence, retreatment and subsequent recurrences after initially successful gallbladder stone extra-corporeal shock wave lithotripsy (ESWL)

Assessing the efficiency of extracorporeal shockwave lithotripsy for stones in renal units with impaired function: a prospective controlled study

The objective was to determine the efficiency of extracorporeal shockwave lithotripsy (ESWL) in clearing stones from renal units with impaired function. Thirty-five patients with poorly functioning kidneys determined by intravenous urogram and 99mtechnetium diethylene triamine pentacetic acid renal dynamic scan underwent ESWL. Stone clearance was assessed at 3 months and compared with that in normally functioning kidneys. The study group was divided into two subgroups. Those with split glomerular filtration rate (GFR) of the concerned kidney between 10 and 20 ml/min were in group 1. Group 2 consisted of patients with split GFR between 20 and 30 ml/min. A control group (group 3) was formed from patients with urolithiasis and normally functioning kidneys. The overall retreatment rate was 84.4%. The overall stone clearance rate in the study group was 34.2% while it was 57.7% in the control group. The stone clearance rate in group 2 was 40%. The difference in stone clearance rate between the study and control groups was statistically significant (P=0.023) but that between group 2 and the control group was not (P=0.159). The incidence of steinstrasse between the study group 2 and control group was not statistically significant (P=0.408). The clearance rate for ureteral stones was comparable in all the three groups. The stone-free rate and rate of steinstrasse for renal stones in kidneys with moderately impaired function were comparable to normally functioning kidneys. However, kidneys with severely impaired function had poor results. The clearance rate for ureteral stones was not influenced by the impairment of renal function.

Noninvasive Anesthesia, Analgesia And Radiation-Free Extracorporeal Shock Wave Lithotripsy For Stones In The Most Distal Ureter: Experience With 165 Patients

Spontaneous ureteral stone passage often causes severe renal colic, especially when the stone passes through the narrow ureteral orifice. In these situations noninvasive anesthesia-free, analgesia-free and radiation-free extracorporeal shock wave lithotripsy (ESWL) (Dornier Medical Systems, Marietta, Georgia) is a valuable tool. It can be performed at any time without needing any further patient preparation. A total of 165 patients underwent ESWL using the Lithostar Ultra device (Siemens, Erlangen, Germany). Only ureteral calculi within 5 cm. of the ureterovesical junction were included in this study. Patients were treated while supine and stones were localized by ultrasound through the filled bladder without x-ray exposure. Treatment was started without anesthesia or analgesia and analgesics were administered only at patient request during treatment. Of the patients 93% were treated without anesthesia or analgesia and 7% required a single intravenous dose of 25 mg. pethidine. Postoperatively renal colic developed in 40 patients (24%). In 4 cases (2.4%) renal drainage was required for analgesia resistant pain or obstructive pyelonephritis. On day 1 after ESWL 90% of the patients were stone-free or had fragments 2 mm. or less, while 10% had residual fragments 3 mm. or greater. Of all patients 7% were re-treated once. At 3 months postoperatively 129 of the 130 evaluable patients (99%) were stone-free. ESWL of stones located in the most distal ureter using the Lithostar Ultra device is effective, safe and radiation-free. It is done without anesthesia and in most cases without analgesics. This simple and noninvasive procedure is an excellent first line treatment modality for prevesical stones and it represents a valid alternative to conservative management or invasive endoscopy.

Treatment of Renal Stones by Extracorporeal Shockwave Lithotripsy

Aim: Despite the extensive experience with minimal invasive stone therapy, there are still different views on the ideal management of renal stones. Materials and Methods: Analysis of the literature includes more than 14,000 patients. We have compared these data with long–term results of two major stone centers in Germany. The results have been compared concerning the anatomical kidney situation, stone size, stone localization and observation time. Results: According to the importance of residual fragments following extracorporeal shock wave lithotripsy (ESWL), we have to distinguish between clinically insignificant residual fragments and clinically significant residual fragments (CIRF). 24 months following ESWL stone passage occurs as a continous process, and if there are no clinical symptoms, any endoscopic procedure should be considered as overtreatment. According to these results, stone–free rates of patients increase in longer follow–up periods. Newer ESWL technology has increased the percentage of CIRF. Conclusion: We consider ESWL in most patients with renal calculi as first–line treatment, except in patients with renal calculi bigger than 30 mm in diameter.