Introduction Of Extracorporeal Shock Wave Lithotripsy Research Articles

Epidemiology of Upper Tract Urolithiasis and ESWL Treatment in Kumasi, Ghana

Background: The incidence of upper tract urolithiasis is rising worldwide and treatment options have improved to include extracorporeal shock-wave lithotripsy (ESWL), percutaneous nephrolitothomy (PCNL) and ureterorenoscopy (URS) but sub- Saharan Africa has lagged behind the rest of the world. Open stone surgery was the main surgical treatment for upper tract stones in Kumasi until the introduction of ESWL five years ago. This study was conducted to evaluate ESWL in the management of upper tract urolithiasis in Kumasi, Ghana.
 Materials and methods: We prospectively analyzed all patients treated for upper tract urolithiasis at the Bomso Specialist Hospital in Kumasi from January 1, 2014, to December 31, 2017. Patients with upper tract stone of 2cm or less underwent ESWL. Data was obtained on patient demographics, stone characteristics, outcome of ESWL and analyzed with PASW Statistics for Windows, Version 18.0. Chicago: SPSS Inc.
 Results: There were 170 patients with upper tract urinary stones over the study period with a male: female ratio of 2:1. The mean age was 46.5 years. Inadequate fluid intake (<3L/day) was the most common predisposing factor, seen in 45.3% of the patients and the commonest symptom was flank pain, seen in 134 (78.8%) patients. There were 149 (87.6%) patients with solitary stones, mostly in the kidney 115 (67.6%). A total of 142 (83.5%) patients underwent ESWL with successful stone clearance in 120 patients. The most common complication of ESWL was flank pain 36 (25.4%).
 Conclusions:ESWL is effective for treatment of upper tract urolithiasis and should be available to selected patients in sub- Saharan Africa.

Outcome of Pushback Stenting and ESWL Versus in Situ ESWL for Upper Ureteric Stone -A Comparative Study

Background: Urolithiasis is one of the most prevalent urological disorders and the prevalence of urinary stones has increased world wide1. The management of urinary calculi was revolutionized by the introduction of extracorporeal shockwave lithotripsy (ESWL) in 1980 and the first successful ESWL treatment was accomplished in Germany by Dr. Christian Chaussy using a Dornier HM1 lithotripter. ESWL is a safe, effective and non-invasive method2.Purpose: To observe the outcome of pushback stenting and ESWL versus in situ ESWL for upper ureteric stone.Materials and methods: It was a quasi-experimental study. The study was under went in the department of urology, Dhaka Medical College and Hospital, between July'2012 to June'2014. Total 60 patients of single upper ureteric stone who satisfy inclusion and exclusion criteria were enrolled in this study. Selected patients were dived into two groups, group A and group B. Group-A for pushback stenting and ESWL and group-B for in situ ESWL. Results were compared in terms of clearance rates, number of shock waves, sessions, incidence of complications and failure rate.Results: Failure of ESWL was significantly higher in Group B (23.33%) than Group A (10%). These results were statistically significant.Conclusion: Pushback stenting and ESWL is better than in situ ESWL for upper ureteric stone.KYAMC Journal Vol. 8, No.-1, Jul 2017, Page 4-9

Cirugía percutánea de la litiasis renal en la era de la litotripsia extracorpórea: Experiencia en 301 pacientes

Percutaneous renal surgery. Experience in 301 patients Introduction: Percutaneous renal surgery was introduced more than 20 years ago in urological practi- ce. Extracorporeal Shock Wave Lithotripsy (ESWL) enter the urological scene shortly after. Our objective is to show our experience in percutaneous renal surgery after the introduction of the ESWL in our institution. Material and Methods: Surgical outcomes of 301 patients who underwent percutaneous renal surgery as treatment of renal stones were analyzed. This series begins just before the introduction of ESWL in our unit. Results: Renal pelvis was the most frequent localization with 142 cases (47.2%). There were 51 patients with straghorn calculi. 255 (84.7%) were stone free after one single procedure. Residual fragments were managed with many methods, until only 16 patients (5.4%) had residual fragments. Complications occurred in 26 patients (8.9%). There was no mortality. Conclusions: Percutaneous surgery is an important tool in the management of renal stones. In general, renal stones managed with this procedure, are more complex, however the achievement of good results is possible.

Use of double-J stents prior to extracorporeal shock wave lithotripsy is not beneficial: results of a prospective randomized study

Since introduction of extracorporeal shockwave lithotripsy (ESWL) in treating patients with urinary tract stones in our clinic for the first time in our city Aden 5 years ago, we stented all patients with kidney stone >1 cm routinely before the procedure. Our aim of this study is to compare symptoms and complications of patients with and without stenting. In 2003, 120 patients with renal stone(s) amenable to ESWL management were prospectively treated in two groups: stented (60 patients) and unstented (60 patients). All patients were admitted for 48 h after ESWL and then followed for 3 months after discharge by the same treating group of doctors. Patients were followed-up radiographically to assess stone-free rate after 1 and 3 months. There was no statistical difference in flank or abdominal pain, nausea, vomiting, transient hematuria, temperature or use of analgesics on the first and second day after ESWL in the stented or unstented group. Fifty-one patients (85%) of stented group complained of side effects attributable to stent including urinary frequency and urgency, bladder pain and hematuria with urination, which in all patients but 3 of them were treated as out patient and one of the unstented group, who were readmitted because of mild to severe pain, fever, and chills. In all stented patients, we removed the stents after 2 weeks; except in readmitted patients where it was removed earlier. Plain X-ray film was done for all patients after one and 3 months. Eight patients with stents (6.7%) had >5 mm residual fragments. In these patients second ESWL session was necessary. Three months stone-free rate was 88% in stented and 91% in unstented group, respectively. The use of double-J stents prior to ESWL treatment is not beneficial.

Percutaneous nephrolithotomy with ultrasonography‐guided renal access: experience from over 300 cases

To report our experience with over 300 patients treated with percutaneous nephrolithotomy (PNL), for although PNL was established as a treatment in the 1970s, its use diminished with the introduction of extracorporeal shockwave lithotripsy (ESWL); clinical experience with ESWL showed its limitations, and the role of PNL for treating urolithiasis was redefined, which with improvements in instruments and lithotripsy technology has expanded the capability of percutaneous stone disintegration. The study included 315 patients (156 males, 159 females, aged 13-85 years) treated with PNL in our department between 1987 and 2002. The mean (range) stone diameter was 27 (7-52) mm. The kidney was punctured under ultrasonography guidance via a lower-pole calyx whenever possible. The working channel was dilated using an Alken dilator under X-ray control. If necessary, a flexible renoscope was used. Ultrasonic, pneumatic and laser probes were used for lithotripsy. Four weeks after treatment the total stone-free rate was 96.5%; 45.7% of all patients were primarily stone-free, 21.3% had clinically insignificant residual stones that passed spontaneously within 4 weeks after PNL, and 33% of the patients needed auxiliary measures (a second PNL, ESWL, ureterorenoscopy). Overall, the early complication rate was 50.8%, the most common complications being transient fever (27.6%), clinically insignificant bleeding (7.6%) or both (3.2%); 3.5% of the patients developed urinary tract infections (with no signs of urosepsis), 3.2% had renal colic and 2.9% upper urinary tract obstruction. One patient (0.3%) developed acute pancreatitis after PNL; one died from urosepsis and one needed selective angiographic embolization of the punctured kidney due to bleeding. No patient required transfusions and there were no injuries to neighbouring organs. These results show that PNL causes no significant blood loss or major complications in almost all patients. Two aspects may especially reduce the potential complications: ultrasonography-guided renal puncture and using PNL in an experienced centre. PNL is a highly efficient procedure that provides fast and safe stone removal.

Urolithiasis in the Pediatric Age Group

Urolithiasis is usually considered a disease of adults and is rarely seen in the pediatric age group. However the incidence as well as the etiology of childhood urolithiasis is variable according to geographical areas. In countries of the Arabian peninsula (Kuwait United Arab Emirates and Saudi Arabia) it has been estimated that 20% of the men who reach the age of 60 years will have at least one episode in their lives which is a projected lifetime risk at least 50% higher than the highest corresponding figure in the West. In Europe and United States the reported incidence of urolithiasis in the pediatric age group ranges from 0.13 to 0.94 cases per 1000 hospital admissions with a predominance of upper urinary tract stones. Bladder stones on the other hand are endemic in Southeast Asia including Thailand Indonesia and India. As industrialization progresses in a geographic area there tends to be a shift in the incidence of urolithiasis from lower urinary tract to upper urinary tract stones. In the United Kingdom and certain European countries 30 to 90% of stones are infection related while in the United States and Scandinavian countries metabolic disorders are the most common cause of kidney stones. During the last two decades the introduction of extracorporeal shockwave lithotripsy (ESWL) has revolutionalized the management of urolithiasis. ESWL is now considered a safe noninvasive and effective method for treatment for urinary tract stones in adults and children. This report describes our experience in the management of childhood urolithiasis in the United Arab Emirates. (excerpt)

Extracorporeal shockwave lithotripsy for treatment of sialolithiasis of salivary glands

Following the clinical introduction of extracorporeal shockwave lithotripsy in the 1980s for the treatment of sialolithiasis of salivary glands this method has been widely used and replaced surgical interventions in selected patients. Between 1/1995 and 1/1999 35 patients were treated by extracorporeal shockwave lithotripsy (ESWL) with the "Minilith SL-1" lithotripter on an outpatient basis. Radiography and sonography were performed to verify sialolithiasis and scintigraphic investigation was done to control sufficient gland function. Treatment was performed in a fractionated manner with up to 3000 shockwaves per session, normally without anesthesia or analgosedation. After treatment 45.4 % of the patients with sialolithiasis of the parotid gland (n = 11) were stone-free and in 36.3 % an adequate desintegration of the stones was achieved. These patients underwent 2.6 sessions on average for sufficient stone-destruction. 41.6 % of the patients with sialolithiasis of the submandibular gland (n = 24) were stone-free and 3.1 sessions were necessary on average. Desintegration of the stones was achieved in 25 %. Mild pain, swelling, bleeding out of the intraoral orifice of the affected gland and skin petechia were the only complications. All patients were symptom-free after lithotripsy, although fragmented stones persisted in the parotid gland (18.3 %) and the submandibular gland (33.4 %). The advantages of ESWL are the relatively painless treatment and the elimination of the need for an operation with its surgical risks.

Intracorporeal Shock Wave Lithotripsy (ISWL) in Bile Ducts under Peroral Endoscopy: Progress and Current Status

Abstract:Attempting to use ISWL (intracorporeal shock wave lithotripsy) for treating large and difficult biliary stones was started in the mid 1970s, approximately 10 years before the introduction of ESWL (extracorporeal shock wave lithotripsy). However, in contrast to ESWL, ISWL did not quickly become popular in practise. The main reason for this delayed recognition, undoubtedly, lay in the technical difficulties of the peroral applications until the mid 1980s, when the development of an improved cholangios‐cope system and a thin, flexible probe allowed the use of EHL (electrohydraulic lithotripsy) under direct vision during peroral cholangioscopy. Thanks to recent advances in technology, a powerful pulsed laser has begun to be used for ISWL through a 0.2 mm sized quartz fiber. A laser version of ISWL with such a thin probe is expected to facilitate its use by minimizing the endoscope system. The automatic stone‐tissue recognition system which interrupts the laser discharge in case of wall contact is another useful advance in technology which increases the safety and therapeutic efficacy. Whereas laser techniques are still in development, ISWL with a laser will be the first choice technique for treating difficult bile duct stones after failure of mechanical lithotripsy and it also promises to improve its therapeutic efficacy for intrahepatic stones in combination with ESWL.In this article, the recent progresses and results of ISWL treatment were reviewed with a respect to the success of ESWL.