Number Of Extracorporeal Shock Wave Lithotripsy Sessions Research Articles

Assessment of pancreatic ductal stone density on non-contrast computed tomography for predicting the outcome of extracorporeal shock wave lithotripsy.

Background and study aims The utility of stone density at non-contrast computed tomography (NCCT) for predicting the effectiveness of extracorporeal shock wave lithotripsy (ESWL) in chronic calcific pancreatitis (CCP) is relatively unexplored. Patients and methods This was a prospective observational study of patients with CCP. Hounsfield units (HU) were determined for the largest pancreatic ductal stone during pretreatment NCCT. All patients underwent ESWL until the largest stone was fragmented to <3mm, followed by endoscopic retrograde cholangiopancreatography (ERCP) for stone extraction. The predictive factors following ESWL for successful stone extraction were studied and the receiver operating characteristic (ROC) curve determined the HU optimal cut-point. Results Eighty-two patients with a median (interquartile range) age of 36 years (range, 29-55); majority male 45 (54.9%), were included. Idiopathic CCP was noted in 78 patients (95.1%). The median stone density (SD) was 1095 HU (range, 860.7-1260.7) and the number of ESWL sessions was 2 (range, 2-3). Complete stone removal at index ERCP was achieved in 55 patients (67.1%). Those with partial clearance (n=27) needed a repeat ERCP, which was successful in 26 (96.3%); one patient (3.7%) underwent surgery. There was a significant, positive correlation between number of ESWL sessions and SD (r=0.797; P <0.001). On bivariate analysis, SD and the number of ESWL sessions revealed a significant association with complete ductal clearance. The optimal cut-point for complete stone removal by the ROC curve was 1106.5 HU (Youden index 0.726), with a sensitivity of 93% and a specificity of 80%. Conclusions The SD is a significant predictor of ESWL success followed by ductal clearance at ERCP, and <1106.5 HU is a predictor of good candidates for ESWL therapy.

Stenting versus non-stenting before extracorporeal shock wave lithotripsy for proximal ureteric stones: A prospective interventional study

Background: Extracorporeal shock wave lithotripsy (ESWL) has become the first-line treatment for stones in the upper urinary tract measuring &lt;2cm. It is the minor invasive treatment for calculi of the upper urinary tract. Aims and Objectives: This study aims to identify the effect of the presence and absence of a ureteric stent on the outcome of ESWL in patients with proximal ureteric stones. Materials and Methods: This was a prospective cohort study done on 300 patients and wasdivided into two equal groups of 150 each. Group A patients were selected for ESWL with DJ stent, and Group B patients werefor ESWL without DJ stent. Non-contrast CT KUB was done as a functional study along with plainX-ray KUB and ultrasound before the intervention. All treatments were done with Direx Compact XL (electromagnetic generator) device as an outpatient procedure. Patients were followed up radiographically at 15 days, 1 month, 2 months, and in 3 months. Hematuria, steinstrasse, fever, ureteric colic, lower urinary tract symptoms (LUTS), stone clearance, number of ESWL sessions, and secondary procedures were recorded for each group. DJ stent was taken out when the stone disappeared or at the end of 3 months. Variables were compared with Chi-square test. Results: The overall stone-free rate at 3 months was 90.6% (272/300). Clearance after the first sitting, second sitting, and the third sitting wasnot significant between the two groups(P&gt;0.05).There was no significant difference between the two groups in regard to clearance according to the size of the stones. A total of 9.3%(28/300) of patients did not have a successful outcome and were termed as ESWL failures. Post- ESWL complications were significant between the both groups in terms of hematuria and ureteric colic. All the ureteric colic patients had a stone size larger than 13 mm, P=0.0005, which was more in the non-stented (Group B) patients. Most of the lower urinary tract symptoms were seen in stented (Group A) patients, P&lt;0.0001 significant between the two groups, and dysuria was also significant between the two groups with P=0.0033. Conclusion: Pre-ESWL ureteral stenting provides no additional benefit over no stent in situ, although ureteral stents are associated with more irritative symptoms.

Factors related to the success rate of pediatric extracorporeal shock wave lithotripsy (ESWL) in Cipto Mangunkusumo Hospital: an 8-year single-center experience

BackgroundESWL is still considered as the first favorable therapeutic option for urinary stone disease with acceptable effectivity. However, factors associated with favorable outcome have not been widely studied in pediatrics due to the small number of urinary stone prevalence. The aim of this study is to evaluate the factors associated with the success rate of pediatric ESWL in our center according to immediate stone-free rate and 3-month stone-free rates.MethodsThis is a retrospective cohort study of children less than 18 years who had ESWL for urolithiasis from January 2008 until August 2015. Patient’s characteristics including age, gender, BMI, stone location, stone length, stone burden, stone opacity, and number of ESWL sessions were gathered from the medical record. Nutritional status was determined according to the Centers for Disease Control and Prevention BMI curve. The outcome of this study was the factors related to the success rate in pediatric ESWL.ResultsExtracorporeal shock wave lithotripsy was done for 36 patients and 39 renal units (RUs) with mean age of 13.7 ± 4.3 years old, height of 1480 ± 16.0 cm, and BMI of 20.0 ± 3. Of 36 patients included, 39 renoureteral units (RUs) and 46 ESWL sessions were recorded. The mean overall treatment was 1.2 ± 0.5 sessions with mean stone length of 11.1 ± 6.3 mm and stone burden of 116.6 ± 130.3 mm2. Within 3 months of follow-up, we recorded that the overall 3-month success rate was 100%, while the overall 3-month stone-free rate was 66.7%. Stone length (p < 0.001 and p < 0.001), stone perpendicular length (p < 0.001 and p < 0.001), and stone burden (p < 0.001 and p = 0.001) were found to be significantly associated with immediate success and 3-month stone-free status, respectively.ConclusionsESWL is an effective and safe modality to treat pediatric urolithiasis cases. Stone length, stone perpendicular length, and stone burden were found to be associated with immediate success and 3-month stone-free status after pediatric ESWL treatment.

Особенности и эффективность экстракорпоральной ударно-волновой литотрипсии у детей с использованием сонографического наведения

The aim of the study was to retrospectively evaluate the efficiency of extracorporeal shock wave lithotripsy (ESWL) with ultrasound guidance and the results of treatment of children with urolithiasis, of different age groups depending on the stone location and size. A total of 135 children and adolescents, aged from 1 to 18 years treated by ESWL at IZMIRLIAN Medical Center from 2005 to 2016 were enrolled in this study. Number, size and location of stones were evaluated. A total of 153 ESWL sessions were performed, including two sessions in 9 cases, three sessions in 1 case, and four sessions in 2 cases. Intra- and posttreatment stone fragmentation rate, number of ESWL sessions, shock-wave pulses per session, stone-free rate, and number of ancillary procedures depending on the stone location and size as well as radiation exposure were evaluated. Follow-up observation was performed after 14, 30 and 90 days. In most cases, there was a good stone fragmentation after ESWL. From 200 to 3000 low-energy pulses with a frequency 1-2 Hz and power of 30-50 units on Modulith SLK scale were delivered. Number of shock-wave pulses up to 1000, 2000 and 3000 was sufficient in 18.3%, 51.9% and 26.8% cases, respectively. SFR in children aged 1-5 years was 95.2%, compared to 100%, 100% and 83.7% in patients in the 6-10, 11-15 and 16-18 year age groups, respectively. Complete stone clearance was achieved in patients of 1-5 and 6-10 years after two weeks. In only one patient in the 11- to 15-year age group, all fragments passed after two weeks, while in 4 adolescents in the 16- 18-year age group SFR was achieved after more than 3 months. In addition, in other 3 patients in this age group ESWL was unsuccessful. Our results suggest high efficiency of ESWL under ultrasound guidance in children and adolescents. Absence of X-ray exposure, minimal complication rate, non-invasiveness and high efficiency allow to consider ESWL as a method of choice for the treatment of urolithiasis in children and adolescents.

Extra corporeal shock wave lithotripsy in renal and ureteric stones: an institutional experience

Introduction:Urolithiasis is one of the most common clinical conditions in the history of medicine. Treatment methods include conservative, surgical treatment and extracorporeal shock wave lithotripsy (ESWL). Several stone characteristics are known to affect outcome of ESWL such as fragility, Hounsfield unit, size, site, composition etc. No study has been done till now regarding the efficacy and safety of ESWL in eastern Indian patients. Objectives: To assess the efficacy and safety of ESWL in the management of patients with renal and ureteral stones. Methods: 112 outpatients were treated with ESWL. Stone size, location, total number of shockwaves, stone-free rate, complications and adjunctive interventions were investigated. Chi-Square and Logistic Regression analyses were used, with p<0.05 set as the level of significance. Result & Conclusion: The authors found significant association between the size and number of stones with fragmentation status. The authors found that stones of more than 11mm size are more resistant to ESWL. Authors found statistically significant association between the number of ESWL sessions with fragmentation status. However, more than 3 sessions also did not help much. It was also found that complications were more in partially fragmented group and more adjunctive procedures were required in partially fragmented group. The authors also noticed that the stented or non stented status and total number of shocks were not significantly associated with the fragmentation status of stones.

Quantitative factors of unenhanced CT for predicting fragmenting efficacy of extracorporeal shock wave lithotripsy on pancreatic duct stones

To find potential predictors at unenhanced computed tomography (CT) to evaluate the stone clearance rate (SCR) of pancreatic duct stones (PDS) by extracorporeal shock wave lithotripsy (ESWL). A total of 106 consecutive patients with multiple stones of maximal transverse length (MTL) 0.3-3.6 cm in pancreatic head region were enrolled. Unenhanced CT was performed both before and after ESWL therapy. All patients underwent ESWL therapy using an electromagnetic lithotripter, and were divided into three groups with threshold values of >90%, 50-90% and <50% of SCR. Factors including sex, age, MTL, mean stone density (MSD), standard deviation of stone density (SDSD), variation coefficient of stone density (VCSD), attenuation density (AD), pancreatic duct diameter (PDD), skin-to-stone distance (SSD), and number of ESWL sessions were analysed, and their impact on SCR was evaluated by univariate and multivariate analyses. The diagnostic threshold of the independent predicting index was further calculated, and its relationship with SCR and ESWL was analysed by drawing a trend line. The only significant predictor of SCR by ESWL was MSD (p<0.05). More courses of ESWL therapy are required in PDS patients with an MSD higher than the cut-off value of 375.4 HU (mean, 2.6 versus 1.8), but with a relatively lower SCR (mean, 43.96 versus 88.68%) . MSD on pre-treatment unenhanced CT is an independent predictor for SCR of PDS patients treated with ESWL. Using a cut-off value of 375.4 HU, patients with low MSD are good candidates for ESWL therapy.

Comparison of efficacy and safety of ESWL in paediatric and adolescent versus adult urolithiasis: A single center 5-year experience from a tertiary care hospital

ObjectiveTo retrospectively compare the efficacy and safety of extra-corporeal shock wave lithotripsy (ESWL) for renal/upper ureteric calculi in pediatric/adolescents (group 1) vs adults(group 2). Subjects and methodsMedical records of 948 patients who underwent ESWL for renal/upper ureteric calculi at a tertiary care center in North India from January 2012 to December 2017 (five years). The Dornier compact alpha-K1025163 (Dornier Med Tech) equipment was used for ESWL. We evaluated the stonefree rates, the number of ESWL sessions, use of ancillary procedures and complications between the two groups. ResultsA total of 110 patients were in group 1 and 838 patients were in group 2. The mean stone size in group 1 patients was 1.20±1.18cm2 while in group 2 it was 1.49±0.37cm2. The stone clearance rate was 85/110 (77%) for the group 1 and 545/838(65%) for group 2 patients. In group 1, a second session was required in 28/110 (25.4%) patients and the third session was required in 5/110 (4.5%) patients while in the adult group two sessions were required in 175 (20.8%) and three sessions were required in 24 (19.2%) patients. The overall complication rate in group 1 was 15/110 (13.63%) and in the group, II was 105/838 (12.5%). No statistical difference was found between post-ESWL complications and use of ancillary procedures (DJ stenting/PCNL) (p=0.067). ConclusionIn renal/upper ureteric calculi ESWL has got better efficacy, comparable safety and requires equivalent ancillary procedures in children and adolescents compared to adults.

MP62-11 EXTRACORPOREAL SHOCK-WAVE LITHOTRIPSY (ESWL) FOR RENAL STONES IS ASSOCIATED WITH DECREASED KIDNEY FUNCTION AFTER LONG TERM FOLLOW-UP

You have accessJournal of UrologyStone Disease: Shock Wave Lithotripsy1 Apr 2017MP62-11 EXTRACORPOREAL SHOCK-WAVE LITHOTRIPSY (ESWL) FOR RENAL STONES IS ASSOCIATED WITH DECREASED KIDNEY FUNCTION AFTER LONG TERM FOLLOW-UP Christian Fankhauser, Josias Grogg, Alexander Holenstein, Qing Zhong, Johann Steurer, Thomas Hermanns, Tullio Sulser, and Cédric Poyet Christian FankhauserChristian Fankhauser More articles by this author , Josias GroggJosias Grogg More articles by this author , Alexander HolensteinAlexander Holenstein More articles by this author , Qing ZhongQing Zhong More articles by this author , Johann SteurerJohann Steurer More articles by this author , Thomas HermannsThomas Hermanns More articles by this author , Tullio SulserTullio Sulser More articles by this author , and Cédric PoyetCédric Poyet More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1942AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Beside well characterized short term adverse effects of extracorporeal shock wave lithotripsy (ESWL) for the treatment of renal stones, concerns regarding long term adverse effects to the kidneys or adjacent organs (e.g. pancreas) were raised. We aimed to analyze whether ESWL applied to the kidneys is associated with decreased kidney function, hypertension or diabetes during long term follow-up. METHODS All patients with urolithiasis treated by ESWL at our tertiary care center between 1992 and 2013 were retrospectively identified. Cases consisted of patients treated by ESWL because of kidney stones (kidney group). Patients with distal ureter stones treated by ESWL served as a control group. Patients treated by ESWL for upper or middle ureter stones or patients treated for both, kidney and distal ureter stones were excluded. In 2016, a questionnaire was sent to all patients to assess the prevalence of decreased kidney function, hypertension and diabetes. The Swiss Health Survey data set (n=21,597) providing population data for hypertension and diabetes but not decreased kidney function was used as an additional comparison group. RESULTS Of 7108 identified patients, 2,776 (39%) met the inclusion criteria. Follow-up questionnaires were returned by 764 (28%) patients of which 585 (77%) questionnaires belonged to the kidney group, and 179 (23%) to the distal ureter group. Median time between first ESWL and returned questionnaire was 12 years (8-18 years) for the kidney group and 16 years (IQR 11-20 years) for the control group. There was no significant difference between the kidney group and the control group regarding age (mean 62+-14 vs. 64+-14, p=0.252), gender (female 34% vs. 28%, p=0.123) and BMI (mean 26+-4 vs. 26+-4, p=0.687). However, in the kidney group more number of ESWL sessions were observed compared to the control group (1 [IQR 1-2] vs. 1 [IQR 1-1], p<0.001). Furthermore the prevalence of decreased kidney function in the kidney group was significantly higher compared to the control group (8.3% vs. 2.9%, p=0.015). The kidney group, control group and general population showed significant differences regarding prevalence of hypertension (47.5% vs. 49.4% vs. 27.5%, p<0.001) and diabetes (14.1% vs. 11.9% vs. 4.9%, p<0.001). In multivariable regression analyses controlling for age, gender and BMI, number of applied ESWL sessions to the kidneys was an independent predictor for decreased kidney function (OR 1.28, 95% CI 1.010 to 1.623, p=0.041) but not for hypertension or diabetes. CONCLUSIONS ESWL for renal stones may lead to decreased kidney function during long term follow-up. The association between increasing number of applied ESWL sessions and decreased kidney function at long-term follow-up supports a causal relationship. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e831 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Christian Fankhauser More articles by this author Josias Grogg More articles by this author Alexander Holenstein More articles by this author Qing Zhong More articles by this author Johann Steurer More articles by this author Thomas Hermanns More articles by this author Tullio Sulser More articles by this author Cédric Poyet More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP62-04 IDENTIFICATION OF THE RECOMMENDED TECHNIQUES, CASE SELECTION, AND INVENTION TO IMPROVE EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY SUCCESS RATES

You have accessJournal of UrologyStone Disease: Shock Wave Lithotripsy1 Apr 2017MP62-04 IDENTIFICATION OF THE RECOMMENDED TECHNIQUES, CASE SELECTION, AND INVENTION TO IMPROVE EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY SUCCESS RATES Atsushi Okada, Teruaki Sugino, Rei Unno, Kazumi Taguchi, Shuzo Hamamoto, Ryosuke Ando, Keiichi Tozawa, and Takahiro Yasui Atsushi OkadaAtsushi Okada More articles by this author , Teruaki SuginoTeruaki Sugino More articles by this author , Rei UnnoRei Unno More articles by this author , Kazumi TaguchiKazumi Taguchi More articles by this author , Shuzo HamamotoShuzo Hamamoto More articles by this author , Ryosuke AndoRyosuke Ando More articles by this author , Keiichi TozawaKeiichi Tozawa More articles by this author , and Takahiro YasuiTakahiro Yasui More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1935AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We previously reported that the success rates of extracorporeal shock wave lithotripsy (ESWL) were increased from 66.3% to 87.2% by technical training (Okada et al. Urolithiasis 2013). In the present study, we analyzed how the technical skills acquired by this training directly affected subsequent ESWL results. METHODS Among 335 ESWL treatments performed at Nagoya City University Hospital from December 2011 to August 2016, we analyzed the 324 cases that could be evaluated by CT three months post-ESWL treatment. All 17 urologists in charge of treatment attended the technical training. We analyzed associations between success rate and the following parameters: patient factors (age and body mass index), kidney stone factors (size, CT value, constituents, intervening period and skin-to-stone distance), conformity to the recommended techniques from training, number of ESWL sessions, grade of hydronephrosis, indwelling of ureteral stents, therapeutic position, use of stretcher wedges, targeting methods, air removal between cushion and skin, type of ESWL apparatus (Gemini or Lithotripter S, Dornier MedTech, Japan), shock wave frequency, and period from apparatus adjustment (stone model tests). The techniques recommended in training were 1) combined use of fluoroscopy and ultrasonography for targeting renal and proximal ureter stones, 2) use of stretcher wedges for middle ureter stones, and 3) semi-supine position with stretcher wedges for distal ureter stones. RESULTS The average total success rate was 84.3% over the study period. Average conformity to the training techniques was 80.2%, and the average success rates of the conformity and nonconformity groups were 86.2% and 76.6%, respectively (p<0.0001). There was a significant difference in the success rates between the types of apparatuses used, where the Gemini group success rate was 90.1% and the Lithotripter S group success rate was 82.0% (p<0.0001). The number of the selected cases with conformity of the recommended techniques, air removal, low CT values (≤1000HU), appropriate stone size (≤10mm), and the first therapy were 90 and their success rate was 95.6%. CONCLUSIONS Conforming to recommended techniques, air removal, and appropriate case selection can all lead to higher success rates in ESWL. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e828-e829 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Atsushi Okada More articles by this author Teruaki Sugino More articles by this author Rei Unno More articles by this author Kazumi Taguchi More articles by this author Shuzo Hamamoto More articles by this author Ryosuke Ando More articles by this author Keiichi Tozawa More articles by this author Takahiro Yasui More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Effects of hydrochlorothiazide on kidney stone therapy with extracorporeal shock wave lithotripsy.

Objective:The aim of this investigation was to assess the efficacy of hydrochlorothiazide as a hypocalciuric diuretic on stone-free rate of renal pelvic calculi after extracorporeal shock wave lithotripsy (ESWL).Materials and Methods:A double-blind, placebo-controlled randomized clinical trial was conducted and 52 patients with renal pelvic calculi (diameter ≤2 cm) were enrolled from February 2010 to September 2010. ESWL protocol was performed by 2,500 shocks per session. The patients were randomized into two groups: (1) 26 patients who were given 25 mg hydrochlorothiazide twice daily; and (2) 26 patients who received placebo. The stone-free rate was defined as residual calculus size ≤4 mm in controlled ultrasound on 2nd week, 1 month and 3 months after ESWL.Results:19 (78%) of the first group and 9 (42.9%) of the second group were stone-free after one session of ESWL (P = 0.02). 88% of the group 1 and 47.8% of the group 2 were stone-free on 1 month after ESWL (P = 0.003); however, this effect of hydrochlorothiazide was not related to the patients' body mass index, age and gender. The accessory treatment procedures were applied in 24% of the group 1 compared with 19% of the group 2 during 3 months (P = 0.68). All patients in both groups were stone-free on 3 months following lithotripsy.Conclusions:Hydrochlorothiazide did not impact on the stone-free rate and using accessory procedure within 3 months; however, it decreased duration of stone-free status and number of ESWL sessions.

Efficacy of alfuzosin after shock wave lithotripsy for the treatment of ureteral calculi.

PurposeWe evaluated the efficacy of alfuzosin for the treatment of ureteral calculi less than 10 mm in diameter after extracorporeal shock wave lithotripsy (ESWL).Materials and MethodsA randomized, single-blind clinical trial was performed prospectively by one physician between June 2010 and August 2011. A total of 84 patients with ureteral calculi 5 to 10 mm in diameter were divided into two groups. Alfuzosin 10 mg (once daily) and loxoprofen sodium 68.1 mg (as needed) were prescribed to group 1 (n=41), and loxoprofen sodium 68.1 mg (as needed) only was prescribed to group 2 (n=44). The drug administration began immediately after ESWL and continued until stone expulsion was confirmed up to a maximum of 42 days after the procedure.ResultsThirty-nine of 41 (95.1%) patients in group 1 and 40 of 43 (93.0%) patients in group 2 ultimately passed stones (p=0.96). The number of ESWL sessions was 1.34±0.65 and 1.41±0.85 in groups 1 and 2, respectively (p=0.33). The patients who required analgesics after ESWL were 8 (19.5%) in group 1 and 13 (30.2%) in group 2 (p=0.31). Visual analogue scale pain severity scores were 5.33±1.22 and 6.43±1.36 in groups 1 and 2, respectively (p=0.056). The time to stone expulsion in groups 1 and 2 was 9.5±4.8 days and 14.7±9.8 days, respectively (p=0.005). No significant adverse effects occurred.ConclusionsThe use of alfuzosin in combination with ESWL seems to facilitate stone passage and to reduce the time of stone expulsion but does not affect the stone-free rate.

Semirigid Laser Ureterolithotripsy for Single Large Renal Pelvic Stones

Background and purpose: Large stones located at the renal pelvis are usually managed with Percutaneous Nephrolithotomy (PCNL); however this procedure carries both a substantial morbidity and a considerable risk for complications. Our objective was to assess the safety and efficacy of semirigid ureteroscopy (S-URS) and laser lithotripsy for the treatment of single large (>1.5 cm) pelvic stones. Patients and methods: Twenty patients (12 women and 8 men, aged 54-72 years) with isolated renal pelvic stone (mean size: 2.1 cm, range: 1.5-3 cm) underwent S-URS under general anaesthesia, over a 2-year period (January 2010 to January 2012). Holmium:yttrium-aluminum-garnet (Ho:YAG) laser was used for the stone fragmentation. In all cases the ureters were stented following completion of the operation. Preoperative data as well as stone-free rate, operative time and associated complications were retrospectively evaluated. Results: In 17 patients (18%; 12 women and 5 men) the stones were accessible with S-URS. The mean operative time was 69.4 min (37.2-94.5). There were no major complications, however 2 female patients developed fever due to Urinary Tract Infection (UTI) in the early postoperative period. The stone-free rate (assessed with X-ray) following S-URS was 70.6% on the 1st postoperative day and increased to 82.3% after 1 month. The mean hospitalization period was 1.4 (1.1-4.3) days. Adjuvant Extracorporeal Shockwave Lithotripsy (ESWL) was performed in 3 patients with residual stones (mean number of ESWL sessions: 1.5). Multivariate analysis revealed that only sex (female vs. male) significantly influenced the results, in favor of the females. Conclusions: S-URS is an effective and safe alternative treatment for single large (>1.5 cm) renal pelvic stones, especially in female patients.

THE OUTCOME OF EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY IN MANAGEMENT OF RESIDUAL KIDNEY STONES AFTER THE FIRST TREATMENT OF THE UPPER URINARY TRACT CALCULUS

Introduction: The aim of this study is to assess the efficiency of extracorporeal shock wave lithotripsy (ESWL) in the treatment of residual kidney stones after the first treatment of the upper urinary tract calculus. Patients and Methods: 110 patients with residual kidney stones were treated with a MZ.ESWL.VI lithotripter. They were analyzed with regard to stone size, number of stones, number of ESWL sessions, retreatment rates, stone free rates. Results: 68,2% of patients became stone free within 3 months after ESWL with the average number of 3,44 sessions of treatment. No complication has occurred during all treatment. Conclusion: ESWL is an effective method in managing the residual kidney stones after the first treatment of the upper urinary tract calculus.

Extracorporeal Shock-Wave Lithoptripsy for Pancreatic Calculi: A 10-year Experience at a Single U.S. Center

8.51, 24.89) months respectively (p=0.0267). Conclusion: Additional EPDBD before pancreatic stent insertion may be an effective method for reducing recurrence of pain or attack of acute pancreatitis in patients undergoing endoscopic treatment of PD stricture. *T1525 Extracorporeal Shock-Wave Lithoptripsy for Pancreatic Calculi: A 10-year Experience at a Single U.S. Center Lee McHenry, James L. Watkins, Kenyon Kopecky, Evan L. Fogel, Chi-Liang Cheng, Anne E. Kochell, Lee Ann Shelly, Stuart Sherman, Suzette Schmidt, Thomas J. Howard, Laura Lazzell-Pannell, Glen A. Lehman Background: Extracorporeal shock-wave lithotripsy (ESWL) for pancreatic calculi has been utilized for the non-surgical management of chronic calcific pancreatitis over the past 15 years. The technique and success of ESWL in facilitating partial or complete clearance of pancreatic stones varies between institutions. We report our IndianaUniversity experience of ESWL for pancreatic duct calculi over the past 10 years. Method: A retrospective review of our lithotripsy database from 01/93-11/03 was performed. During this 10 year period, three types of lithotriptors were utilized, including Wolfe ultrasound image piezoelectric lithotriptor (1993-1998) (n=34), Dornier fluoroscopic image sparkgap lithotriptor (1993-2001) (n=42) and Healthtronics Lithotron fluoroscopic image spark-gap lithotriptor (1999-2003) (N=118). The type of lithotriptor, number of sessions, number of sessions per patient, and the complete, partial, or failed clearance of calculi were analyzed. Clearance of main pancreatic duct stones was assessed by the endoscopists at subsequent ERCP. Clearance was defined as complete; (all or >95% of main duct stone burden cleared), partial; (50-95% cleared), and failed; (<50%cleared). Results: A total of 184 patients (106M: 78 F, mean age 51.5 yrs, range 7-87 yrs) underwent a total of 314 ESWL sessions (mean 1.7 sessions per patient; range 1-6 sessions). The number of ESWL sessions per patient varied between lithotriptors: Wolfe 2.6 sessions/patient, Dornier HM-3, 1.5 sessions/patient, and Healthtronics Lithotron 1.3 sessions/patient. Of the 184 patients who underwent ESWL, 174 patients had adequate assessment at followup pancreatography. Complete clearance of main pancreatic duct stones was achieved in 76 patients (44%), partial clearance in 74 patients (42%), and failed clearance in 24 patients (14%). Complete clearance rates were highest with the Dornier (50%) and Healthtronics (42%) spark-gap lithotriptors. Conclusions: ESWL effectively fragments pancreatic stones to allow for complete or partial clearance in 86% of patients. The impact of ESWL in facilitating the complete or partial clearance of pancreatic stones on long-term pain relief in painful chronic calcific pancreatitis requires further investigation.

Outcome and Safety of Extracorporeal Shock Wave Lithotripsy as First-Line Therapy of Lower Pole Nephrolithiasis

Introduction: The aim of this study is to assess the efficiency of extracorporeal shock wave lithotripsy (ESWL) as initial therapy for isolated lower pole kidney stones smaller than 20 mm. Patients and Methods: During a 24-month period 116 patients with previously untreated single stones under 20 mm in diameter were treated with a Dornier lithotripter S. They were analyzed with regard to stone site and size, number of ESWL sessions, auxiliary measures, retreatment rates, complications and the time taken for stone clearance. Results: 76 patients (65.5%) became stone free, 50 of them (43.1%) within 3 months after ESWL. Depending on stone size the stone-free rates were 67.1% for patients with a stone diameter of <10 mm (59 of 88 patients), and 60.7% for stone diameters between 10 and 20 mm (17 of 28 patients). Complications during and after treatment were rare, i.e. the necessity of ureteral stent insertion due to colic (n = 10), endoscopic stone removal (n = 2), acute pyelonephritis (n = 1), stonestreet (n = 1) and 1 case of hematoma not requiring intervention. The recurrence rate during follow-up (13.2–36.9, mean 25.0 months) was low: 16 patients (13.8%) had recurrent or persistent stones, and 74 patients (63.8%) had no evidence of urolithiasis. Conclusions: ESWL is a safe and efficient first-line therapy for treatment of isolated small lower pole kidney stones with acceptable stone-free rates, low morbidity, few complications and a low stone recurrence rate.

Extracorporeal Shock Wave Lithotripsy for Lower Pole Nephrolithiasis: Efficacy and Variables That Influence Treatment Outcome

Objectives. Extracorporeal shock wave lithotripsy (ESWL) for the treatment of lower caliceal stones (LCS) tends to have a poor success rate, prompting many urologists to advocate alternative treatment modalities. This study attempts to identify variables that may influence the outcome of ESWL treatment for LCS to help in selecting patients that are likely to benefit from the treatment. Methods. One hundred forty-two patients with isolated LCS treated with the Dornier HM3 lithotriptor were reviewed. The study data include characteristics of patients, stones, urinary tract treated, previous treatment of stones in the same kidney, and details of the ESWL treatment. Results. Eighty patients (56%) were stone free 3 months after ESWL. Multivariate analysis with logistic regression identified six independent and significant variables that influenced treatment outcome: these included number of stones ( P = 0.001), previous percutaneous nephrostolithotomy (PNL) treatment ( P = 0.001), side of the stone ( P = 0.002), presenting stone type ( P = 0.004), number of ESWL sessions ( P = 0.01), and maximum kilovoltage setting of ESWL at treatment ( P = 0.02). Stone size did not influence the treatment outcome in this study. Conclusions. ESWL provides an acceptable first line treatment for patients with LCS. Patients who fail ESWL and have poor prognostic features (ie, multiple LCS, hard stones requiring high voltage and multiple ESWL sessions, lower caliceal stone formation secondary to ESWL treatment of stones in other locations of the renal unit, or previous treatment with PNL) should be counseled for alternative treatment modalities.

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.