Lithotripsy Sessions Research Articles

The Effect of Tamsulosin and Combination of Terpenes (Rowatinex) on the Clearance of Renal Stone Gravels After Single Session of Extracorporeal Shock Wave Lithotripsy (ESWL)

The Effect of Tamsulosin and Combination of Terpenes (Rowatinex) on the Clearance of Renal Stone Gravels After Single Session of Extracorporeal Shock Wave Lithotripsy (ESWL)

Monitoring the Coupling of the Lithotripter Therapy Head With Skin During Routine Shock Wave Lithotripsy With a Surveillance Camera

With lithotripters today the shock waves are typically transmitted into the body via water filled bellows using coupling gel to make contact with the skin. Usually the coupling zone is not visible to the operator. We investigated coupling quality during routine clinical shock wave lithotripsy and the associated effect on shock wave disintegration efficiency. During 30 routine shock wave lithotripsy treatments the coupling zone was continuously monitored by a video camera integrated into a DoLi SII lithotripter (Dornier MedTech, Wessling, Germany). However, it was not shown to the blinded operator to resemble the standard clinical situation. We used 3 coupling gels, including LithoClear®, Sonogel® and a custom-made gel of low viscosity. The ratio of air in the relevant coupling area was measured. Lithotripter disintegration efficiency was evaluated by in vitro model stone tests at an air ratio of 0%, 5%, 10% and 20%. Only in 10 of 30 treatments was good coupling achieved with an air ratio of less than 5%. In 8 treatments the ratio was greater than 20%. The best coupling conditions were achieved with low viscosity gel. The mean ± SD number of shock waves needed for complete fragmentation in the model stone tests was 100 ± 4 for bubble-free coupling, and 126 ± 3 for 5%, 151 ± 8 for 10% and 287 ± 5 for 20% air bubbles. At 20 of 30 shock wave lithotripsy sessions there was imperfect coupling, accompanied by significant loss of disintegration capability. A surveillance camera is useful to monitor and improve coupling.

Adjuvant Tamsulosin or Nifedipine After Extracorporeal Shock Wave Lithotripsy for Renal Stones: A Double Blind, Randomized, Placebo-controlled Trial

To evaluate the effects of the adjuvant use of tamsulosin or nifedipine after extracorporeal shock wave lithotripsy for nonlower pole kidney stones 5-20 mm in size. We conducted a randomized double-blind trial involving 136 patients with radiopaque kidney stones. The patients received daily treatment with 0.4 mg tamsulosin, 20 mg nifedipine retard, or placebo for ≤30 days after 1 session of extracorporeal shock wave lithotripsy. Success was defined as plain film radiography showing the patient was completely stone free or with asymptomatic stone fragments ≤4 mm in size at any time during the weekly follow-up. The success rate was 60.5% (23 of 38) in the tamsulosin group, 48.6% (17 of 35) in the nifedipine group, and 36.8% (14 of 38) in the placebo group (P = .118). In the subgroup analysis, stones 10-20 mm had significantly greater success rates in the tamsulosin (13 of 21, 61.9%) and nifedipine (15 of 25, 60%) groups compared with the placebo group (6 of 23, 26.1%; P = .024), but not for stones 5-9 mm (P = .128). The number needed to treat was 2.9 for tamsulosin and 3 for nifedipine. Adverse events were more frequent in the nifedipine than in the placebo group (28.5% vs 2.6%, respectively, P = .009), but without a significant difference between the nifedipine and tamsulosin (28.5% vs 15.8%, P = .15) or the tamsulosin and placebo (P = .54) groups. No difference was found among the groups with regard to pain intensity, interval to clearance, or steinstrasse. The stone-free rates after extracorporeal shock wave lithotripsy with adjuvant tamsulosin or nifedipine were significantly increased only for nonlower pole renal stones 10-20 mm in size compared with placebo. Nifedipine was associated with more adverse effects than placebo.

STONE-FREE RATE DIFFERENCES IN KIDNEY STONES PATIENTS WITH AND WITHOUT TAMSULOSIN AFTER ESWL

Objective: To determine whether the administration of tamsulosin, as adjunctive medical therapy, increases the efficacy of one session of extracorporeal shock wave lithotripsy (ESWL) to treat renal stones. Material & Method: A prospective randomized placebo controlled study enrolled 21 patients. They underwent a single ESWL session to treat solitary radiopaque renal stones 4 to 20 mm in diameter. After ESWL, the study group (11) received 0,4 mg tamsulosin daily and the control group (10) received placebo until stone clearance or a maximum period of 8 weeks. The primary endpoint was stone-free rate and parameters were stone size and clearance time. Results: The overall stone-free rate was better in the study group than in the control group (90,9% vs. 60,0%). The clearance time after 2, 4, 6 and 8 weeks was greater in the study group than in the control group (36,4%; 63,6%; 72,7% and 90,9% vs 30,0%; 50,0%; and 60,0% respectively) but statistically insignificant. Conclusion: Clinically, the results of our study have demonstrated that tamsulosin therapy, as an adjunctive medical therapy after ESWL, is more effective than lithotripsy alone for the treatment of patients with renal stones.
 Keywords: ESWL, tamsulosin, medical expulsive therapy, renal stones.

Laparoscopic Pyelolithotomy in Selected Patients with Ectopic Pelvic Kidney: A Feasible Minimally Invasive Treatment Option

Ectopic pelvic kidney is a rare congenital anomaly. It carries more risks for obstruction and stone formation than a normal located kidney. The treatment of renal stones in these patients is challenging. We present our experience with laparoscopic pyelolithotomy for treatment of selected patients with large and multiple renal stones in ectopic pelvic kidneys. After insertion of a ureteral catheter, pneumoperitoneum was achieved by Veress needle, and the kidney was exposed. The renal pelvis was identified, dissected, and opened. The stones were extracted using laparoscopic forceps. The rigid nephroscope was used to extract any caliceal stones. The renal pelvis was sutured, and the stones were removed from the peritoneal cavity. The procedure was concluded after placement of an intraperitoneal drain. A total of 11 patients with large renal pelvic and/or multiple stones underwent laparoscopic transperitoneal pyelolithotomy. A transmesenteric approach was used in eight patients while the colon was mobilized off the kidney in three patients. All stones were removed except one that needed Double-J stent placement and one session of shockwave lithotripsy. After one auxiliary procedure, the stone-free rate was 100%. There were no major intraopertive or postoperative complications. Within a mean follow-up period of 23 months, no stone recurrence occurred. Laparoscopic pyelolithotomy for large and multiple stones in ectopic pelvic kidneys is a feasible minimally invasive treatment option. The technique allows removal of all the stones without fragmentation, which may decrease the possibility for rapid stone recurrence.

Management of Pediatric Urolithiasis Induced by Melamine-contaminated Powdered Formula (Report of 619 Cases)

To investigate the clinical features and therapeutic efficacy in children with urolithiasis caused by ingestion of melamine-contaminated powdered formula. The clinical presentation, laboratory data, ultrasound findings, and treatment methods used for 619 children with melamine-induced urolithiasis were retrospectively recorded and analyzed. The efficacy of the treatment in these children was summarized and evaluated. A total of 619 children aged 1-88 months were included in the present study (mean age 16.32 months). The male/female ratio was 1.9:1. Of the 619 patients, 577 received conservative treatment and 454 became stone free (78.7%). Of the 151 patients with renal and/or ureteral stones, 1-6 sessions of extracorporeal shock wave lithotripsy were performed in 81 patients (61 successful [35.5%] of 172 sessions) and retrograde ureteral catheterization in 70 patients (56 successfully treated [80.0%]). In centers without expertise in minimally invasive medical techniques, 5 patients with bilateral obstructive renal failure were successfully treated with ureteral lithectomy (n = 4) and percutaneous nephrostomy (n = 1). For the remaining 27 children with refractory renal or ureter stones, 9 were successfully treated with percutaneous nephrolithotomy and 18 children underwent ureteroscopic lithotripsy to become stone free. A total of 22 bladder and/or urethral stones were successfully treated with cystoscopic lithotripsy. Most children with melamine-induced urolithiasis were treated successfully with an infusion of fluids, urine basification, and diuresis. Extracorporeal shock wave lithotripsy is a safe and effective technique for patients in whom conservative treatment fails. However, for patients who have presented with obstructive renal failure, surgical intervention should be considered as early as possible to relieve the obstruction.

EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY

Aim and Objectives: (1) To determine the efficacy of extra-corporeal shock wave lithotripsy with reference to stone size, site and radiodensity in children. (2) To determine acute early complications during and following extra-corporeal shock wave lithotripsy in children. Study Design: Analytical case series study. Material and Methods: Fifty patients of either sex below the age fourteen (14 years) having renal, ureteric and bladder stones between 5-20 mm in size along with their long axis presented to department of urology Shaikh Zayed Hospital Lahore during the period of one year extending from 02-02-2008 to 02-02-2009 were included in this study. Children with serum creatinine level greater than or equal to 3mg/dl, obstruction distal to the stone, patient with active bleeding disorders, uncorrected hypertension, patient unfit for general anaesthesia, untreated urinary tract infection and patients with gross anatomical anomaly were excluded from study. All the patients were given shock waves under intravenous sedation or general anaesthesia in a standard manner on out door basis. All the children were evaluated for stone clearance and early complications at first 24-72 hours. At the end of three months ESWL treatment was considered successful, if the patients were stone free or had residual fragments 4 mm or less in size. Results: Out of the fifty patients, 40 (80%) were males and 10 (20%) females with male to female ratio of 4.1. The age range of patients was 2-14 years (mean ± SD 9.24±3.48 years). Thirty three patients (66%) had renal stones, 7 (14%) ureteric and 10 patients (20%) had bladder stones. Single successful treatment session was noted in 22 patients (44%), 18 patients (36%) received two sessions and 10 patients (20%) required three sessions for successful stone fragmentation.Seventeen patients did not show stone clearance even after three sessions within three months follow-up. Twenty one patients (42%) felt pain after lithotripsy session, and they were given injectable analgesia and the pain settled, haematuria in 17 patients (34%), impacted stone in five (10%), ureteric colic and urinary tract infection in three, three cases respectively and only one case developed steinstrasse. Twenty patients(40%) developed minor complications of anaesthesia, like nausea, vomiting which relieved with injectable antiemetics.

Pain Perception During Shock Wave Lithotripsy: Does It Correlate With Patient and Stone Characteristics?

To investigate the correlation of various clinical parameters [number of shock wave lithotripsy (SWL) sessions, body mass index, patient age, gender, and stone characteristics] with pain perception during the SWL procedure. A total of 88 patients who underwent 165 SWL sessions for renal or ureteral stones in our institution were included in the study. The degree of pain perception during the procedure was evaluated with a 10-point visual analog scale. A significant p value was reached when the cut-off value for stone burden was taken as 100 mm(2). Mean pain scores during the SWL procedures were affected by gender and the number of SWL sessions. However, they were not affected by laterality, patient age, body mass index, and location of stones. Our results suggest that patient comfort is better during the first SWL session than in the following sessions for renal or ureteral stones with a stone burden of less than 100 mm(2). In addition, severity of pain during SWL treatment may be better tolerated in males than in females.

Preoperative Stone Attenuation Value Predicts Success After Shock Wave Lithotripsy in Children

We determined whether stone attenuation can predict stone fragmentation after shock wave lithotripsy in the pediatric population. Previous studies show that preoperative attenuation in HU on noncontrast computerized tomography predicts shock wave lithotripsy success. To our knowledge study of this parameter in the pediatric population has been lacking to date. We performed a multi-institutional review of the records of 53 pediatric patients 1 to 18 years old who underwent shock wave lithotripsy for 3.8 to 36.0 mm renal calculi. Stone size, average skin-to-stone distance and attenuation value were determined by bone windows on preoperative noncontrast computerized tomography. Success was defined as radiographically stone-free status at 2 to 12-week followup after a single lithotripsy session without the need for further sessions or ancillary procedures. After lithotripsy 33 patients (62%) were stone-free and 20 had incomplete fragmentation or required additional procedures. Mean ± SD stone attenuation in successfully treated patients vs those with incomplete fragmentation was 710 ± 294 vs 994 ± 379 HU (p = 0.007). Logistical regression analysis revealed that only attenuation in HU was a significant predictor of success. When patients were stratified into 2 groups (less than 1,000 and 1,000 HU or greater), the shock wave lithotripsy success rate was 77% and 33%, respectively (p <0.003). Stone attenuation less than 1,000 HU is a significant predictor of shock wave lithotripsy success in the pediatric population. This finding suggests that attenuation values have a similar predictive value in the pediatric population as that previously reported in the adult population.

Evaluation of Renal Function in Children Undergoing Extracorporeal Shock Wave Lithotripsy

The effect of extracorporeal shock wave lithotripsy on the growing kidneys of young children has always been a concern. We determined whether shock wave lithotripsy causes renal parenchymal scarring or affects glomerular filtration rate in children. This prospective study included 100 children with renal stones who presented to the shock wave lithotripsy unit at our institution between March 2005 and March 2008. A total of 28 children had multiple stones in the same kidney. All children with bilateral renal stones had 1 kidney cleared of stones by percutaneous nephrolithotomy before undergoing shock wave lithotripsy. A total of 138 stones were subjected to shock wave lithotripsy. All children underwent radionuclide scan of the renal parenchyma using dimercapto-succinic acid, and glomerular filtration rate was estimated using diethylenetriamine pentaacetic acid before extracorporeal shock wave lithotripsy and 6 months afterward. Children with renal scarring due to previous surgery or vesicoureteral reflux were excluded from the study. The number of shock wave lithotripsy sessions to achieve stone-free status and the dose of shock waves used were recorded for each patient. No patient demonstrated renal parenchymal scarring on dimercapto-succinic acid scan or any statistically significant change in glomerular filtration rate on diethylenetriamine pentaacetic acid scan up to 6 months after shock wave lithotripsy. Shock wave lithotripsy is a safe modality for treating renal calculous disease in children up to 16 years old, with no impact on long-term kidney function.

Greater and Lesser Ischiadic Foramina as Path of Shock Wave Lithotripsy for Distal Ureteral Stone in Children

We evaluated the efficacy and safety of shock wave lithotripsy in the supine position through the greater and lesser ischiadic foramina as a path of shock wave to treat distal ureteral stones in young children. We treated 22 young children with distal urinary calculi using the Dornier Compact S lithotriptor between 1997 and 2007. The study population consisted of 15 boys and 7 girls 6 months to 7 years old (mean +/- SD 5.4 +/- 2.1 years). Stone size ranged from 5 to 16 mm (mean 6.8). All patients were treated in the supine position under dissociative anesthesia with ketamine. The focused shock wave targeted the stone in the distal ureter through the greater and lesser ischiadic foramina. Number of shocks ranged from 600 to 3,000 (mean +/- SD 2,346.2 +/- 483.7). Energy per pulse ranged from level 4 to 5 (mean 4.5). Treatment time varied from 20 to 40 minutes (mean 31). Stone-free rate at 2 weeks after lithotripsy was 77.3%, which increased to 100% at 3 months after a single lithotripsy session. No serious side effects were observed. Shock wave lithotripsy in the supine position through the greater and lesser ischiadic foramina as the path of shock wave treats distal ureteral stones in young children with an excellent success rate and few side effects.

Safety of Shock Wave Lithotripsy for Treatment of Pediatric Urolithiasis: 20-Year Experience

This retrospective study was designed to assess the impact of shock wave lithotripsy on the pediatric kidney using pretreatment and posttreatment (99m)technetium dimercapto-succinic acid renal scintigram. A total of 182 patients 5 months to 19.8 years old (mean 5.3 years) were treated for renal calculi with shock wave lithotripsy during a 20-year period. Pretreatment evaluation included clinical assessment, urine culture, renal ultrasound and plain abdominal radiograph with or without excretory urogram. Dimercapto-succinic acid scintigram was performed before and 6 months after completion of treatment in 94 patients (52%). Patients underwent 1 to 4 sessions of shock wave lithotripsy per kidney with at least 1 month between treatments. Median number of shocks delivered per session was 3,000 (IQR 2,601 to 3,005). No new scars were observed on any posttreatment dimercapto-succinic acid scan. Regarding renal function, patients fell into 1 of 4 groups. Group 1 (66 patients, 70%) had normal function on dimercapto-succinic acid scan before and after treatment, group 2 (18, 19%) had decreased function in the affected kidney on pretreatment scan with no change after treatment, group 3 (2, 2%) had impaired function in the treated kidney that was transient (1) or permanent (1) and group 4 (7, 7%) had improved function in the treated kidney. Shock wave lithotripsy is an effective treatment for renal calculi in children. Renal parenchymal trauma associated with extracorporeal shock wave lithotripsy does not seem to cause long-term alterations in renal function or development of permanent renal scars in children.

Should Percutaneous Nephrolithotripsy Be Considered the Primary Therapy for Lower Pole Stones?

The efficacy of percutaneous nephrolithotripsy (PCNL) as a primary therapy for the treatment of lower pole caliceal lithiasis was determined. We reviewed 144 consecutive files of patients, over a period of 10 years, with noncomplicated lower pole calculi, who underwent PCNL after a single unsuccessful session of extracorporeal shockwave lithotripsy (SWL). The stone-free rate for stones less than 10 mm was 95%. A 97% rate was accomplished for stones between 11 and 20 mm and a 98% rate for stones larger than 20 mm. PCNL achieved a mean overall stone-free rate of 96.7% after a 3-month follow-up, regardless of stone size. PCNL outclasses SWL, when stratified by stone burden and lower pole location. No significant postoperative complications were encountered. PCNL is a safe and effective procedure for the management of lower pole caliceal calculi after a single unsuccessful SWL session. This procedure should be considered the primary method for the treatment of lower pole stones.

Is high diuresis an important prerequisite for successful SWL-disintegration of ureteral stones?

A randomised comparison was made between high and normal diuresis during the primary session of extracorporeal shock wave lithotripsy (SWL) for removal of ureteral stones. High diuresis was accomplished by pressure infusion of approximately 1 L of Ringer acetate solution together with 20 mg of furosemide during the 30-40 min treatment session (Group D). These patients also had a bladder catheter. Patients in Group 0 had a normal diuresis and no bladder catheter. The mean (SD) number of treatment sessions for the 65 patients in Group D were 1.26 (0.51) and for the 60 patients from Group 0 1.35 (0.84) [p > 0.10]. 51 (78%) and 46 (77%) patients in Group D and Group 0, respectively, required only one SWL session. Stones were located in the proximal, mid and distal ureter in 22, 9, and 29 of the patients in Group D and in 22, 5, and 38 in Group 0. No difference in treatment outcome was observed with regard to stone localisation. The stone treatment index (STI(GR)) calculated for Group D and Group 0 were 4.77 and 4.70, respectively. In conclusion there was no obvious advantage of using a forced diuresis during the primary SWL-session for treating patients with ureteral stones. Although a high diuresis and bladder catheter might be beneficial in certain complicated cases, in most situations it seems appropriate to omit this step.

Laparoscopic nephrolithotomy in a patient with crossed fused renal ectopia

A 32-year-old man was referred to a tertiary care center for stone management. The patient had initially presented to his primary physician 3 months earlier with right flank pain of 2 month's duration. Abdominopelvic ultrasonography and intravenous urography had revealed left-to-right crossed fused renal ectopia with a 25 mm opaque stone in the crossed kidney. The patient had received two sessions of extracorporeal shock wave lithotripsy, which had failed to remove the renal stone. Noncontrast CT, blood tests (hemoglobin and creatinine levels), abdominopelvic ultrasonography and intravenous urography. Left-to-right crossed fused ectopia with a 25 mm opaque renal stone in the anomalous kidney. The patient underwent laparoscopic nephrolithotomy to remove the renal stone. Intravenous urography and abdominopelvic ultrasonography 1 month after surgery confirmed that the patient was stone free and had functional renal units. The patient will be followed up every 3 months with abdominopelvic ultrasonography for early detection of stone recurrence.

Novel Electromagnetic Lithotriptor for Upper Tract Stones With and Without a Ureteral Stent

We compared the treatment efficacy and safety of the novel Lithoskop electromagnetic extracorporeal shock wave lithotriptor for upper urinary tract stones with and without prior ureteral stent placement. A total of 665 consecutive patients harboring single renal or ureteral stones underwent shock wave lithotripsy between August 2006 and July 2008. In 75 and 46 patients with renal and ureteral stones, respectively, stents were placed before the first shock wave lithotripsy session. Treatment outcome was assessed in relation to stent placement. All data were derived from a prospectively maintained database. The mean size of nonstented vs stented renal and ureteral stones was 8.6 vs 12.5 mm (p <0.0001) and 7.1 vs 7.3 mm (p = 0.6), respectively. The stone-free rate in nonstented vs stented renal and ureteral stone cases was 76.3% vs 77.3% and 91.4% vs 93.5%, respectively (each p >0.99). The total energy applied per stone was 110 +/- 83 vs 150 +/- 89 J (p <0.0001) and 183 +/- 131 vs 209 +/- 125 J (p = 0.1), respectively. Auxiliary measures were required after shock wave lithotripsy for renal and ureteral stones in 5.4% and 10.8% of nonstented, and in 1.3% and 4.3% of stented cases, respectively. No complications were detected in stented renal and ureteral stone cases compared to 2.9% and 6.9% in nonstented cases, respectively. A high success rate and a low complication rate were achieved in renal and ureteral stone cases with and without prior ureteral stent placement. Total energy needed to achieve a stone-free state did not differ between stented and nonstented ureteral cases, suggesting the absence of a significant influence of the stent. Overall stents decreased complications necessitating hospitalization and auxiliary invasive measures.

Laser Lithotripsy with Direct Cholangioscopy for Complex Biliary Stones

Introduction: Biliary stones can be successfully removed in greater than 90% of patients during ERCP with balloon/basket catheters, with some requiring mechanical lithotripsy. Complicated stones that are unable to be managed with standard therapies often require more advanced modalities including extracoporeal shockwave lithotripsy (ESWL), electrohydraulic lithotripsy (EHL) and laser lithotripsy. We report our experience with endoscopic laser lithotripsy with direct cholangioscopy in patients with complex bile stones. Methods: Between March 2001 and November 2008, laser lithotripsy was used for the treatment of complicated biliary stones in 16 patients, reviewed retrospectively. For all procedures, a Holmium Laser was used under direct visualization using cholangioscopy with the SpyGlass System (Boston Scientific, Natick, USA) (15 cases) and, prior to 2006, a mother-daughter cholangioscope CHF B20 (Olympus, USA) (6 cases). Results: Sixteen patients (mean age 63 years, 25% men) with complex choledocholithiasis were treated with laser lithotripsy after failed stone clearance with ERCP using standard therapies including balloon/basket extraction and mechanical lithotripsy (mean 2.6 ERCP attempts). The mean stone size was 22.5mm and mean number of stones was 2.3. All procedures resulted in partial or complete stone fragmentation. Eight of the 16 patients (50%) had complete stone clearance after completion of laser lithotripsy. Eight patients without complete stone clearance received CBD stents and underwent subsequent ERCP with stone extraction using balloon/basket catheters and/or mechanical lithotripsy. All 16 patients eventually had complete resolution of stones. A total of 30 procedures (mean 1.9 ± 0.7 procedures) were performed, including 21 laser lithotripsy sessions (mean 1.4 ± 0.8). Two complications occurred: one patient had nausea and abdominal pain requiring admission post-procedure and one had a wire perforation in the cystic duct during an attempt at mechanical lithotripsy after laser lithotripsy. Conclusion: Resolution of complex biliary stones using laser lithotripsy can obtain in all cases, with few side effects but require a mean of 2.6 sessions. Laser lithotripsy with direct cholangioscopic visualization is safe and effective for treatment of complex biliary stones. Table 1Treatment Outcomes Complete Stone Clearance After Laser Session(s) 8/16 (50%) Persons Requiring Additional Therapy ∗ Additional therapy included CBD stenting with subsequent ERCP with balloon/basket retrieval and/or mechanical lithotripsy. 8/16 (50%) Final Stone Clearance 16/16 (100%) Procedure Complications Nausea/Pain Wire perforation 2 1 1 ∗ Additional therapy included CBD stenting with subsequent ERCP with balloon/basket retrieval and/or mechanical lithotripsy. Open table in a new tab

Single-center North American Experience With Wolf Piezolith 3000 in Management of Urinary Calculi

To review our experience with the newest generation piezoelectric lithotripter, the Piezolith 3000, in adult patients undergoing extracorporeal shock wave lithotripsy for solitary urinary calculi. We identified 139 shock wave lithotripsy procedures that had used the Piezolith 3000 from February 2005 to July 2007. All procedures were performed under intravenous sedation. Retrospective chart review was used to obtain the pertinent information. Stone-free status was defined as the absence of any fragments, and success as the absence of stone fragments >4 mm, on follow-up imaging after a single treatment. The stone-free and success rate 1 month after a single shock wave lithotripsy session was 45% and 64%, respectively. Only stone size correlated with the overall success rate (P = .004). The overall complication rate was 15% and included a 5.8% major complication rate requiring intervention or admission. The median time in the procedure room was 33 minutes. The adjunctive procedure rate was 1.4%, and the secondary retreatment rate was 10%. The Piezolith 3000 provides modest, but acceptable, single-treatment stone-free and success rates, with a reasonable safety profile, and offers rapid and convenient lithotripsy requiring only intravenous sedation.

Single puncture percutaneous nephrolithomy for management of complex renal stones

BackgroundThe purpose of this report is to assess the safety and efficacy of single lower pole access for multiple and branched renal calculi. A prospective non randomized clinical study included 26 patients with complex renal stones (9 patients had branched renal stones and the other 17 had multiple renal stones) in the period from May 2003 to May 2004. Mean patient age was 42 years ± 13.2 (range 18 to 67 years). All patients underwent percutaneous nephrolithotomy (PCNL) via a single lower calyceal puncture. Small stones were intactly extracted by a range of stone graspers while large stones (smallest diameter more than 1 cm) were disintegrated using either the pneumatic EMS Swiss lithoclast or Holmium YAG laser. Flexible nephroscope was used for stones inaccessible by the rigid instruments.FindingsOverall stone-free rate was 74.8%. Patients with residual stones were managed by one session of shock wave lithotripsy (SWL). Mean operative time was (80 minutes ± 27.4) for branched stones and (49.1 minutes ± 15.9) for multiple stones. No significant blood loss reported. Perforation of pelvicalyceal system occurred in 2 patients (11.5%) with no serious sequelae. Only 1 patient developed secondary hemorrhage which necessitated blood transfusion and selective angio-embolization.ConclusionIn our hands, the efficacy and safety of single lower calyceal puncture PCNL in management of complex renal stones are comparable to those of the general procedure stated in literature.

Extracorporeal Shock Wave Lithotripsy in Pediatric Patients Using a Late Generation Portable Lithotriptor: Experience at Children's Hospital Boston

Kidney stones in children are increasing in incidence. The continued evolution of stone treatment modalities, including shock wave lithotripsy, makes the assessment of continuous outcomes essential. We describe contemporary shock wave lithotripsy outcomes in pediatric patients. A medical record review was performed of all patients younger than 20 years who underwent shock wave lithotripsy in 1998 to 2007. Patients were treated using a Dornier Compact Delta lithotriptor with ultrasound and fluoroscopic imaging. Subjects were defined as stone-free if imaging within 12 months showed no evidence of stones with no additional treatment. Patient and treatment factors associated with successful outcomes were analyzed. In 101 children a total of 114 treatment sequences were performed at a total of 150 shock wave lithotripsy sessions. Mean patient age was 10.5 years and 53% of the patients were girls. Mean stone diameter was 8 mm. Treatment was done for a solitary stone in 76% of cases, for 2 stones in 17% and for 3 or more in 7% with a mean shock count of 2,247. One, 2 and 3 or more treatment sessions were done in 78%, 16% and 6% of patients, respectively. The overall stone-free rate was 58.6%. However, the stone-free rate was only 12.5% after treatment sequences in 20 children with a history of anatomical urological conditions or surgery, while the stone-free rate in children without urological conditions was 67% (p <0.0001). Another factor associated with a decreased stone-free rate was stone size greater than 10 mm (25% vs 63%, p = 0.01). Complications included requiring acute reevaluation or treatment after 7% of shock wave lithotripsy sessions and 3.4% of patients required readmission. Extracorporeal shock wave lithotripsy is effective in many children with urolithiasis and it is well tolerated. However, in some children, particularly those with a history of urological surgery or congenital genitourinary conditions, success rates are low. These children may be best treated with other modalities.