Shock Wave Lithotripsy Sessions Research Articles

Salvage extracorporeal shockwave lithotripsy after failed distal ureteroscopy.

When intervention is necessary, controversy remains as to the best treatment modality for stones of the distal ureter. In general, ureteroscopy is favored over extracorporeal shockwave lithotripsy (SWL) as the treatment of choice for distal ureteral stones. Although uncommon, ureteroscopy failures have traditionally necessitated repeat ureteroscopy to retrieve retained stone fragments. We evaluated the efficacy of salvage SWL for failed primary distal ureteroscopy in the community setting. From December 1989 to December 2000, 6099 patients underwent SWL with the Dornier HM4 lithotripter at our institution. We retrospectively identified 31 patients who had undergone the SWL after a failed distal ureteroscopy. The average stone size in these patients was 9.4 mm, the average time interval from ureteroscopy to SWL was 17.2 days, and the average number of shockwaves delivered was 2386. All patients had had stents placed after ureteroscopy. Twenty-seven patients (87%) had resolution of their stone burden after one SWL session. The remaining four patients underwent additional procedures. Ureteroscopy is an effective modality for the treatment of distal ureteral stones. However, when unsuccessful, a salvage procedure may be necessary. Extracorporeal lithotripsy is a less invasive procedure with comparable success rates in the distal ureter. This report suggests that salvage SWL is an appropriate option for patients in whom distal ureteroscopic stone extraction fails.

Is measurement of stone surface area necessary for SWL treatment of nonstaghorn calculi?

The size of urinary tract stones is usually assessed by the longest diameter (LD) alone. Logically, however, two-dimensional measurement of the stone surface area (SSA) susceptible to shockwaves would give more useful information for the planning of treatment by extracorporeal shockwave lithotripsy (SWL). This has been shown for staghorn calculi. The aim of this study was to determine for nonstaghorn kidney and ureter stones whether the LD alone identifies as reliably a subgroup of patients with a stone of a certain size as does the SSA. Furthermore, we sought to determine whether the LD alone indicates as reliably the number of patients who would be rendered stone free after one SWL session within a certain subgroup as would the SSA. Retrospectively, SWL treatment and radiographic data of 330 patients who had undergone SWL for a single stone were analyzed. Ureteral stones were significantly smaller on average, and ureteral stone patients needed fewer SWL treatment sessions and fewer shockwaves to become stone free. Stratification of both kidney and ureteral stones by either LD or SSA resulted in comparable groups of patients. There were no significant differences in patient, stone, or treatment data. More importantly, the stone-free rates after one treatment did not differ significantly. The LD does accurately reflect the size of a nonstaghorn kidney or ureteral stones. Therefore, the measurement of LD, as generally practiced, appears clinically sufficient and appropriate for the assessment of stone size prior to SWL in both kidney and ureteral stones.

Extracorporeal Shock Wave Lithotripsy in Children

Extracorporeal Shock Wave Lithotripsy in Children

ACUTE RENAL FAILURE ASSOCIATED WITH SULFUR CALCULI

An 85-year-old Japanese man presented with abdominal discomfort and general fatigue. History included (stage A1) prostate cancer, G1T1a transitional cell carcinoma of the bladder for 4 years and ulcerative colitis, which had been treated with 4.5 gm. sulfasalazine daily for 14 years. Laboratory examination showed renal failure (serum blood urea nitrogen was 26 mg./dl. and creatinine was 1.71 mg./dl.). Ultrasonography, computerized tomography and x-ray revealed bilateral hydronephrosis, right multiple renal stones, a ureteropelvic junction stone and a left ureterovesical junction stone (see figure). The left ureteral stone was spontaneously discharged 5 days after the initial consult. The patient underwent 4 sessions of shock wave lithotripsy and percutaneous nephrolithotomy to remove stones in the right renal pelvis and ureteropelvic junction, after ureteral stenting. After stenting, renal function returned to normal (blood urea nitrogen 10 mg./dl. and serum creatinine 0.89 mg./dl.). Stone analysis revealed acetylsulfapyridine, which is a metabolite of sulfasalazine. After the final diagnosis, sulfasalazine was replaced with mesalamine (5-aminosalicylic acid) to treat the ulcerative colitis, and at 6-month followup no recurrence of stone disease was observed.

Effect of vibration massage therapy after extracorporeal shockwave lithotripsy in patients with lower caliceal stones.

To determine whether vibration massage influences the results of extracorporeal shockwave lithotripsy (SWL) in patients with lower caliceal stones. One hundred three patients with lower caliceal stones were entered in the study. Patients were divided into two groups that received either SWL alone (Group A, N = 52) or with vibration massage (Group B, N = 51). There was no statistically significant difference between the two groups in stone size, duration of follow-up, or patient age. The complication, stone-free, and stone recurrence rates of the groups were compared. There was no statistically significant difference between the groups in the number of shockwaves, number of SWL sessions, or shockwave energy. The renal colic rate was higher in Group B than in Group A (P = 0.03). The stone-free rates in Group A and Group B were 60% and 80%, respectively (P = 0.003). The stone recurrence rate was higher in Group A than in Group B (P = 0.0006). This retrospective study demonstrates that SWL with vibration massage appears to have a beneficial effect on the passage of fragments in patients with lower caliceal stones.

Two-year experience with ureteral stones: extracorporeal shockwave lithotripsy v ureteroscopic manipulation.

Extracorporeal shockwave lithotripsy (SWL) and ureteroscopic manipulation became the standard treatments for ureteral stones in recent years. There still exists significant debate as to the most appropriate treatment modality for ureteral stones. During a period of 2 years, from January 1994 to December 1995, 651 patients with ureteral stones were treated, and 589 patients were retrospectively reviewed, excluding 62 patients with incomplete follow-up. Four hundred forty-two patients were treated with SWL using the MPL 9000 with ultrasonic guidance and 115 patients with ureteroscopic manipulations using 7.9F to 11.5F rigid and semirigid ureteroscopes. In SWL treatments, the overall stone-free rate was 74.7% with one session. The stone-free rate was significantly affected by the size of stones, being 83.6% when the stone was <1.0 cm and 42.1% when the stone was >1.0 cm. The stone-free rate after a second SWL session was 84.4% and was 90.3% after a third session. The stone-free rates according to the site of the stone were 72.4 (proximal), 70.0 (mid), and 80.2% (distal) after a single session. In ureteroscopic manipulation, an overall stone-free rate of 87.8% was obtained regardless of the size of the stones. The success rates according to the location of stones were 75.0 (proximal), 94.6 (mid), and 86.4% (distal). Open ureterolithotomy was performed in 32 patients, with a 100% success rate. In our study, the size of the stones was the most important factor influencing the success rate of SWL treatment. We consider ureteroscopic manipulation as the first-line treatment modality when the stone is >1.0 cm, especially if it is in the distal ureter. Proper selection of patients for in situ SWL or ureteroscopy would improve the results of initial treatment.

Pneumatic lithotripsy applied through deflected working channel of miniureteroscope: results in 143 patients.

Although extracorporeal shockwave lithotripsy (SWL) is a successful treatment for ureteral calculi, introduction of miniureteroscopes has advanced endoscopic management. We combined the use of a semirigid ureteroscope with a pneumatic lithotripter (Swiss Lithoclast) for the treatment of ureteral calculi. From January 1992 to August 1994, 143 patients (87 male, 56 female; mean age 48.7 years; age range 22-74 years) with urolithiasis underwent endoscopic lithotripsy with the Swiss Lithoclast under general anesthesia. The 0.8 = mm probe was inserted through the deflected working channel (3.4F) of the Micro-6L ureteroscope (tip diameter 6.9F). The calculi were in the distal (N = 96; 67.1%), mid (N = 34; 23.8%), and proximal part (N = 13; 9.1%) of the ureter. The mean stone size was 6.8 mm (range 5-26 mm). Of the 137 patients whose stones we could access adequately, 70 (51.1%) were stone free immediately after the procedure, and another 31 (22.6%) had residual fragments <3 mm that passed spontaneously. The remaining 36 patients underwent another 50 procedures; 30 SWL sessions in 26 patients (19%), 17 further endoscopic lithotripsies in 14 (10.2%), and open surgery in 3. Application of the Swiss Lithoclast through semirigid miniureteroscopes is highly effective for endoscopic lithotripsy, regardless of stone composition. Deflection of the probe up to 30 degrees did not impair the disintegration rate. Because of the high migration rate of mid and proximal ureteral stones, the Swiss Lithoclast is not recommended in these cases as a primary procedure. Low capital cost and simple and safe handling are the device's major advantages over laser lithotripsy.

ESWL experience in the therapy of difficult bile duct stones.

In recent years, alternatives to surgery for difficult bile duct stones have been developed. Routine endoscopy fails in about 10% of patients. To verify the role of extracorporeal shock wave lithotripsy in residual CBD stones, we treated 32 patients by HM4 or MPL 9000 Dornier lithotripters. Ten (34.4%) patients needed two extracorporeal shock wave lithotripsy sessions, and 3 (10.3%) patients three. Complete clearance was achieved in 29 patients (90.6%) after one or more sessions either by endoscopic (20 pts) or percutaneous (9 pts) extraction of the debris; of the remaining 3 patients, in 2 a bilioduodenal stent was placed and in 1 electrohydraulic lithotripsy was performed. Eighteen and seven-tenths percent transient mild hemobilia, 12.5% microhematuria, and no mortality were observed. It is possible to state that in site- or size-related difficult biliary stones, extracorporeal shock wave lithotripsy is a rapid, safe, and highly effective treatment as an additional nonoperative option to resolve the failure of routine endoscopic measures.

Knotting of a Double Pigtail Stent within the Ureter: An Initial Report

No AccessJournal of UrologyClinical Urology: Case Report1 Nov 1995Knotting of a Double Pigtail Stent within the Ureter: An Initial Report Thierry A. Flam, Nicolas Thiounn, Pierre-Francois Gerbaud, Marc Zerbib, and Bernard Debre Thierry A. FlamThierry A. Flam More articles by this author , Nicolas ThiounnNicolas Thiounn More articles by this author , Pierre-Francois GerbaudPierre-Francois Gerbaud More articles by this author , Marc ZerbibMarc Zerbib More articles by this author , and Bernard DebreBernard Debre More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)66801-0AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Knotting of a Double Pigtail Stent within the Ureter: An Initial Report." The Journal of Urology, 154(5), pp. 1858–1859 References 1 : Ureteral stents. Indications, variations, and complications. Urol. Clin. N. Amer.1988; 15: 481. Google Scholar 2 : Adventitious knots in urethral catheters: report of 5 cases. J. Urol.1989; 148: 1496. Google Scholar Department of Urology, Hopital Cochin, Paris, France.© 1995 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byQuek M and Dunn M (2018) Knot Formation at the Mid Portion of an Indwelling Ureteral StentJournal of Urology, VOL. 168, NO. 4 Part 1, (1497-1497), Online publication date: 1-Oct-2002.BALDWIN D, JURIANSZ G, STEWART S and HADLEY R (2018) KNOTTED URETERAL STENT: A MINIMALLY INVASIVE TECHNIQUE FOR REMOVALJournal of Urology, VOL. 159, NO. 6, (2065-2066), Online publication date: 1-Jun-1998. Volume 154Issue 5November 1995Page: 1858-1859 Advertisement Copyright & Permissions© 1995 by American Urological Association, Inc.MetricsAuthor Information Thierry A. Flam More articles by this author Nicolas Thiounn More articles by this author Pierre-Francois Gerbaud More articles by this author Marc Zerbib More articles by this author Bernard Debre More articles by this author Expand All Advertisement PDF downloadLoading ...

Early Experience with Extracorporeal Shockwave Dornier Lithotriptor "Compact"

One of the latest developments in extracorporeal shockwave lithotripsy (SWL) is a combination of an electromagnetic energy source with an upgraded parallel online ultrasound imaging for localization. The device is compact, requiring no significant installation or site preparation. Furthermore, it increases the margin of safety of SWL by virtue of the continuous ultrasound monitoring. A hundred sessions of SWL were performed on 88 patients using the Dornier Compact machine. Ninety three renal units having an average of 1.7 stones were treated (two had upper ureteric stones). Of the 135 stones, 2 (1.5%) were radiolucent and 4 (3%) were of faint opacity. Intravenous sedation was used in all patients except one 13-year-old patient, who required general anesthesia. Patients received an average of 2409 shocks per session, and the maximum power setting ranged from 1 to 6 (average 4.7). A plain film was obtained immediately before and after treatment. Early adverse effects were uncommon, and all were mild. Patients were followed by plain films at 2 weeks and 3 months. In 35 sessions (25 solitary and 10 multiple stones), the stones were considered completely fragmented; in 63 sessions, the stones (43 solitary and 20 multiple) were judged to be partial fragmented; and 2 sessions (solitary stones) resulted in poor fragmentation. The mean (+/- SD) stone dimension in the group with complete fragmentation was 9 +/- 4.8 (range 2-24) mm, compared with 11 +/- 6.3 (range 2-38) mm in those with no or partial fragmentation (P = 0.0095). After 2 weeks, 23 of 69 systems (33%) were stone free, while 46 showed residual stones.(ABSTRACT TRUNCATED AT 250 WORDS)

Severe Perinephric Hemorrhage after Shockwave Lithotripsy

We report a case of a 69-year-old man who, after a second session of shockwave lithotripsy for multiple stones in the right kidney, showed symptoms of severe hemorrhage and flank pain unresponsive to analgesics, with the gradual development of extensive and serious perinephric hematoma. The bleeding necessitated nephrectomy. Unrecognized chronic pyelonephritis may have been a predisposing factor.

Fate of Clinically Insignificant Residual Fragments after Extracorporeal Shock Wave Lithotripsy with EDAP LT-01 Lithotripter

The stone-free rate of 248 cases of clinically insignificant residual fragments (CIRF) was 32.7% by 1 month, 73.0% by 3 months, and 92.7% by 6 months of follow-up. The stone-free rate decreased but not remarkably in accordance with the increment of the caliceal dilatation (92.9%, 94.9%, 85.7%, and 83.3% for no, mild, moderate, and severe dilatation, respectively) by 6 months of follow-up. The clearance of the CIRF was not influenced by their location, the pelviocaliceal angle, the infundibular length, or the number of the lower calices. Of 16 patients who had residual stone fragments at 6 months and underwent an additional session of extracorporeal shock wave lithotripsy (SWL), 12 became stone free by another 6 months of follow-up. Therefore, it is desirable to wait for clearance of CIRF for at least 6 months before offering further treatment, regardless of their location and anatomic variation of the calices containing CIRF. Repeated SWL, even for stone fragments of 3 to 4 mm in diameter found initially 1 month after the last session of SWL, might promote clearance of the CIRF, and additional SWL for persistent CIRF could be an appropriate adjunctive measure.

Treatment of Renal Stones in a Solitary Functioning Kidney with Extracorporeal Shock Wave Lithotripsy

Forty extracorporeal shock wave lithotripsy (ESWL) sessions were performed in the treatment of 36 stones in 22 solitary functioning kidneys between October 1990 and October 1991. We inserted a double-J catheter in all patients preoperatively and no serious obstruction such as stone street formation was observed after treatments. Following ESWL therapy, at the end of 3 months follow-up, 14 patients (63.6%) were completely stone free while in 5 patients ESWL therapy was unsuccessful. ESWL became the treatment of choice for stones in solitary kidneys as a result of its highly effective, safe and encouraging outcome.

Role of Metabolic Evaluation and Specific Prophylaxis in the Long-Term Outcome of Extracorporeal Shock Wave Lithotripsy in Children*

Children (28 boys, 24 girls) with an average age of 10.1 years (range 2–17) who underwent 63 sessions of extracorporeal shock wave lithotripsy for 64 urinary stones (57 renal, 7 ureteral) between 1984 and 1991 have been evaluated with special regard to long-term recurrences and stone regrowth. The first 10 patients were treated on a Dornier HM3, the rest on the Siemens Lithostar. Of the 52 patients, 35 were first-time stone formers, and 17 had recurrent disease. A uniform metabolic evaluation with 24-hour urinalysis was not performed in all patients. Fourteen children received urinary calcium analysis according to Pak's test. After 3 months, 93% were either stone free or had a residual stone mass of less than 3 mm. Within an average follow-up of 39.3 (9–80) months, 74% were stone free, 9.5% had recurrences, and 17% showed regrowth. Only 1 of 16 patients who received specific prophylaxis for hypercalciuria (n = 6), cystinuria (n = 6), or infection stones (n = 4) developed new stone episodes, while the other 10 patients with either recurrence or regrowth belonged to the no-prophylaxis group. We think that all children with urolithiasis should undergo a metabolic evaluation and have specific prophylaxis to enhance the long-term stone-free rate following SWL.

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

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

Factors Influencing Radiation Exposure During the Extracorporeal Shock Wave Lithotripsy

A prospective evaluation of 89 consecutive sessions of extracorporeal shock wave lithotripsy (ESWL) was undertaken to try and find the best way of minimising the amount of exposure to radiation. Forty-two patients were randomly allocated to undergo ESWL treatment by experienced surgeons (group A), and 47 to undergo the treatment by inexperienced surgeons (group B). The mean calculated entrance radiation exposure was 3.01 rads (group A: 2.64 (0.97) rads, range 1.00-4.48, group B: 3.38 (0.86) rads, range 1.11-5.75). Among factors that influenced radiation exposure, the tissue: air ratio should be borne in mind and the level of skill in controlling movement of gantry was the most important in reducing the exposure to radiation.

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

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

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

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

Long-Term Results of Extracorporeal Shock Wave Lithotripsy in Children

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

PAINLESS LITHOTRIPSY: EXPERIENCE WITH 100 PATIENTS

123 patients underwent 320 extracorporeal shock wave lithotripsy (ESWL) sessions with the Wolf 'Piezolith 2200' lithotripter. The overall success rate, judged by adequate stone fragmentation into particles of 2 mm or less as seen on X-ray, was 92%. Few complications occurred. The lithotripter was easy to operate, and treatment was painless.