Use Of Extracorporeal Lithotripsy Research Articles

Efficacy of the lithotripsy in treating lower pole renal stones

Use of extracorporeal lithotripsy is declining in North America and many European countries despite international guidelines advocating it as a first-line therapy. Traditionally, lithotripsy is thought to have poor efficacy at treating lower pole renal stones. We evaluated the success rates of lithotripsy for lower pole renal stones in our unit. 50 patients with lower pole kidney stones ≤15mm treated between 3/5/11 and 19/4/12 were included in the study. Patients received lithotripsy on a fixed-site Storz Modulith SLX F2 lithotripter according to a standard protocol. Clinical success was defined as stone-free status or asymptomatic clinically insignificant residual fragments (CIRFs) ≤3mm at radiological follow-up. The mean stone size was 7.8mm. The majority of stones (66%) were between 5 and 10mm. 28% of stones were between 10 and 15mm. For solitary lower pole stones complete stone clearance was achieved in 63%. Total stone clearance including those with CIRFs was achieved in 81% of patients. As expected, for those with multiple lower pole stones the success rates were lower: complete clearance was observed in 39% and combined clearance including those with CIRFs was 56%. Overall, complete stone clearance was observed in 54% of patients and clearance with CIRFs was achieved in 72% of patients. Success rate could not be attributed to age, stone size or gender. Our outcome data for the treatment of lower pole renal stones (≤15mm) compare favourably with the literature. With this level of stone clearance, a non-invasive, outpatient-based treatment like lithotripsy should remain the first-line treatment option for lower pole stones. Ureteroscopy must prove that it is significantly better either in terms of clinical outcome or patient satisfaction to justify replacing lithotripsy.

Percutaneous treatment of renal staghorn calculosis: 8 years experience

This study reports 8 years of personal experience in percutaneous nephrolithotripsy (PCNL) of complex renal calculosis. It is emphasised that even in this era of widespread use of extracorporeal lithotripsy (ESWL), PCNL is regaining importance in the more complex cases of renal calculosis, to try to reduce times for adequate stone clearance and to reach a better benefit/cost ratio. A success rate of 87.3% with monotherapy PCNL, 78.6% with debulking PCNL and 91.3% with associated PCNL-ESWL (programmed from the beginning or attempted out of necessity), has convinced us of the correct application we have given the method for treating complex renal calculosis.

Removal of a stone in Stensen's duct with endoscopic laser lithotripsy: Report of case

Gland ablation is often necessary in cases of obstructive sialolithiasis when the calculus cannot be extracted by dilatation or dissection of the salivary duct. 1 The use of lithotripsy provides another method of treatment. Initial experimental study on the use of extracorporeal lithotripsy was done using electrohydraulic Dornier HM3 equipment (Germering, Germany). 2 Brouns et al also described the satisfactory fragmentation of salivary calculi, although they pointed out the possibility of destroying dental amalgam restorations. 3 Iro et al indicated the danger of lesions to the ear or the central nervous system. 4 Extracorporeal salivary lithotripsy has been successfully done with piezoelectric lithotriptors. However, the results obtained by this technique have not been as satisfactory as might have been expected. Between 40% and 50% of residual lithiasis remains after 3 to 4 months of treatment. 1,4–8 A first description of laser lithotripsy for submandibular gland lithiasis was made by Köningsberger et al. 9 Later, Gundlach et al reported an in vitro study and clinical application in 11 cases of submandibular lithiasis. 10 We describe a case of endoscopically controlled laser lithotripsy for removal of a stone in Stensen's duct.