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PubMed2003

Serum troponin levels are not increased in patients with ventricular arrhythmias during shock wave lithotripsy.

PURPOSE: Ventricular arrhythmias are common during ungated shock wave lithotripsy. We determined whether lithotripsy induced arrhythmias are associated with myocardial damage. MATERIALS AND METHODS: A total of 51 patients presenting for shock wave lithotripsy for right renal stones were prospectively evaluated for arrhythmias during lithotripsy. In patients with arrhythmias troponin levels were determined 24 hours after the procedure. RESULTS: Ventricular arrhythmias developed in 21 patients. In this group all troponin levels were below the level of detection (less than 0.5 ng/ml). CONCLUSIONS: Lithotripsy associated arrhythmias do not appear to be associated with myocardial injury.

Arrhythmias, Cardiac↗
PubMedDate not supplied

An early gallstone clearance following repeat piezoelectric lithotripsy.

Piezoelectric extracorporeal litotripsy was performed in 128 symptomatic patients with radiolucent gall-bladder stones to assess the significance of disintegration in fragment clearance. Up to 10 repeat lithotripsy sessions were scheduled to achieve a fragment target size of < 3 mm. Fragmentation assessed by the size of the largest fragments after the last session was graded into three classes. I: sludge-like disintegration, 18%; II: < 3 mm (mean +/- s.d., 1.7 +/- 0.5 mm), 56%; and III: > or = 3 mm (3.3 +/- 0.6), 26%. All patients were initially subjected to lithotripsy alone. Bile acid dissolution therapy was started only when ultrasonography failed to show the evidence of decrease in the < 3 mm fragments during a 1 month follow up. Finally, 69 patients (54%) were treated by lithotripsy alone, and the remaining 59 received additional dissolution therapy at a mean period of 2.5 months after the initial lithotripsy. The rate of complete clearance in class I, II and III patients was 91, 42 and 10% at 6 months and 100, 68 and 49% at 18 months, respectively. Significant differences were noted between the three fragmentation grades (I vs II, III, P < 0.0001; II vs III, P < 0.02). The patients with complete clearance within 6 months were seen only in those treated by lithotripsy alone, while the majority (87%) of patients with complete clearance during the later period were seen in those treated by additional dissolution therapy. We conclude that a high degree of fragmentation appears to lead stones to an earlier period clearance, and reduce the need for dissolution therapy.

Actuarial Analysis↗
PubMed1994

Choosing the correct pain relief for extracorporeal lithotripsy.

OBJECTIVES: To determine the best choice of analgesic for patients undergoing lithotripsy, and to attempt to identify factors which might predict which patients are most likely to find the procedure painful. PATIENTS AND METHODS: Sixty patients with stones in the pelvicalyceal system of the kidney were randomized prospectively to undergo lithotripsy with the Dornier MPL9000 lithotripter (Dormier Medical Systems, Marietta, GA, USA) after receiving either diclofenac 100 mg per rectum (n = 30) or pethidine 50 mg intravenously (n = 30) for analgesia. The patients completed a detailed questionnaire prior to treatment, and the level of pain perceived during lithotripsy was monitored using visual analogue scales (VASs). Arterial oxygen saturation (SaO2) was monitored before analgesia was given, throughout the treatment and for 30 min after cessation of treatment. RESULTS: The VASs were available for 56 patients and the results of pulse oximetry for 51 patients. Although a higher kilovoltage was recorded in the group who received pethidine this difference was not significant. Patients who received diclofenac or pethidine alone, showed a non-significant fall of SaO2 30 minutes after the end of treatment, although the largest fall in SaO2 observed with pethidine was 10%. Patients who received diclofenac and pethidine similarly showed a non-significant fall in SaO2. Four patients received intravenous benzodiazepines in addition to pethidine, and in this group there was a dramatic fall in SaO2 which persisted more than 30 min after the end of treatment (P < 0.0027). Diclofenac provided effective analgesia for most of the patients who underwent lithotripsy. Overall 11 patients (18%) required additional analgesia. Diclofenac or pethidine alone, in the doses used in this study, did not cause a significant drop in SaO2 during ESWL. The only response found to be of value in predicting a painful experience was fear of the dentist. CONCLUSIONS: This study shows that modern lithotripsy, in addition to being safe and effective, can be performed as an out-patient procedure using simple non-opiate analgesics. The need for stronger analgesia and/or sedation should be tailored to the needs of the individual patient, although it remains difficult to predict which patients will require such measures.

Adult↗
PubMed1991

Renal extracorporeal shock wave lithotripsy performed in patient with implantable cardioverter defibrillator.

The effect of extracorporeal shock wave lithotripsy on the automatic implantable cardioverter defibrillator is unknown. To evaluate what effect might occur, a non-implanted automatic implantable cardioverter defibrillator was subjected to a full course of extracorporeal shock wave lithotripsy while inactive. Bench testing by the manufacturer after lithotripsy demonstrated normal function of the device. A patient with an automatic implanted cardioverter defibrillator who required contralateral extracorporeal shock wave lithotripsy then underwent this procedure. The right renal calculus was destroyed successfully with no apparent damage to the automatic implantable cardioverter defibrillator. A test of the automatic implantable cardioverter defibrillator after lithotripsy demonstrated normal sensing and conversion of induced ventricular tachycardia.

Aged↗
PubMed1987

Extracorporeal shockwave lithotripsy: first 1000 cases at the London Stone Clinic.

One thousand patients underwent extracorporeal shockwave lithotripsy for renal and ureteric calculi at this clinic. An overall success rate of 91.8% was achieved (stone free or less than 2 mm fragments at three months) and for stones measuring 1 cm 96.3%. Lithotripsy produced extremely low morbidity, and no deaths have occurred at the clinic. Patients who had lithotripsy alone had a mean hospital stay of three days and in most instances were able to perform their full range of activities on discharge. Planned combination of lithotripsy with minimally invasive endourological procedures such as percutaneous nephrolithotomy and ureterorenoscopy has allowed us to extend the range of treatable cases to include large stones. Prophylactic use of Double-J ureteric stents in selected cases has reduced the incidence of obstruction by stone fragments after lithotripsy, thereby decreasing morbidity and hospital stay.

Adolescent↗
PubMed1992

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.

Aged↗
PubMed1990

In situ lithotripsy of ureteral calculi: review of 261 cases.

The authors report 261 cases of single ureteral calculi treated with in situ lithotripsy after retrograde manipulations had failed. Previous reports have indicated that extracorporeal lithotripsy of impacted ureteral calculi has not been highly successful. Two hundred five of the calculi were located in the proximal ureter, above the sacroiliac joint; 27 were in the presacral ureter, overlying the bony pelvis; and 29 were in the juxtavesicular ureter, below the inferior border of the sacroiliac joint. Retrograde ureteral catheters were in place during lithotripsy for 215 calculi. Two hundred fifty-four (97%) calculi were successfully treated with lithotripsy and, when necessary, with additional postlithotripsy radiologic and urologic interventions. Seven (3%) calculi were not successfully fragmented. Nephrostomy was performed in 13 (5%) patients. Retrograde ureteral catheters were not found to enhance calculus fragmentation. In situ lithotripsy of ureteral calculi has been shown to be feasible as an alternative to ureterolithotomy when retrograde manipulation has failed.

Follow-Up Studies↗
PubMed1997

Salivary gland stones: US evaluation in shock wave lithotripsy.

PURPOSE: To assess the usefulness of ultrasonography (US) in the selection and monitoring of patients with sialolithiasis to be treated with extracorporeal electromagnetic shock wave lithotripsy. MATERIALS AND METHODS: US was performed in 80 symptomatic outpatients who were to undergo shock wave lithotripsy because they were not candidates for endoral extraction of calculi. The location and diameter of stones and the condition of the affected gland and duct were determined. RESULTS: Swollen and sclerotic glands and dilated ducts were the most frequently observed characteristics. After lithotripsy, stone clearance or a residual fragment of less than 2 mm in diameter was seen at US in 37 of 56 patients with submandibular gland calculi and in all 24 patients with parotid gland calculi. Favorable outcome after lithotripsy was associated with smaller (less than 7 mm) stone diameter (P < .001) and, in the case of submandibular gland stones, with intraductal location (P < .05). A return to a normal parenchymal echotexture was seen in all patients in whom the stone was completely eliminated; a limited reduction in swelling was observed in patients with residual fragments. CONCLUSION: US is useful in the selection of candidates for extracorporeal electromagnetic shock wave lithotripsy and in monitoring the progress of treatment.

Female↗
PubMed2005

Subjective pain scale and the need for analgesia during shock wave lithotripsy.

OBJECTIVE: To investigate patients' opinions on the degree of pain during shock wave lithotripsy, and the need for analgesics in patients with urinary stone. METHODS: A prospective questionnaire study involving subjective pain assessment during and just after shock wave lithotripsy was performed in consecutive patients with uncomplicated renal or ureteral stones. The patients were given unbiased information on the analgesics prior to the procedure. Ten minutes after beginning shock wave lithotripsy, the degree of pain was rated by the patient using a 10-point visual analog scale. After the procedure, the patients were asked to complete a self-administered questionnaire. Based on the response for the questionnaire, the patients were divided as 'tolerable' or 'non-tolerable' group. RESULTS: The results from 180 patients (males 113, females 67) with a mean age of 50.0 +/- 13.0 were analyzed. The average subjective pain score was 6.6 +/- 2.3 during the procedure, and 70 (38.9%) patients responded that they were able to tolerate the pain without analgesics. A total of 116 (64.4%) patients did not agree that analgesic should be recommended to other patients. Subjective pain score during the procedures was not affected by laterality, size of stone, level of education or socioeconomic status, but was affected by patient age (p = 0.042), sex (p = 0.012) and location of stone (p = 0.014). Right and kidney stones were significantly higher in the 'non-tolerable' group than in the 'tolerable' group (p = 0.003 and p = 0.011, respectively), and the 'non-tolerable' patient group had a significant higher pain score than the 'tolerable' group (p < 0.001). CONCLUSIONS: Our result shows that subjective pain severity during shock wave lithotripsy is high but may be well tolerated in some patients. Our findings raise the question as to whether routine analgesics are required during newer generation shock wave lithotripsy procedures in all patients with a urinary stone.

Analgesia↗
PubMed1988

Biliary lithotripsy by extracorporeal shock waves: integral part of nonsurgical intervention.

Nine patients with cholelithiasis were selected for adjuvant therapy with extracorporeal shock-wave lithotripsy when radiologic or endoscopic intervention alone had been unsuccessful for stone removal. This preliminary experience with shock-wave lithotripsy includes four patients with one or more common duct stones, one patient with a large solitary gallbladder stone, and four patients with impacted cystic duct stones. Lithotripsy failed in two patients with cystic duct stones. The seven patients with successful lithotripsy underwent subsequent fragment extraction by intervention via T-tube tract, minicholecystostomy, or endoscopic sphincterotomy. Our approach to cholelithotripsy varied from previous reports in that we included patients with cystic duct stones, relied on interventional fragment removal without adjuvant chemolitholysis, and treated four patients with acute symptoms or multiple risk factors. Our initial experience with biliary lithotripsy in selected patients indicates that it can play an integral part in nonsurgical intervention for cholelithiasis.

Adult↗
PubMed1997

Intracorporeal pneumatic lithotripsy for ureteral and vesical calculi.

To evaluate the effectiveness of pneumatic lithotripsy, 92 patients with 98 lower or mid-ureteric calculi and 8 with vesical calculi were treated with pneumatic lithotripsy (Swiss Lithoclast) under spinal anaesthesia. Successful stone fragmentation was achieved in 96 patients. In two patients their stones migrated to the upper ureter and renal pelvis during the procedure and so they were referred for extra corporeal shock wave lithotripsy. Total ureteral avulsion occurred in one patient and in another case attempts to dilate the stenotic ureteral orifice failed. In both cases, ureterolithotomy and ureteral reimplantation were performed. Pneumatic lithotripsy is found to be an easy, reliable and cost-effective method of endoscopic lithotripsy.

Adult↗
PubMed1993

Extracorporeal shock wave lithotripsy combined with litholytic therapy in the treatment of patients with symptomatic gallstones--the Melbourne experience.

OBJECTIVE: To investigate the role of extracorporeal shock wave lithotripsy using the Dornier MPL9000 lithotripter and adjuvant litholytic therapy in the treatment of symptomatic gallbladder stones. PATIENTS AND METHODS: Between August 1989 and March 1991, 399 patients had their one to three gallbladder stones fragmented by the Dornier MPL9000 lithotripter. Chenodeoxycholic acid alone was used as adjuvant litholytic therapy in the majority. A minority received a combination of chenodeoxycholic acid and ursodeoxycholic acid or ursodeoxycholic acid alone. Patients who died, had cholecystectomies or failed to complete the treatment program were excluded from analysis, leaving a cohort of 287 patients with a follow-up of at least 12 months. This cohort comprised 173 patients with single small stones (20 mm or less in diameter), 32 patients with single large stones (21 mm to 30 mm in diameter) and 82 patients with two to three stones. OUTCOME MEASURES: Patients were followed up by repeated ultrasound examination to monitor the disappearance of fragments from the gallbladder. Stone-free rates, recurrences and complications of treatment were determined. RESULTS: The stone-free rate 12 months after treatment was 37.6% for patients with a single small stone, 3.1% for patients with a single large stone and 18.3% for patients with two to three stones. Of 70 patients with a single small stone who had become stone free at some time during the 12 months after treatment, five (7.1%) experienced recurrence, as did one of the 16 patients (6.9%) with two to three stones. Some 179 patients (44.9%) experienced biliary colic after lithotripsy. Most attacks were mild. Eleven patients (2.8%) developed cholecystitis and nine (2.3%) became jaundiced. Five patients (1.3%) suffered from pancreatitis, of whom one died from severe necrotising pancreatitis. Treatment mortality was 0.25%. Cholecystectomy was needed in 44 patients (11.9%). CONCLUSIONS: Only about 15%-20% of all patients with symptomatic gallbladder stones are suitable for lithotripsy. In this study, only about 28% were stone free after 12 months. As the gallbladder is not removed, stones may re-form. Laparoscopic cholecystectomy and open cholecystectomy by comparison will produce a "stone-free state" in 100% of patients, no matter how many stones are present in the gallbladder, their size, or whether the gallbladder is non-functioning. Consequently, lithotripsy and litholytic therapy are now reserved for those few patients who are unable to tolerate general anaesthesia and cholecystectomy and those who refuse surgery. Even in centres showing the most favourable results, lithotripsy and litholytic therapy will have at best a minor role to play in the overall management of symptomatic gallbladder stones.

Adult↗
PubMed1998

Extracorporeal lithotripsy of intrahepatic stones with associated strictures of intrahepatic biliary ducts.

BACKGROUND AND AIMS: Intrahepatic stones are a frequent disease in the Eastern world but rare in Western countries. Treatment is complex and often requires surgical intervention. Extracorporeal shock wave lithotripsy is a relatively recent technique, widely used in the treatment of stones in the gallbladder and common bile duct. It can also be used in the treatment of intrahepatic stones. The present study analyses the efficacy of extracorporeal shock wave lithotripsy in intrahepatic stones. PATIENTS AND METHODS: In our study, we used extracorporeal lithotripsy in six cases of intrahepatic stones (mean age 53 years). In five of these cases deformities of the intrahepatic bile ducts were also present: stenoses and angulated strictures. The stones were in the right lobe of the liver in 5 patients, and in both lobes in 1 patient. Four patients had multiple stones and 2 a single stone, all varying in diameter from 6 to 25 mm. The stones were localized radiologically with contrast medium through a drainage tube. The technique does not require anaesthesia. An average of three lithotripsy sessions were necessary, with a mean total of 8050 shock waves per patient. RESULTS: Successful fragmentation was obtained in 5 out of 6 patients, while the remaining subsequently underwent surgery. No complications were observed. CONCLUSIONS: Extracorporeal shock wave lithotripsy proved to be effective, easy to perform and safe for the treatment of intrahepatic stones.

Adult↗
PubMed1993

Improved results of extracorporeal shock wave lithotripsy with the Dornier MPL 9000 for single gallstones.

Our aim was to compare the results of extracorporeal shock wave lithotripsy with the Dornier MPL 9000 for patients with single radiolucent gallstones less than or equal to 20-mm diameter using higher power (kV) and more shock waves during lithotripsy with our results during the Dornier National Biliary Lithotripsy Study using lower power and fewer shock waves. Nineteen patients were treated at higher power (mean +/- SE, 21.0 +/- 0.4 kV) vs 11 patients at lower power (18.8 +/- 0.5 kV). In the higher power group, the actuarial rate for complete clearance of gallstone fragments was 39 +/- 9%, 63 +/- 9% and 78 +/- 9% after 6 weeks, 3- and 6-months follow-up, respectively, versus only 19 +/- 12% after 6 months in the lower power group. We conclude that the use of higher power and more shock waves during extracorporeal shock wave lithotripsy with the MPL 9000 results in fragment clearance rates over 6 months for patients with single gallstones that are significantly higher than those previously achieved in the Dornier National Biliary Lithotripsy Study.

Cholelithiasis↗
PubMed1990

Gallstone lithotripsy: early American results and the new reality.

Early comparative data is now available from several different American Gallstone Lithotripsy, ("GSL") trials (Technomed, Dornier, and Medstone). While the 6-month gallbladder clearance results appear to be remarkably similar (36%-43% in less than 20-mm solitary stones), they do not appear to match the results obtained by the Munich group in their first 175 patients (63% clearance at 4-8 months). We review the currently available American data and describe our on-going national clinical trial with the Technomed Sonolith 3000 investigation. In this trial, patients are randomized to lithotripsy plus ursodiol (Actigall,¿ Ciba Geigy), or lithotripsy alone to determine the effect of oral bile salts on the gallbladder fragment clearance rate. To date, the early success rate is clearly better in the GSL plus ursodiol arm. Following one or two lithotripsy sessions, 62.1% of patients with solitary stones, 5-20 mm in size, have had fragmentation to 7 mm or less. In the same group, 39.1% of gallbladders are clear at 6 months. While the 6-month gallbladder clearance rate appears to be a reliable indicator of eventual gallbladder status it should not be regarded as the end point of therapy and it clearly does not represent the final efficacy rate for gallstone lithotripsy. A review of the results obtained from on-going American IDE trials is compared with the published German results using GSL and combination oral dissolution therapy.

Cholelithiasis↗
PubMed1991

Computed tomographic evaluation of gallstone calcification for biliary lithotripsy.

As the Food and Drug Administration trials for biliary lithotripsy in the United States near completion, future criteria for patient eligibility remain to be defined. Gallstone calcification greater than 3-mm partial rim on plain film (KUB) or oral cholecystogram (OCG) has excluded patients thus far, since early results of gallstone clearance (lithotripsy plus chemodissolution) were suboptimal with calcified stones. To evaluate the usefulness of these criteria for gallstone fragmentation, computed tomographic (CT) scans were performed on 20 patients immediately prior to lithotripsy to evaluate gallstone density and 24 hours after lithotripsy to observe the CT appearance of fragmentation. The adequacy of fragmentation was determined by pre- and post-lithotripsy sonography. This report constitutes the results of these investigations.

Calcinosis↗
PubMed2000

Low success rate of repeat shock wave lithotripsy for ureteral stones after failed initial treatment.

PURPOSE: We determined the number of shock wave lithotripsy treatments that should be given for a single ureteral stone before alternate modalities are used. MATERIALS AND METHODS: We compared the stone-free rate of initial shock wave lithotripsy for ureteral calculi with that of subsequent treatments. We evaluated 1,593 ureteral stones treated with the Dornier MFL 5000 lithotriptor* from January 1, 1994 to September 1, 1999 using various parameters associated with treatment outcome. RESULTS: The stone-free rate after initial treatment was 68% (1,086 of 1,593 stones), which decreased to 46% (126 of 273) after re-treatment 1. We observed a further decrease in the stone-free rate after re-treatment 2 to 31% (19 of 61 stones, p = 0.001). The cumulative stone-free rate increased to 76% (1,212 of 1,593 stones) after 2 treatments and to 77% (1,231 of 1593) after 3. The stone-free rate for stones 10 mm. or less was significantly better than that of stones 11 to 20 mm. initially (64% versus 43%) and after re-treatment (49% versus 37%). A ureteral stent decreased the stone-free rate of initial treatment and re-treatment 1 by 12% and 14%, respectively (p = 0.001). After initial treatment the stone-free rate of the upper and mid ureter was significantly higher than that of the lower ureter. Patient weight had no significant impact on success in either group. CONCLUSIONS: The stone-free rate of re-treating ureteral calculi with shock wave lithotripsy decreases significantly after the initial treatment. These findings imply that ureteroscopic management of ureteral stones may be better than shock wave lithotripsy after initial shock wave lithotripsy fails.

Adolescent↗
PubMed2002

Is ureteral stenting necessary after uncomplicated ureteroscopic lithotripsy? A prospective, randomized controlled trial.

PURPOSE: We conducted a prospective, randomized controlled study to investigate the advantages and disadvantages of ureteral stenting after ureteroscopic lithotripsy. MATERIALS AND METHODS: A total of 60 patients who underwent ureteroscopic lithotripsy were equally randomized into a stented or a nonstented group. The inclusion criteria were stone 6 to 10 mm., absence of polyp or stricture in the ureter and no mucosal injury during ureteroscopy. The operation was performed with a 6Fr rigid ureteroscope without ureteral dilation and stones were fragmented with a 1.9Fr electrohydraulic lithotriptor without extraction. A 7Fr double pigtail stent was placed in the stented group for 3 days after ureteroscopy. Urinalysis, plain x-ray and renosonography were performed before and after lithotripsy in each patient. Subjective symptoms and pain score were recorded on admission to the hospital and 3 days postoperatively. RESULTS: The stone-free rate was 100% in each group and preoperative hydronephrosis equally resolved in both groups. Mean pain score plus or minus standard deviation improved significantly in the nonstented (6.33 +/- 1.81 preoperatively to 2.30 +/- 1.93 postoperatively, paired Student's t test p <0.0001) and stented (7.10 +/- 1.03 to 2.30 +/- 2.22, p < 0.0001) group. There was no statistical difference in pain reduction between the 2 groups (p = 0.18). The amount of extra parenteral analgesic used was similar in both groups. One patient in the nonstented group visited the emergency room for postoperative renal colic, 25 (83.3%) patients in the stented group complained of at least 1 irritative bladder symptom and only 4 (13.3%) in the nonstented group experienced bladder discomfort. CONCLUSIONS: After uncomplicated ureteroscopic electrohydraulic lithotripsy patients without ureteral stenting tend to have similar renal function recovery and satisfactory pain reduction with less irritative symptoms compared to those treated with a ureteral stent. We suggest that it is not necessary to place a ureteral stent routinely after uncomplicated ureteroscopic electrohydraulic lithotripsy for stones smaller than 1 cm.

Adult↗