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PubMedDate not supplied

[Use of extracorporeal shockwave lithotripsy for kidney calculi].

278 patients with coral nephrolithiasis were examined in 1990-2003. Extracorporeal shock-wave lithotripsy was made in 46 (16.5%) patients with 48 coral stones (mean age 48.2 +/- 18.3 years) as a basic treatment. The length of the concrement was 4.9 +/- 1.8 cm, width 3.8 +/- 1.4 cm, a relative area 19.72 +/- 13.01 cm2. All the patients have initially undergone internal drain of the kidney by a catheter (n = 13) or stent (n = 33). Each lithotripsy session included, on the average, 2882 +/- 318 impulses (17-19 kV). The number of high-energy impulses per a session comprised 342 +/- 23. A total number of the sessions reached 3.4 +/- 1.55. Initial destruction of the concrement requires 1.6 +/- 0.6 sessions in 10144 +/- 1081.2 impulses per one patient including 1436 +/- 96.6 high-energy impulses. One procedure comprises 2-3 sessions of lithotripsy with a 5-7 day interval. The results were assessed at discharge after the first session and 6 months later, the degree of stones elimination from the kidney, complications, manipulations to manage the complications. At discharge after 3 lithotripsy sessions recovery was achieved only in 3 out of 46 (6.52%) patients. Six months later the fragments eliminated in 26.1% (12 of 46 patients). Monolithotripsy caused complications in 13 patients. Additional manipulations made up 65.2%. Inefficacy of explorative treatment necessitated conversion to open intervention in 6 (13.1% 0 patients. The use of extracorporeal lithotripsy as a monotherapy in coral nephrolithiasis is now limited.

Adult↗
PubMed2005

[Consequences of lithotripsy treatment in children with urolithiasis].

The authors discuss the consequences of lithotripsy treatment in children with urolithiasis. The study included 316 children (168 girls and 148 boys) aged 2-18 years treated in our Department since 1991 until 2004 y. In 316 children 597 lithotripsy procedures (526 kidney and 71 ureter units) were performed. In the study group of patients after lithotripsy treatment most often were observed: hematuria 408/597 (68,3%) and in ultrasonography examinations changes in kidney parenchyma 128/526 (24,3%) and urinary retention in urinary tract 72/526 (13,7%). The most often complications after lithotripsy treatment were short-term changes. The authors think that lithotripsy procedure is a safe method in the treatment of the children with urolithiasis.

Adolescent↗
PubMedDate not supplied

[Endoscopic mechanical lithotripsy in choledocholithiasis of difficult extraction handling].

BACKGROUND: Large stones are difficult to remove in block through a small papillotomy, a relative narrowed distal bile duct, periampular diverticula or in those who have undergone only balloon sphincteroplasty prior to stone extraction. Extending the papillotomy is not always possible, and may carry, an increased risk of bleeding and perforation. Lithotripsy facilitates stone extraction and clearance of the common bile duct. AIM: This study investigated the predictors of successful or unsuccessful mechanical lithotripsy. PATIENTS AND METHODS: A series of 100 consecutive patients who underwent mechanical lithotripsy was evaluated retrospectively and a large number of variables tested for their association with successful outcome. RESULTS: The procedure was safe (morbidity rate 4.4%) and effective (68% stone clearance rate). The statistic analysis showed that lithotripter type was the only outcome predictor (p = 0.044). The other factors analyzed were not statistically significance. CONCLUSION: Mechanical lithotripsy is successful in about 70% of patients with difficult bile duct stones. The only significant factor that predicts failure of mechanical lithotripsy is lithotripter type.

Adult↗
PubMed2006

[Extracorporeal lithotripsy of upper urinary tract stones in children].

OBJECTIVE: The objective of this study was to evaluate the efficacy of extracorporeal lithotripsy for the treatment of urinary stones in children. MATERIAL AND METHODS: From November 2002 to November 2004, 34 children from the department of paediatric urology of Rabat children's hospital, aged 3 to 15 years (mean age: 6 years), including 15 children under the age of 6 years, were treated for symptomatic urinary stones in the extracorporeal lithotripsy centre with a Lithostar Multiline lithotriptor adapted to the treatment of adults as well as children, even very young children. At the time of treatment, all 34 children had normal blood pressure, normal blood urea and creatinine, normal clotting parameters, sterile urine and no urinary tract obstruction. All children under the age of 6 years were treated under ketamine sedation. RESULTS: Treatment required a variable number of sessions from 1 to 3 (mean: 1.5) and concerned 38 stones: 30 renal stones including 6 staghorn and 8 ureteric stones. The number of impacts delivered per session ranged from 1,500 to 3,500 for renal stones (mean: 2,500 impacts), with a maximum of 5,000 impacts for ureteric stones (mean: 3,250 impacts). Three months after the last lithotripsy session, 30 patients presented no fragments. No lesion of the treated kidney or adjacent organs was demonstrated on follow-up ultrasound performed 3 to 6 months after treatment. CONCLUSION: Evaluation of the results confirms the efficacy of extracorporeal lithotripsy for the treatment of even very large urinary stones in children, even in very young children. Extracorporeal lithotripsy is now the first-line treatment for-urinary stones in children.

Adolescent↗
PubMed1992

Lithotripsy of urinary bladder stones with a mechanical lithotriptor inserted through a narrow introducer. An experimental study in pigs.

Mechanical lithotripsy of urinary bladder stones was performed with the RotoLith lithotriptor in 8 pigs with implanted human stones or artificial stones after open cystotomy. The effect of the treatment on the urinary bladder was investigated macro- and microscopically immediately after the lithotripsy in 4 animals and 4 weeks after the lithotripsy in the other 4 animals. The stones were fragmented into very small pieces which would have been possible to pass with the urine. The histopathologic examination immediately after the procedure showed slight mucosal edema, patches of erosions in the mucosa, and minor submucosal bleeding. Microscopic examination of the bladders removed 4 weeks after lithotripsy showed slight chronic inflammation. The experimental results have encouraged us to plan to use this lithotripsy procedure in selected patients with bladder stones.

Animals↗
PubMedDate not supplied

[Complications during and after extracorporeal lithotripsy in elderly patients].

Report of our experience of complications arisen from treatment of urinary lithiasis with extracorporeal shock-wave lithotripsy, using a Dornier HM3 lithotripter in 218 elderly patients (over 65 years). No complications arose during lithotripsy in 160 patients (73.39%). Most frequent complications (when they happened) were skin disorders, which occurred in 33 patients (15.13%). One hundred and thirty-six (62.38%) patients had no post-lithotripsy non-obstructive urological complications, but when these occurred, renal colic, evident in 52 patients (23.85%), was the most frequent one. During the post-lithotripsy period, 88.53% patients (193) had no obstructive urological complications. When they emerged, they usually developed asymptomatically (13 patients, 5.95%). With regard to the approach used to treat the obstructive cases, the most common one was medical, representing 56%. Surgery was used only in 2 occasions. A total of 175 patients (80.27%) presented no post-lithotripsy complication, fever of up to + 38 degrees C being the most prevalent condition (9.65%).

Aged↗
PubMed1990

[Milk of calcium syndrome: a diagnosis to be made before the scheduling of lithotripsy. Consideration apropos of 6 cases].

The authors report six cases of milk of calcium syndrome. As in previously published cases, the diagnosis was established by the film taken in the standing position: the "lithiasic density" shrinks, densifies and exhibits a horizontal upper edge. Four patients were at first mistakenly diagnosed as having urinary lithiasis for which extracorporeal lithotripsy was scheduled. In one case, the lithotripsy was actually performed and the diagnosis of milk of calcium disease was established only immediately after the procedure. In another patient, lithotripsy was performed because small stones were thought to be present in the milk of calcium. In the two other cases, the diagnosis was made on the day before scheduled lithotripsy and this procedure was therefore cancelled. The purpose of the authors in reporting these cases is above all to point out the diagnostic value of a plain film of the abdomen in the standing position. Diagnosis must be made in time to avoid extracorporeal lithotripsy since, in milk of calcium syndrome, this procedure is illogical, inefficient and probably more hazardous than useful. On the basis of the six cases reported herein and of data from the literature, several characteristics of milk of calcium syndrome can be emphasized. Milk of calcium syndrome predominantly affects individuals with a positive personal or family history for renal lithiasis. It occurs in both sexes and all age groups, including childhood. Milk of calcium syndrome complicates partial or total dilatation of the urinary tract. Crystallization may be of the phosphatic or oxalic type. Concomitant urinary tract infection is common.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Extracorporeal lithotripsy in experimental vesicular lithiasis in pigs].

Experimental extracorporeal shock wave lithotripsy of gallstones was performed with the EDAP LT 01 piezoelectric lithotripter. Fragmentation of biliary stones was evaluated after implantation of human stones inside the gallbladder in 10 pigs. Lithotripsy was performed with a firing frequency of 2.5 shots per second during a mean time of 50 min. Zero to 18 days after lithotripsy, complete fragment clearance was seen in 6 cases, fragments less than 2 mm were found in 2 cases and fragments larger than 2 mm with only 1 non fragmented stone in 2 cases. There were no stone fragments in the cystic and common ducts. Damage to gallbladder and adjacent organs was appreciated after lithotripsy to the empty gallbladder of pigs with firing frequencies from 40 to 1.25 shots per second. Perforation of the gallbladder was observed in both pigs treated with a firing frequency of 40 shots per second and in 1 pig out of 3 treated with a firing frequency of 20 shots per second. With 10 shots per second and lower firing frequencies, mild histological changes of the gallbladder walls were only observed in 3 cases reoperated on the 2nd day after lithotripsy. The gallbladder wall was normal in the 5 cases reoperated on the 15th day and there were no hepatic, duodenal and pancreatic lesions. These experimental results are consistent with utilization of this machine in the treatment of gallstones in man; low firing frequencies are effective for fragmentation of gallstones without any adverse effects.

Animals↗
PubMed1989

[Extra-corporeal lithotripsy (EDAP LT 01) in urinary lithiasis].

Five hundred and twenty six extracorporeal lithotripsies have been performed for renal and ureteric stones. Using low frequencies (1.25 to 2.5 cycles per second), extracorporeal lithotripsy was performed without anaesthesia and without premedication in 85% of cases. 91.9% of patients treated were followed and reviewed after one and three months: 292 (55%) were successes, 124 (22.5%) obtained partial results, 122 (22.5%) were failures. The best results were obtained in stones less than 20 mm in diameter. The results could only be improved by a second session of extracorporeal lithotripsy. Scintigraphic scars observed after high frequency lithotripsy and not observed after low frequency lithotripsy were again seen after renewal of the firing head.

Evaluation Studies as Topic↗
PubMed1989

Antegrade ureteroscopy and ultrasonic lithotripsy in the treatment of difficult upper and middle ureteric stones.

34 patients with difficult upper and middle ureteric stones were treated by antegrade ureteroscopy with ultrasonic lithotripsy over a 2-year period. 14 patients (41 percent) had failed extracorporeal wave lithotripsy and another 20 patients (59 percent) were considered unsuitable for extracorporeal shock wave lithotripsy due either to obstruction associated with urosepsis or renal failure. Thirty patients (88 percent) had large stones with a transverse diameter from 10 to 20mm in size. Thirty-three of the 34 patients (97 percent) were successfully treated by this method with minimal morbidity. Of the 7 patients with residual stones, only one needed transurethral ureteroscopic removal and another by piezoelectric extracorporeal shock wave lithotripsy. This technique is a safe and effective method in removing impacted upper and middle ureteric stones for patients who have failed or are unsuitable for extra-corporeal shock wave lithotripsy treatment.

Endoscopy↗
PubMed1988

[Extracorporeal lithotripsy in urinary calculi using the LT 01 EDAP].

Three hundred and sixty nine extracorporeal lithotripsies for renal stones have been performed using the EDAP apparatus (ultrasound detection, piezoelectric destruction). In 7.1% of cases, the stone could not be located. By using low frequencies (1.25 to 5 cycles per second), extracorporeal lithotripsy was able to be performed in 82% of cases without anaesthesia and without premedication. 96.5% of patients treated have been followed and reviewed at one and three months: 169 (61%) cases were successful, 59 (21.3%) were partial results and 49 (17.7%) were failures. The best results were obtained in stones less than 20 mm in diameter. A poor result can only be improved by a second session of extracorporeal lithotripsy. The scintigraphic scars observed after high frequency extracorporeal lithotripsy were not observed when low frequencies were used. This new outpatient extracorporeal lithotripsy procedure without anaesthesia currently represents 79% of our primary indications in renal stones.

Adult↗
PubMed1986

[Extracorporeal lithotripsy in the treatment of renal lithiasis. 5 years' experience].

The historical background to extracorporeal lithotripsy using shock waves is described and indications for use of this treatment discussed in relation to other types of therapy for reno-ureteral lithiasis: percutaneous or trans-ureteral endoscopy. The reduction in invasive surgical procedures is emphasized. The first human use of extracorporeal lithotripsy by shock waves dates back to 1980. Since then, more than 30,000 calculi have been treated in this way, either exclusively or in combination with other therapy. For simple small calculi (less than 1 cm in diameter and situated in the pelvis or a calyx) the incidence of complications is minimal: renal colic (15%), fever (13%), need for complementary therapy (7%). With extension of use of extracorporeal lithotripsy to complex calculi (multiple calculi, staghorn calculi) these figures increased to 30, 5 and 12% respectively. Patients with obstructive and infected lithiasis were treated by percutaneous drainage nephrostomy with intensive antibiotic therapy prior to extracorporeal treatment. Extending indications also provided data on contraindications: coagulation disorders, major vascular problems, abnormal size or weight of patient, pregnancy and finally difficulty in localizing calculi. Of interest is the almost total lack of efficacy of shock waves for treating staghorn calculi. Treatment in these cases should be by an initial percutaneous approach to reduce size of calculus followed by extracorporeal lithotripsy under nephrostomy cover. Surgery for lithiasis should therefore be reserved for complex lithiasis cases with large caliceal calculi proximal to a long narrow infundibulum and to calculi proximal to a stenosis of pyelo-ureteral junction. Whenever possible, lumbar ureter calculi should be raised towards the pelvis by endoscopic manipulation before extracorporeal lithotripsy.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1995

Shock wave lithotripsy with the Dornier MFL 5000 lithotriptor using an external fixed rate signal.

PURPOSE: We examine the effects of fixed rate shock wave administration on the cardiac rhythm and treatment efficacy of a tubless lithotriptor (Dornier MFL 5000*). A secondary goal was to examine the treatment efficacy of fixed shock wave administration compared to R wave triggered lithotripsy. MATERIALS AND METHODS: In this prospective study Holter monitoring was used before, during and after nonR wave triggered shock wave lithotripsy. RESULTS: An increase in premature ventricular contractions was noted during shock wave lithotripsy. However, there were no episodes of significant ventricular ectopia, ventricular tachycardia, asystole or heart block as a result of nonR wave triggered shock wave administration. NonR wave gated shock wave lithotripsy expedited patient treatment and (mean treatment time 46 +/- 21 minutes)., minimized the use of sedation during treatment and produced results similar to R wave gated shock wave lithotripsy with the MFL 5000 lithotriptor. CONCLUSIONS: With adequate precautions, fixed rate shock wave administration would appear to be a reasonable option to treat urolithiasis with the MFL 5000 lithotriptor as with other newer lithotriptors.

Adult↗
PubMed1994

[Laser lithotripsy of ureteral calculi].

A total of 149 patients with 152 ureteral stones were treated with intraureteral lithotripsy by Dye-laser (83.55%), Alexandrite-laser (41.27%), electrohydraulic lithotripsy adapted for use in the ureter (25.16%) or neodymium: YAG laser with optomechanic coupling (3.2%). The Dye-laser has an automatic pulse shut-off mechanism with spectral analysis of the reflected laser beam, so that effective laser pulses can only be released by contact with a stone. Most (127 of 83.5%) of the stones could be completely fragmented, so that no further treatment was necessary. In 16 cases (10.5%) the stone was too hard for fragmentation and had to be removed by alternative techniques. Intraureteral lithotripsy is a save and effective method of treating ureteral stones that cannot be reached or have not been treated successfully by shockwave lithotripsy. No significant differences in outcome were found between the different lasers or electrohydraulic lithotripsy. In selected cases endoscopic treatment may be recommended as treatment of first choice.

Adolescent↗
PubMed1994

[The combination of extracorporeal lithotripsy and percutaneous nephrostomy in the treatment of obstructive ureteral urate calculi].

The authors report their experience with combined percutaneous nephrostomy and extracorporeal shock-wave lithotripsy to treat obstructive uratic ureteral stones. The role of nephrostomy is stressed as a diagnosis and treatment method before, during and after lithotripsy. Thus, the method proved especially useful to drain obstructed kidneys and restore peristalsis, to evacuate septic urine, to facilitate the elimination of lithiasic fragments, to perform anterograde pyelography before, during and after lithotripsy and finally to allow pharmacological litholysis. Fourteen patients were successfully treated with combined extracorporeal lithotripsy and percutaneous nephrostomy and the results compared with those obtained with other techniques--e.g., ureteroscopy, whose value appears lower because the method requires general anesthesia and is more traumatic to the ureter. The authors conclude that combined extracorporeal lithotripsy and percutaneous nephrostomy make the best technique to treat obstructive uric acid stones thanks to their positive results, low invasiveness and to patients compliance.

Adult↗
PubMed1993

Would revision arthroplasty be facilitated by extracorporeal shock wave lithotripsy? An evaluation including whole bone strength in dogs.

Extracorporeal shock-wave lithotripsy has been proposed as a modality to facilitate the removal of bone cement during revision arthroplasty; however, concomitant cortical microfractures have been reported. The current study examines the effect on whole bone strength of extracorporeal shock-wave lithotripsy directed at the cement-bone complex. Canine femora were subjected to manual cement extraction or lithotripsy followed by manual cement extraction. Contralateral femora served as controls. Torsional fractures were created, and maximum torque, maximum angular displacement, and energy capacity to failure were determined. Although cement extraction alone reduced mean torque by 6.6% and failed to reduce mean torque angle or mean energy capacity, the combination of lithotripsy and cement extraction reduced mean torque by 7.3%, mean torque angle by 14.3%, and mean energy capacity by 18.3%. No statistical significance was demonstrated between the two groups in torque, angle, or energy capacity. At magnitudes and numbers of shock waves previously shown to significantly reduce cement-bone interface mechanical strength, lithotripsy exposure had a minimal and insignificant effect on whole bone strength.

Animals↗
PubMed1993

[Extracorporeal lithotripsy or ureteroscopy for the treatment of calculi of the lower ureter].

Two therapies, ureterolithotripsy (URL) and extracorporeal shock wave lithotripsy (ESWL) can be used in the treatment of lower ureteral calculi. In a retrospective analysis ureterolithotripsy and extracorporeal shock wave lithotripsy for lower ureteral calculi were compared to evaluate morbidity. During a 3 year period 161 patients treated with ureterolithotripsy and 71 who underwent extracorporeal shock wave lithotripsy (Siemens Lithostar) were analysed as to the success rate, effectiveness quotient, complication rate and length of hospitalization. Followup consisted of ultrasound and a plain film of the kidneys, ureteres and bladder 1 day and 1 to 3 months postoperatively. Complete removal of all stone fragments was achieved in 95.5% of the patients treated endourologically with a 1.2% retreatment rate. In the group treated with extracorporeal shock wave lithotripsy success rate was 82.1% with a 19.6% retreatment rate. Among the patients who underwent ureteroscopy and stone removal 16.1% had complications compared to 10.7% in the ESWL group. The mean stone diameter was 0.8 cm in the endourological group and 0.7 cm in the ESWL group. Stone size was not a determining factor for the stone free rate and effectiveness quotient in the patients treated endourologically. Indeed, in patients who underwent ESWL for large stones the stone-free rate and effectiveness quotient decreased to 78.9% and 57.7%. Ureterolithotripsy will continue to have a primary role in the management of lower ureteral stones. As extracorporeal shock wave lithotripsy is an effective noninvasive procedure, requiring no anesthesia and hospitalization as routine, it may be considered an alternative either primarily or after failed ureteroscopy.

Adolescent↗
PubMed1995

[Role of extracorporeal shock wave lithotripsy in the treatment of common bile duct and intrahepatic calculi].

The management of intrahepatic and common bile duct stones has been modified by the advent of endoscopic sphincterotomy and percutaneous extraction through a T-tube tract or transhepatic access. Occasionally, nonoperative extraction is incomplete. The use of extracorporeal lithotripsy is reviewed in this setting. From May 1990 to February 1994, 18 patients (age 68.4 +/- 4.6 years) were treated by extracorporeal shockwave lithotripsy combined with endoscopic sphincterotomy and retrograde extraction or percutaneous approach. 72% of patients had previously undergone a cholecystectomy and 44% exploration of the common duct. Patients were submitted to 1.56 +/- 0.17 session of lithotripsy (5.546 +/- 701 shockwaves). Hospital stay was 19.5 +/- 3.3 days. After the lithotripsy, 1.17 +/- 0.19 endoscopic or percutaneous procedures per patient were necessary to clear the biliary tract. Seventy-eight percent of patients became stone-free. The five failures were treated by endobiliary prosthesis (n = 4) or cholecystectomy and bile duct exploration (n = 1). Lithotripsy in association with the usual therapeutic modalities contributes to clearing the bile duct from stones and avoids surgery in the majority of patients. A multidisciplinary approach is necessary in order to obtain those results.

Aged↗