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PubMed1989

Selective elevation of urinary enzyme levels after extracorporeal shock wave lithotripsy.

Urinary enzyme testing has been used by many investigators to diagnose and monitor various types of renal injury. Three urinary enzymes, N-acetyl-beta-glucosaminidase, beta-galactosidase and gamma-glutamyl transferase were monitored in 17 patients before and after a single, unilateral extracorporeal shock wave lithotripsy treatment. Stones were in the renal pelvis or calices except for 1 treated in situ in the proximal ureter. Urine specimens were collected before extracorporeal shock wave lithotripsy and at 1, 3, 5, 7, 10, 14, 21 and 28 days after treatment. N-acetyl-beta-glucosaminidase and beta-galactosidase levels increased significantly after treatment (p less than 0.05). Gamma-glutamyl transferase levels increased after treatment but this was not statistically significant. All enzyme levels were highest on days 1 and 3 after lithotripsy and returned to baseline by day 28. Factors associated with post-treatment enzyme elevation included female sex, a lower pre-treatment creatinine clearance and stone size greater than 1 cm. These findings indicate that there is a transient selective increase in urinary enzyme excretion after extracorporeal shock wave lithotripsy.

Acetylglucosaminidase↗
PubMed1989

Extracorporeal shock wave lithotripsy as monotherapy of staghorn renal calculi: 3 years of experience.

From May 1985 to February 1988, 61 patients with renal staghorn calculi (41 with incomplete C4 and 20 with complete C5 lesions) underwent extracorporeal shock wave lithotripsy monotherapy. Of the patients 37 were treated without preoperative Double-J* stenting, while 24 underwent Double-J stenting before extracorporeal shock wave lithotripsy. Of the patients with incomplete staghorn calculi (C4) and a preoperative ureteral stent 85% were free of stones after 6 months in contrast to only 52.4% of those without a stent and 85.7% of those with infected C4 calculi who underwent preoperative stenting. Hospitalization decreased from 17.7 days in patients without a stent to 14.2 days after stenting, followed by the number of auxiliary procedures (nephrostomy, Zeiss loop and ureteroscopy) and postoperative complications. Complete staghorn calculi (C5) without a preoperative stent had the smallest success rate of stone elimination: only 43.7% of the patients were free of stones after 6 months with a rehospitalization rate of 62.5%. For incomplete staghorn renal calculi (C4) extracorporeal shock wave lithotripsy monotherapy with a preoperative Double-J stent is the noninvasive method that offers excellent stone elimination (85%), comparable to the results of percutaneous nephrolithotripsy (with or without complementary extracorporeal shock wave lithotripsy) and anatrophic nephrolithotomy.

Combined Modality Therapy↗
PubMed1990

The effect of extracorporeal shock wave lithotripsy on the microbiological flora of urinary calculi.

To determine whether extracorporeal shock wave lithotripsy can sterilize infection stones and, thus, decrease the recurrence rate we investigated its impact on the microbiological flora of staghorn calculi. Fragments from 17 staghorn calculi retrieved percutaneously were divided into paired sets. One set was fractured by extracorporeal shock wave lithotripsy at 18 kv. and with increasing numbers of shock waves up to 1,000. One set was fractured mechanically with a surgical clamp. Bacterial cultures were then compared between the 2 groups. Of the 17 staghorn calculi 10 showed significant bacterial growth (59%). The number of colony-forming units was not significantly different between stones fragmented by lithotripsy and those that were mechanically fractured. Furthermore, exposing fragments to an increasing number of shock waves did not alter the colony count. We conclude that extracorporeal shock wave lithotripsy has no discernible effect on the microbiological flora of infected staghorn calculi.

Colony Count, Microbial↗
PubMed1990

Extracorporeal shock wave lithotripsy in patients with bleeding diatheses.

Five patients with known bleeding diatheses were treated with extracorporeal shock wave lithotripsy. Specific therapy was administered before extracorporeal shock wave lithotripsy to reverse the bleeding disorder. After treatment each patient was monitored with serial hemoglobin determinations and renal ultrasonography. The course during and after lithotripsy was uneventful in all patients. We conclude that extracorporeal shock wave lithotripsy is a viable option for patients with significant bleeding diatheses provided that specific therapy to reverse the coagulopathic condition is available and used before treatment.

Female↗
PubMed1990

Extracorporeal shock wave lithotripsy monotherapy for staghorn stones with the second generation lithotriptors.

We reviewed 50 patients with staghorn stones to determine whether extracorporeal shock wave lithotripsy monotherapy is a successful alternative to the classical approaches (open operation versus percutaneous lithotripsy alone or with extracorporeal shock wave lithotripsy). Results free of stones at long-term followup (greater than 3 months) were obtained in 28 of 50 patients (56%) and when we included residual fragments with a diameter of less than 4 mm. (9 patients, or 18%) an over-all success rate of 74% (37 patients) was achieved. Of the patients 41 had a Double-J stent to improve fragment evacuation (5 experienced obstructive elimination), while uncomplicated evacuation was noted in the remaining 9 without a stent. No case of septicemia after extracorporeal shock wave lithotripsy was observed but all patients had received strict antimicrobial prophylaxis.

Anti-Bacterial Agents↗
PubMed1990

Treatment of pacemaker patients with extracorporeal shock wave lithotripsy: experience from 2 continents.

Patients with cardiac pacemakers currently are treated by extracorporeal shock wave lithotripsy only by agreement between individual physicians and patients. We present the results of a survey of patterns of extracorporeal shock wave lithotripsy treatment (or nontreatment) of patients with pacemakers in the United States and Europe. Letters of inquiry regarding treatment of pacemaker patients were sent to 141 United States extracorporeal shock wave lithotripsy sites and 55 sites in Europe. Responses were received from 81 (57%) and 17 (31%) sites, respectively. A total of 131 patients received 142 treatments and pacemaker-related complications occurred in 4 (none was lethal, 3 were minor and all were corrected immediately). No patient required replacement of the pacemaker. No correlation existed between complications and pacemaker type or manufacturer. Urologists who treat patients with a pacemaker required previous clearance of the patients by the cardiologist, a cardiologist in or near the extracorporeal shock wave lithotripsy suite and standby of corrective equipment or temporary pacemakers.

Europe↗
PubMed1989

Retroperitoneal air, extracorporeal shock wave lithotripsy and epidural anesthesia.

During a 13-month period, 1,344 patients underwent extracorporeal shock wave lithotripsy. Plain x-rays done routinely 24 hours after lithotripsy to assess stone fragmentation revealed evidence of retroperitoneal air in 6 patients. All 6 patients had epidural anesthesia induced by loss of resistance to air in a syringe to identify the epidural space. It was believed likely that this was the cause of the air and 2 types of distribution were identified: 1 showed tracking of air along spinal nerves and 1 along tissue planes. This hypothesis eventually was confirmed by 2 patients in whom the air was identified after epidural anesthesia but before extracorporeal shock wave lithotripsy. Retroperitoneal air is found in a small number of patients undergoing epidural anesthesia and extracorporeal shock wave lithotripsy, and physicians treating these patients in the early postoperative period should be aware of this possible radiological finding and appreciate its benign nature.

Adult↗
PubMed1988

Bacteriuria following extracorporeal shock wave lithotripsy of infection stones.

Extracorporeal shock wave lithotripsy effectively pulverizes infected (struvite) renal calculi. However, after treatment minute residual fragments that may harbor bacteria and cause persistent bacteriuria remain in the renal collecting system for months. We investigated prospectively the incidence of persistent Proteus mirabilis bacteriuria after extracorporeal shock wave lithotripsy among 15 consecutive women with Proteus mirabilis urinary tract infections and struvite calculi. All patients received parenteral gentamicin for 3 to 8 days (mean 4.7 days) immediately before and after extracorporeal shock wave lithotripsy. Oral antimicrobials then were administered for 14 to 34 days (mean 25 days). Ten patients have maintained a sterile urine or experienced urinary reinfection by other organisms during 8 to 19 months (mean 13 months) of subsequent bacteriological surveillance. Of these 10 patients 9 had residual fragments. Five patients had Proteus mirabilis bacteriuria after 1 to 7 months of surveillance, including 3 with residual fragments. The mean stone size, methods and duration of renal drainage procedures, and duration of antimicrobial therapy were similar for the 2 patient groups. Proteus mirabilis was isolated from the cultures of only 3 of 11 retrievable stone fragments. In contrast to intact infected renal calculi, residual stone fragments after extracorporeal shock wave lithotripsy often are susceptible to sterilization with antimicrobials.

Adult↗
PubMed1988

Ureteral stone manipulation before extracorporeal shock wave lithotripsy.

We randomized 75 patients with solitary ureteral calculi that could not be dislodged by ureteral catheterization to receive instillation of saline, 2 per cent lidocaine viscous solution or dilute surgical lubricant before repeat stone manipulation with ureteral catheters. Of the stones irrigated with saline 76 per cent were returned to the pelvis along with 60 per cent of the lidocaine group and 48 per cent of the surgical lubricant treated stones. There was no statistical significance among the 3 groups. The success rates for upper, mid and lower ureteral stones were 80, 54 and 30 per cent, respectively. Of stones 0.5 cm. or less and between 0.6 and 1.0 cm. 77 and 72 per cent, respectively, were manipulated successfully but only 38 per cent of the stones larger than 1.0 cm. could be dislodged. Extracorporeal shock wave lithotripsy was successful in treating pelvic and ureteral stones, although higher kilovolt settings and additional shocks were necessary to fragment the ureteral stones completely. Percutaneous nephrostomy or ureteral meatotomy was required in 10 per cent of the patients with impacted ureteral stones following in situ extracorporeal shock wave lithotripsy but in only 4 per cent of the patients with stones successfully returned to the pelvis. Of the ureteral stones 17 per cent were treated with repeat extracorporeal shock wave lithotripsy. No patient with pelvic stones required repeat treatment. Retrograde manipulation of ureteral stones is an effective adjunctive procedure before extracorporeal shock wave lithotripsy.

Combined Modality Therapy↗
PubMed1988

Treatment of ureteral calculi by extracorporeal shock wave lithotripsy at a multi-use center.

We reviewed our experience with extracorporeal shock wave lithotripsy therapy in 138 patients who presented with mid and upper ureteral calculi. In the patients who had successful stone manipulation back into the renal collecting system the success rate was significantly higher compared to that for stones treated primarily within the ureter (92.8 versus 80.8 per cent, p less than 0.05). Among the stones treated within the ureter the success rates appeared to be similar for stones treated in situ (83.3 per cent) compared to those treated when a catheter could be placed alongside the calculus (79.3 per cent). Higher voltage and more shock waves were administered to stones treated within the ureter compared to stones that were manipulated back into the kidney. However, this increase power did not enhance the success rate. In addition, it appears that a plain film of the abdomen obtained within 24 hours of lithotripsy treatment is a good predictor of success as defined by the rate free of stones at 6 weeks of followup. Our results from a community-based multi-use lithotripsy center suggest that ureteral stone manipulation should be attempted before extracorporeal shock wave lithotripsy for mid and upper ureteral calculi.

Health Facilities↗
PubMed1987

Percutaneous renal calculus removal in an extracorporeal shock wave lithotripsy practice.

The introduction of extracorporeal shock wave lithotripsy and transurethral ureteroscopy have altered markedly the incidence of standard surgical and percutaneous stone removal procedures. To help define the present role of percutaneous procedures in our practice we evaluated our indications, results and the clinical course of 143 patients who were treated primarily with percutaneous methods during 1 year in which extracorporeal shock wave lithotripsy also was available. The complexity of these residual percutaneous cases necessitated repeat endoscopic or fluoroscopic stone removal procedures in 20 per cent and ancillary extracorporeal shock wave lithotripsy in 22 per cent, and led to a slightly higher complication rate than in our previous percutaneous series. Despite the effectiveness of extracorporeal shock wave lithotripsy, percutaneous methods still are necessary for comprehensive therapy of upper tract urolithiasis.

Body Height↗
PubMed2002

Ureteroscopy and holmium:YAG laser lithotripsy: an emerging definitive management strategy for symptomatic ureteral calculi in pregnancy.

OBJECTIVES: To review the results of holmium laser lithotripsy in a cohort of patients who presented with symptomatic urolithiasis in pregnancy. Symptomatic urolithiasis in pregnancy that does not respond to conservative measures has traditionally been managed with ureteral stent insertion or percutaneous nephrostomy. Holmium:yttrium-aluminum-garnet (YAG) laser lithotripsy using state-of-the-art ureteroscopes represents an emerging strategy for definitive stone management in pregnancy. METHODS: A retrospective analysis was conducted at two tertiary stone centers from January 1996 to August 2001 to identify pregnant patients who were treated with ureteroscopic holmium laser lithotripsy for symptomatic urolithiasis or encrusted stents. Eight patients with a total of 10 symptomatic ureteral calculi and two encrusted ureteral stents were treated. The mean gestational age at presentation was 22 weeks. The mean stone size was 8.1 mm. The stones were located in the proximal ureter/ureteropelvic junction (n = 3), midureter (n = 1), and distal ureter (n = 6). RESULTS: Complete stone fragmentation and/or removal of encrusted ureteral stents were achieved in all patients using the holmium:YAG laser. The overall procedural success rate was 91%. The overall stone-free rate was 89%. No obstetric or urologic complications were encountered. CONCLUSIONS: Ureteroscopy and holmium laser lithotripsy can be performed safely in all stages of pregnancy, providing definitive management of symptomatic ureteral calculi. The procedure can be done with minimal or no fluoroscopy and avoids the undesirable features of stents or nephrostomy tubes.

Adult↗
PubMed1995

Extracorporeal shock-wave lithotripsy in children.

OBJECTIVES: To analyze the efficacy and complication rates of extracorporeal shock-wave lithotripsy in children. METHODS: Between 1987 and 1994, 8760 patients with urinary calculi were treated at our institution. A total of 70 (0.8%) children 3 to 14 years old underwent lithotripsy using the Siemens Lithostar or the Lithostar Plus. A total of 100 calculi in 74 urinary tracts were treated, requiring 129 extracorporeal shock-wave lithotripsy sessions. There were 47 caliceal stones, 31 in the renal pelvis, 16 in the ureter, and 6 staghorn stones. The Lithostar Plus was used in 8 patients, for 3 caliceal, 3 pelvic, and 2 staghorn stones. Follow-up consisted of nephrotomogram or ultrasound 1 day and 1 to 3 months postoperatively. RESULTS: Complete removal of all stone fragments was achieved in 98.5% of the patients after 3 months. Re-treatment was necessary in 20 patients (29.4%). All patients were treated as outpatients, 51 (72.9%) with intravenous sedation and 19 (27.1%) without anesthesia. Complications were present in 7 patients (10%) who had colic and received medical treatment, and convalescence was uneventful. CONCLUSIONS: Extracorporeal shock-wave lithotripsy using the Lithostar and the Lithostar Plus has been demonstrated to be an effective noninvasive procedure to treat radiopaque and even radiolucent or slightly opaque urinary calculi in children.

Adolescent↗
PubMed1993

Gallbladder emptying is an important factor in fragment disappearance after shock wave lithotripsy.

The role of gallbladder emptying in fragment disappearance following shock wave lithotripsy of gallstones is poorly understood. We studied gallbladder motility in two groups of patients who had been treated by electrohydraulic shock wave lithotripsy and bile acid dissolution therapy. Group I (n = 20) consisted of patients with fragment disappearance within 18 months after lithotripsy, while patients in group II (n = 20) still harboured fragments in the gallbladder 18 months after lithotripsy. Fasting gallbladder volume was 19 +/- 10 ml (mean +/- S.D.) in group I, and 24 +/- 12 ml in group II (not significant). The residual volume was 8 +/- 9 ml in group I, but 18 +/- 14 ml in group II (p < 0.005). Thus, patients in group I ejected nearly twice as much of the fasting gallbladder volume as patients in group II. This difference in gallbladder emptying was still present if only the patients with single stones were compared in both groups. From the results of this retrospective study we conclude that gallbladder emptying is an important factor for complete fragment disappearance after gallstone disintegration by extracorporeally generated shock waves. Further prospective studies are needed to confirm these observations.

Adult↗
PubMed1999

Electrohydraulic and extracorporeal shock-wave lithotripsy.

The literal meaning of lithotripsy is the "act of breaking stones." There are two forms of lithotripsy available for use in veterinary medicine: electrohydraulic shock-wave lithotripsy (EHL) and extracorporeal shock-wave lithotripsy (ESWL). With EHL, a shock-wave is generated immediately adjacent to a urolith within the urinary bladder. In dogs, nephroliths or ureteroliths can be successfully treated with ESWL. With ESWL, the shock-waves are generated outside the body and directed toward the urolith.

Animals↗
PubMed2000

[Extracorporeal lithotripsy in Spain in the 20th. Century].

INTRODUCTION: In November of 1998, the Spanish Association of Urology decides to carry out a study on the lithotripsy in Spain, through the Group of Work in Lithiasis Urinary, with the objective of knowing the n(o) and distribution of Units and the real situation of the extracorporeal litotripsy for shock waves, in connection with other complementary methods or therapeutic alternatives. METHODOLOGY: We remit to all the Units of Lithotripsy a record of collection of data: Characteristic of the unit, no. of sick, localization of the calculi, complications, evolution and personal comments. RESULTS: 63 units of lithotripsy have participated in the study, at the moment 3 of them don't work and 23 belong to the Public Sanitary System. The Spanish population belong to 39,848,000 inhabitants, distributed in 17 autonomous communities, there is a lithotripsy unit for each 660,000 Spaniards. 264,875 sick people have been treated, they present synchronous bilateral lithiasis, 18,276 (6.9%) and a new treatment for relapse of calculi has been carried out in 18,592 sick people. The treated calculi are located at renal level in 60% of the cases, ureteral, 39% and vesical, 1%. The expelled, deposited or not expelled lithiasis residue corresponds to 9%, 6.8% and 6% respectively, and to 21.8% in total. CONCLUSIONS: After the analysis of these data, it is observed with evidence that in Spain, each million of inhabitants generate 602 cases of lithiasis/year, susceptible of being treated with shock waves. The distribution of resources decreases the complementary expenses: displacements, derivation temporary urinary, prevention infection urinary, analgesic, etc.

Health Care Surveys↗
PubMed1999

Sphincter of Oddi dysfunction after successful gallstone lithotripsy (postlithotripsy syndrome): manometric data and results of endoscopic sphincterotomy.

After successful gallstone lithotripsy, biliary pain recurs in about one third of patients. However, gallstone recurrence can be shown in only 40-60% of these patients. Therefore, other causes, such as sphincter of Oddi dysfunction (SOD), may be suspected. Twenty-two consecutive patients with recurrent biliary pain after successful gallstone lithotripsy without evidence of gallstone recurrence at ultrasonography were enrolled. Liver tests were elevated in 13 patients and ERC showed a dilated bile duct in nine. All 22 patients underwent sphincter of Oddi (SO) manometry, bile sample analysis for microlithiasis, endoscopic sphincterotomy (ES), and bile duct exploration with a Dormia basket. Thereafter, the patients were clinically followed at bimonthly intervals. SO manometry revealed SOD in 15/22 patients. This was more often the case in patients with initially larger (>2 cm) or multiple stones than after lithotripsy for solitary small stones (P < 0.01). Microlithiasis was detected in one patient, another patient had small biliary calculi at bile duct exploration (both without SOD). After ES, 14/15 patients with biliary SOD but none of the five without SOD improved (median follow-up: two years; P < 0.01). The one patient with CBD stones became symptom-free after ES, while the patient with microlithiasis improved after additional cholecystectomy only. Overall, ES proved to be the adequate therapy in 15/22 patients (68%, median follow-up: 22 months). After gallstone lithotripsy, SOD is found in about two thirds of patients with recurrent symptoms but without gallstone recurrence. In this group CBD stones or microlithiasis are rare. Therefore, SOD has to be suspected in this situation and ES gives favorable results, even when performed on a clinical basis only (without SO manometry).

Adult↗
PubMed1996

Management of ureteric calculi during pregnancy by ureteroscopy and laser lithotripsy.

OBJECTIVE: To evaluate the efficacy and safety of ureteric stone treatment by ureteroscopy and laser lithotripsy during pregnancy. PATIENTS AND METHODS: Four pregnant women (mean age 29.5 years, range 27-35) with five episodes of ureteric stones were treated by ureteroscopy and laser lithotripsy when the fetus was at 26-35 weeks of gestation. The stones (between 5 and 16 mm in diameter) were located in the proximal (one) or distal ureter (four). RESULTS: All five stones were removed successfully by ureteroscopy and laser lithotripsy. The operating time varied between 15 and 70 min. In two of the five cases, topical anaesthesia was adequate and in no case was fluoroscopy necessary. No complications occurred that could be related to the procedure. CONCLUSIONS: Ureteroscopy and laser lithotripsy seem, in experienced hands, to be a safe and reliable method in the treatment of ureteric calculi during pregnancy. Most cases can be treated without using fluoroscopy and in some cases the operation can be performed under local anaesthesia.

Adult↗