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PubMed2001

Bilateral extracorporeal shock wave lithotripsy in a spinal cord injury patient with a cardiac pacemaker.

OBJECTIVES: To review the precautions to be observed before and during extracorporeal shock wave lithotripsy (ESWL) in spinal cord injury (SCI) patients with a cardiac pacemaker and the safety of bilateral ESWL performed on the same day. DESIGN: A case report of bilateral ESWL in a SCI patient with a permanent cardiac pacemaker. SETTING: The Regional Spinal Injuries Centre, Southport, the Lithotripsy Unit, the Royal Liverpool University Hospitals NHS Trust, Liverpool, and the Department of Cardiology, Manchester Royal Infirmary, Manchester, UK. SUBJECT: A 43-year-old male sustained a T-4 fracture and developed paraplegia with a sensory level at T-2. During the post-injury period, he developed episodes of asystole requiring implantation of a dual chamber (DDD) permanent pacemaker. Twenty-one months later, he developed a right ureteric calculus with hydronephrosis. A radio-opaque shadow was seen in the left kidney with no hydronephrosis. During right ureteric stenting, the ureteric stone was pushed into the renal pelvis. 1,500 shock waves were delivered to this stone on the right side, followed by ESWL to the left intra-renal stone with 1250 shock waves. RESULTS: The patient tolerated ESWL to both kidneys. The pacemaker was reprogrammed to a single chamber ventricular pacing mode at 30 beats per minute with a reduced sensitivity during lithotripsy. There were no untoward cardiac events during or after lithotripsy. The serum creatinine was 45 micromol/l before lithotripsy and 44 micromol/l two weeks after ESWL. CONCLUSION: SCI patients with a cardiac pacemaker may be able to undergo extracorporeal shock wave lithotripsy following temporary reprogramming of the pacemaker. Bilateral, simultaneous ESWL is safe in the vast majority of patients provided that there is no risk of simultaneous ureteric obstruction by stone fragments. However, it should be remembered that a decrease in renal function could occur following bilateral ESWL of renal calculi.

Adult↗
PubMed1992

[Extracorporeal gallbladder lithotripsy: technology, practical methods, results and current value].

Extracorporeal shock wave lithotripsy of gallstones is a safe and well-tolerated procedure. Patients are now treated without general anesthesia and, increasingly, on an outpatient basis. Skin petechiae and transient hematuria are the most common side effects. Episodes of biliary colic are common in the follow-up period, but more serious adverse side effects such as cholecystitis and pancreatitis are distinctly uncommon. It is estimated that only 15% to 20% of all patients with symptomatic cholelithiasis are suitable lithotripsy candidates. As our knowledge of the procedure grows, it seems clear that the best results are obtained in patients with solitary radiolucent stones less than or equal to 20 mm, with stone-free rates at 12 months above 80%, for this selected group of patients. Adjuvant oral bile-acid dissolution therapy should be used in conjunction with gallstone lithotripsy. Gallstone recurrence remains to be established by clinical studies. Therapy for gallstones in 1991 has to be reevaluated by an interdisciplinary approach, taking into account not only open cholecystectomy, but also other modalities such as medical dissolution, laparoscopic surgery, percutaneous cholecystolithotomy and extra-corporeal shock wave lithotripsy. The appeal of the laparoscopic approach will substantially reduce the pool of patients for lithotripsy. Nevertheless, lithotripsy will continue to be a viable treatment option for patients with a single radiolucent stone. It is an outpatient procedure and doesn't require any incision or general anesthesia.

Bile Acids and Salts↗
PubMed1999

Holmium: YAG lithotripsy: optimal power settings.

PURPOSE: We tested the hypothesis that holmium:YAG laser lithotripsy speed is best maximized by using low pulse energy at high pulse frequency. MATERIALS AND METHODS: To demonstrate that optical fiber damage increases with pulse energy and irradiation, the 365-microm optical fiber irradiated calcium hydrogen phosphate dihydrate (CHPD), calcium oxalate monohydrate (COM), cystine, magnesium ammonium phosphate hexahydrate (MAPH), and uric acid calculi at pulse energies of 0.5 to 2.0 J. Optical energy output was measured with an energy detector after 10 J to 200 J of total energy. To demonstrate that lithotripsy efficiency varies with power, fragmentation was measured at constant power settings at total energies of 200 J and 1 kJ with the 365-microm optical fiber. Fragmentation was measured for the 272-microm optical fiber at pulse energies of 0.5 J to 1.5 J at 10 Hz. To demonstrate that low pulse energy produces smaller fragments than high pulse energy, fragment size was characterized for COM and uric acid calculi after 0.25 kJ of irradiation using the 272-microm to 940-microm optical fibers at 0.5 J to 1.5 J. RESULTS: Damage to the 365-microm optical fiber was greatest for irradiation of CHPD, followed by MAPH, and COM (P<0.001). There was no significant optical fiber damage after cystine and uric acid lithotripsy. For the 365-microm optical fiber and CHPD, fragmentation after 200 J was greatest for pulse energies < or =1.0 J (P< 0.001). For other compositions, fragmentation was not statistically different among the power settings for constant irradiation. No significant difference was noted in fragmentation for any composition at different pulse energies (1.0 v. 2.0 J) for 1-kJ irradiation. However, for all compositions, the calculated lithotripsy speed was greatest at high power settings (P<0.001). For the 272-microm optical fiber, CHPD fragmentation was greatest for the 1.0-J pulse energy. The mean fragment size and relative quantity of fragments > or =2 mm both increased as pulse energy increased. CONCLUSIONS: Optical fiber degradation varies with stone composition, irradiation, and pulse energy. Holmium:YAG lithotripsy speed is maximized with higher power (either increased pulse energy or higher pulse frequency). Because low pulse energy may be safer and yields smaller fragments than high pulse energy, holmium:YAG lithotripsy speed is best increased by using pulse energies < or =1.0 J at a high repetition rate.

Calcium Oxalate↗
PubMed1995

Ungated Medstone outpatient lithotripsy.

Ungated lithotripsy has raised the specter of possible cardiac arrhythmias. We reviewed ungated outpatient lithotripsy performed on 82 patients to evaluate the incidence of arrhythmias encountered and time saved. All patients were chosen in a random nonselected, prospective fashion. All treatments were performed on a mobile Medstone 1050 STS lithotriptor. The incidence of arrhythmias was 21%. All but 2 arryhthmias were benign and all reversed with gating. No arrhythmias occurred during treatment of right ureteral stones. In the left ureter only 1 patient had benign premature ventricular contractions during treatment. Arrhythmias occurred at 20 to 24 kv. in 20% of patients with right renal stones and 31% with left renal stones. All arrhythmias resolved with gating. No arrhythmias were encountered at an energy level of less than 20 kv. There was no evidence of electrocardiographic changes up to 1 hour after treatment. Pharmacological manipulation to maintain a heart rate of 100 may allow a treatment time of approximately 24 minutes. With ungating the rate may reach 120, allowing for a treatment time of approximately 20 minutes. In this series average ungated lithotripsy time was 36 minutes. In comparison, the average treatment time in 20 patients undergoing gated lithotripsy was 38.7 minutes. It is not clear from this study whether persistent ungated lithotripsy would have precipitated any life threatening arrhythmias since our practice has been to terminate the procedure and re-gate the shocks at the first sign of any persistent change in cardiac rhythm. Our data indicate that ungated lithotripsy with the Medstone device is safe when simple monitoring rules are followed.

Ambulatory Care↗
PubMed2003

Shock wave lithotripsy causes ipsilateral renal injury remote from the focal point: the role of regional vasoconstriction.

PURPOSE: Shock wave lithotripsy induced renal damage can occur as a result of multiple mechanisms, including small vessel injury and free radical production. Previous studies have demonstrated that shock wave lithotripsy exerts a regional change in renal hemodynamics, resulting in a global reduction in the glomerular filtration rate and renal plasma blood flow. We determined if biochemical evidence of cellular damage could be identified in ipsilateral locations remote from the shock wave site or in the contralateral kidney, suggesting regional or systemic alterations in renal function. MATERIALS AND METHODS: Ten juvenile female swine underwent open insertion of microdialysis probes into the renal parenchyma at the right upper and lower poles, and left lower pole. The animals were divided evenly into a sham and a treatment group. Dialysate samples were collected from all 3 sites from the sham group at 10-minute intervals for 100 minutes and quantitatively assessed for conjugated dienes, a measure of lipid peroxidation and free-radical activity, signifying renal cellular damage. The animals in the treatment group underwent shock wave lithotripsy focused on the right lower pole. Dialysate samples were collected from all 3 sites at baseline and at 1,000 shock intervals for a total of 10,000 shocks and analyzed for conjugated dienes. The results from the sham and treatment groups as well as from the different locations within each group were compared using Student's t test. RESULTS: The mean conjugated diene ratio for the sham group was 3.59, 3.42 and 2.7 microM. for the right upper and lower poles, and left kidney (p >0.05). A dose related increase in conjugated diene ratio levels from the right lower pole (lithotripsy site) and to a lesser degree from the ipsilateral right upper pole were observed, which were significantly different from sham group measurements or the contralateral kidney of the treatment group (p <0.05). The elevation in conjugated diene levels at the lithotripsy site was also noted to be significantly greater than that of the upper pole of the ipsilateral kidney (p <0.05). CONCLUSIONS: The increase in free radical activity at a site remote from the treated region suggests detrimental global effects from shock wave lithotripsy therapy. These observations could be the result of vasoconstriction throughout the treated kidney with resultant ischemia-reperfusion injury. Although these global renal effects may subject patients with baseline renal dysfunction to irreversible renal damage, the clinical significance of our findings is unclear and warrants further investigation.

Animals↗
PubMed1989

Electrohydraulic lithotripsy with peroral choledochoscopy.

OBJECTIVE: To determine the efficacy of peroral electrohydraulic lithotripsy performed with an extra large duodenoscope (outside diameter 14.8 mm) and a choledochoscope with a diameter of 4.1 mm (Olympus "mother and baby" endoscope system) in the removal of very large stones from the common bile duct. DESIGN: Prospective study of patients with giant stones in the common bile duct that were resistant to extraction by conventional means. SETTING: Endoscopy unit at a university hospital. PATIENTS: Four women and one man aged 48-82 (mean 66.4 years) with a total of nine stones in their common bile ducts ranging from 2.2 to 3.6 cm in diameter. INTERVENTIONS: Peroral electrohydraulic lithotripsy was performed after intravenous sedation and under antibiotic cover. Two endoscopists took part in each procedure, coordination being achieved by means of a video monitor. The procedures were performed with a Lithotron EL-23 lithotripter and a 3 French lithotripsy probe inserted through the choledochoscope under direct vision. MAIN OUTCOME MEASURE: Complete clearance of the common bile duct confirmed by occlusion cholangiography. RESULTS: All nine stones (mean minimal diameter 2.6 cm; mean maximal diameter 3.1 cm) were successfully fragmented by electrohydraulic lithotripsy, allowing subsequent extraction with the aid of endoscopy and clearance of the common bile duct. A median of three (range two to five) sessions of endoscopic retrograde cholangiopancreatography were required to achieve complete clearance of the ducts. Patients stayed a median of eight days in hospital after lithotripsy (range eight to 14). There were no complications. CONCLUSION: Peroral electrohydraulic lithotripsy offers a safe and effective alternative for the management of patients with large stones in the common bile duct.

Aged↗
PubMed2002

Urethroscopy and laser lithotripsy for the diagnosis and treatment of obstructive urolithiasis in goats and pot-bellied pigs.

OBJECTIVE: To explore the use of urethral endoscopy and laser lithotripsy in the diagnosis and management of urolithiasis in goats and pot-bellied pigs. DESIGN: Prospective clinical study. ANIMALS: 16 male goats and 6 male pot-bellied pigs with dysuria. PROCEDURE: Abdominal ultrasonography and urethral endoscopy were performed on all 22 animals. Endoscopic-guided holmium:yttrium-aluminum-garnet laser lithotripsy was performed in 3 goats and 2 pot-bellied pigs. RESULTS: Urolithiasis was identified in 15 goats and 5 pot-bellied pigs. Primary urinary bladder paralysis and cystitis were identified in the remaining pot-bellied pig and goat. Mean bladder diameters of obstructed small- and large-breed goats were 7 and 9.5 cm, respectively. The mean bladder diameter of obstructed pot-bellied pigs was 9.5 cm. Five of 20 animals with obstructive urolithiasis had severe urethral necrosis or stricture formation at the time of urethroscopy. All of these animals were euthanatized within 6 months because of persistent dysuria. When used, laser lithotripsy successfully fractured the distally located obstructing stones in the 3 goats and 2 pot-bellied pigs. CONCLUSIONS AND CLINICAL RELEVANCE: Urethral endoscopy is useful for evaluating urethral patency in goats and pot-bellied pigs. Examination of the urethral mucosa following relief of urethral obstructions aids in the assessment of the long-term prognosis for urethral stricture. Urethral endoscopy also expands the therapeutic options for management of urolithiasis by providing a route for conducting laser lithotripsy. Laser lithotripsy proved to be safe and effective for clearing distally located calculi refractory to removal by traditional urethral flushing. Lithotripsy application is restricted to calculi lodged in the urethra.

Abdomen↗
PubMed1999

Initial experience with endoscopic holmium laser lithotripsy for pediatric urolithiasis.

PURPOSE: Due to the unavailability of suitable pediatric instruments children have not benefited from advances in endoscopic lithotripsy. This limitation may be overcome by the holmium: YAG laser. We evaluated the indications for, and efficacy and complications of holmium:YAG laser lithotripsy. MATERIALS AND METHODS: We retrospectively reviewed all cases of laser lithotripsy. Access to the calculus was antegrade or retrograde. A solid state holmium:YAG laser was used. RESULTS: Eight patients 4 to 14 years old underwent laser lithotripsy during the study period. Average calculous surface area was 357.13 mm.2 (range 14 to 1,645). Five patients required 1 procedure to render them stone-free, while the remaining 3 required multiple procedures. No complications were associated with laser lithotripsy. CONCLUSIONS: The ability of the holmium:YAG laser to pulverize urinary calculi makes it an alternative choice for lithotripsy. In our series all patients are stone-free with stable renal function. The advantages of the holmium:YAG laser are that it may be precisely applied via small fibers, and it pulverizes calculi with minimal scattering of energy and retropulsion of the calculus, decreasing trauma to tissues at the perioperative site. There is also a lower risk of residual fragments, which is associated with a lower incidence of calculous regrowth. Holmium: YAG laser is safe and effective for treating pediatric urolithiasis.

Adolescent↗
PubMedDate not supplied

Pancreatic pseudocyst caused by extracorporeal shock wave lithotripsy for right renal pelvic calculi.

A 39-year-old white man with a history of right renal pelvic stones treated 1 year before by extracorporeal shock wave lithotripsy, but with no history of major surgery, alcoholism, pancreatitis, hyperparathyroidism or trauma, was admitted, suffering from an abdominal mass. Abdominal and pelvic computed tomography revealed an enlarged pancreatic head (9 cm in transverse diameter) with, inside it, a heterogeneous, cyst-like structure, measuring 7 cm in diameter. It was suspected that this lesion was a cystic neoplasm and the patient underwent a proximal pancreaticoduodenectomy and a cholecystectomy. After the operation, the microscopic findings ruled out the presence of a neoplasm and we were obliged to reconsider the case. Speculating as to the possible role of past extracorporeal shock wave lithotripsy in determining the pancreatic pseudocyst, it was found that damage to the intra-abdominal organs during extracorporeal shock wave lithotripsy has been mentioned in published series, but it was also noted that this case seemed to differ from the other published cases, where cirrhosis and thrombocytopenia, gallbladder stones, or adhesions between the pancreas and surrounding tissue caused by laparotomy were considered the causes of the lithotripsy complications. We suggest a direct traumatic disruption of the pancreas as a result of the extracorporeal shock wave lithotripsy and conclude that the post-lithotripsy follow-up should include periodic ultrasonographic investigation of the pancreas and serum amylase level determinations in order to diagnose pancreatic complications, if any, and plan the correct treatment.

Adult↗
PubMed2005

[Stone Cone: a device that prevents ureteral stone migration during intracorporeal lithotripsy].

OBJECTIVES: Proximal migration of stone fragments during ureteroscopic lithotripsy is a common problem influenced by pressure of irrigation solution, type of energy for lithotripsy, site and degree of fixation of the stone to the ureteral wall, and degree of proximal ureteral dilation. The Stone Cone (Boston Scientific & Spencer) is a device that helps to prevent proximal migration of fragments and favours a safe extraction during ureteroscopic lithotripsy. TECHNIQUE: The Stone Cone is an helical device made of stainless steel and nitinol alloy, which consists of an internal guide wire and a sheath-like radiopaque catheter with a 3 Fr. calibre. Once the cone is placed above the stone it is maintained in that position during lithotripsy to avoid fragment migration. The external catheter is used to coil and unroll the cone, and allows access to place the cone above the stone. METHODS: We describe two cases of urinary calculi in the left lumbar ureter treated by ureteroscopy and intracorporeal lithotripsy with holmium YAG laser using the Stone Cone to avoid migration of fragments. RESULTS: One month after surgery no lithiasic fragments were observed in the imaging tests. CONCLUSIONS: The Stone Cone decreases the need to perform repeated ureteral instrumentations, and is also a safer and simpler method for the extraction of stone fragments. The use of Stone Cone seems to have more advantages than Dormia's basket during ureteroscopic lithotripsy in terms of lower incidence of residual fragments and reoperation rate.

Adult↗
PubMed1990

[The endoscopic treatment of large calculi in the choledochus. The preliminary results with intracorporeal electrohydraulic shock-wave lithotripsy].

Results are reported of endoscopic treatment of: 236 patients with common bile duct calculi treated by endoscopic sphincterotomy with or without hydrostatic balloon extraction and extraction of the calculi, mechanical lithotripsy and endoprosthesis; preliminary results in 12 patients treated by intracorporeal electrohydraulic lithotripsy. Complete removal of calculi from the common bile duct was achieved in 171 of 236 sphincterotomized patients (72 per cent). Complications were observed in 11 per cent of the patients. Mechanical cracking of common bile duct calculi was realized in 60 of 65 patients (92 per cent) with complications observed in 3 per cent. Thus, with the use of mechanical lithotripsy the success of endoscopic treatment rose to 98 per cent, without increase in the incidence of complications. Seven patients had endoprostheses placed because of failure to extract the calculi. Intracorporeal electrohydraulic lithotripsy was performed in 12 patients with common bile duct lithiasis (4 with single and 8 with numerous stones with diameter 20-40 mm. In one patient transient acute pancreatitis was observed. A rise in serum amylase content was recorded in 9 patients. The stones in the common bile duct were effectively broken to pieces and removed in 8 patients. Lithotripsy was unsuccessful in 4 patients, two of whom had solid calcium depositions. In the common bile duct of the other two MTBE gas applied. The patients were subjected to repeated lithotripsy with positive effect. It is pointed out in conclusion that crushing stones in the common bile duct allows real improvement of the results of endoscopic sphincterotomy in common bile duct calculosis. Endoscopic treatment of larger calculi became also feasible which until a few years ago were contraindication for endoscopic treatment.

Aged↗
PubMed1990

[The organization of gallstone lithotripsy using the MPL-9000 at the Zurich University Hospital, successes and failures. Initial results].

At Zurich fragmentation of gallstones is a joint venture between the Visceral Surgery Clinic, the Medical Clinic, Medical Policlinic, Radiodiagnostic Central Institute and Urologic Clinic. Lithotripsy is performed by a team from the Visceral Surgery Clinic with apparatus placed at their disposal by the Urologic Clinic. Indications for lithotripsy include symptomatic cholecystolithiasis, functioning gallbladder, and up to 3 gallstones of at least 10 mm and at most 30 mm diameter. Bile duct stones, acute cholecystitis, coagulopathy, pregnancy, aortic aneurysm and pacemakers are exclusion criteria. Patients spend two days in hospital, lithotripsy is performed without anesthesia, and outpatient follow-up is performed 1, 3, 6 and 12 months afterwards. Our experiences show that lithotripsy is more difficult and more treatments are needed if multiple gallstones are present. We had to perform cholecystectomy in 6 of a total 48 patients, mainly because of therapy resistant biliary pain due to stone fragments. The intraoperative findings did not correspond to the ultrasonic examination before lithotripsy in two of the patients who underwent cholecystectomy. Histologic examination of the six gallbladders in the surgical cases showed no abnormality. After an average treatment duration of 209 days, 9 of 48 patients are stone-free, 15 patients show improvement, in 14 patients no distinct reduction of fragments could yet be shown in recent follow-ups and 4 patients have not yet been reached for follow-up. Of the 230 patients examined lithotripsy was indicated only in 48 (21%) cases.

Adult↗
PubMed1995

[Pneumatic intracorporeal lithotripsy of salivary calculi. In vitro and animal experiment studies].

BACKGROUND: The effort to use minimally invasive strategies in the treatment of human sialolithiasis in principle seems to allow the clinical application of pneumatic lithotripsy because of the small diameters of the probes involved. While this kind of therapy is already used successfully in urology, we investigated the method during in vitro and animal experiments. MATERIALS AND METHODS: The treatment of stones and tissue utilized the pneumatic lithotripter "Lithoclast". This system works with ballistic energy and is similar to a biologic "pneumatic hammer". Thirty salivary calculi were treated with pneumatic lithotripsy. Four submandibular salivary glands and their ducts were removed intraoperatively and were exposed to the pneumatic probes. Moreover, in two cases a salivary concretion was also implanted prior to pneumatic lithotripsy. In two rabbits the ducts of the parotid glands were ligated for 2 weeks. On the basis of the in vitro experiments, concretions were placed in two of the four salivary ducts. Following this, the pneumatic probes were inserted along the ducts and lithotripsy was completed. RESULTS: All of the 30 salivary calculi were reduced to sizes smaller than 1.5 mm in diameter. No macroscopic or microscopic damage was detectable while the probe was in a duct. However, in both cases with implanted calculi retropulsion of fragments occurred consequent perforation of the ducts. After application of ballistic pulses along the duct, small periductal hematoma without any perforation were detected macroscopically. Microscopically, only small bleeding was observed along the submucosa and partial loss of epithelium was found. In contrast, the pulse application to the implanted concretions lead to destruction of the calculi with perforation of the ducts as well as hemorrhage in the surrounding tissue. CONCLUSIONS: The method of pneumatic lithotripsy used in the present study resulted in sufficient destruction of salivary calculi. In vitro and in vivo lithotripsy of duct implanted calculi led to perforation of the salivary duct in all cases. Because of these results, the clinical use of this technique to treat human sialolithiasis appears to be not justified.

Animals↗
PubMed1994

Gallstone lithotripsy: the Rotterdam experience.

In the period between September 1988 and September 1992, 133 patients (34 males and 99 females; mean age 49 years [range 24-81]) underwent 299 extracorporeal shockwave lithotripsy sessions with adjuvant oral bile acid therapy. The mean number of extracorporeal shockwave lithotripsy sessions was 2.5 (1-7) and the mean number of shock waves 2,817 (75-4000), while the mean duration per session was 62 minutes (35-210). Ninety-eight patients (73.7%) required intravenous analog-sedation. At last follow-up (mean: 17.7 months [2-46]), 37 patients (27.8%) were free of stones and 30 (22.6%) had undergone cholecystectomy. At 1 year after the first session of extracorporeal shockwave lithotripsy, 51.0% of the patients with a solitary stone and 8.3% of the patients with 2-10 stones were free of concrements (p < 0.0001). Fourteen per cent [6/43] of the patients developed recurrent stones. Major complications comprised pancreatitis (n = 4; 3.0%) and acute cholecystitis (n = 1; 0.8%). Our results reconfirm that extracorporeal shockwave lithotripsy is safe and moderately effective in selected patients. Because of the wide acceptance of the laparoscopic cholecystectomy, extracorporeal shockwave lithotripsy should be restricted to patients at increased surgical risk and patients who refuse surgery. In view of the poor results in multiple stones, extracorporeal shockwave lithotripsy should be performed only on solitary stones.

Administration, Oral↗
PubMed1996

Extracorporeal shock wave lithotripsy in the treatment of ureteral lithiasis: methodological controversies and therapeutic efficacy.

The treatment of ureteral stones has undergone a radical change in the last 15 years. First, the increased use of endoscopic procedures and then the introduction of extracorporeal lithotripsy relegated traditional surgery to a marginal role for this type of disorder. The best available treatment modality for ureteral lithiasis, particularly distal ureteral stones, is still a matter of great controversy among urologist. With the introduction in clinical use of second- and third generation lithotripters, which are even less invasive and require no anesthesia, interest has increased in treating patients by extracorporeal lithotripsy, reducing endoscopic monoeuvres to a minimum. The absolute contraindications to extracorporeal lithotripsy for ureteral stones are the same as those for renal stones: intractable hemostatic alterations, pregnancy, physical structure that limits positioning and altered patency of the urinary tract. From June 1990 to December 1994, 270 patients with ureteral stones were treated by extracorporeal lithotripsy at our center. The Dornier MPL 9000 lithotripter was used in 68 cases (25%) and the modified HM3 Dornier in 202 (75%). Pretreatment manoeuvres were performed in 130 patients (48%). Endoscopic manoeuvres were not performed in 140 patients treated in situ. 18 patients (13%) treated initially in situ subsequently underwent post-treatment manoeuvres which were required only in 3 patients who had undergone pretreatment. All patients were examined as outpatients 3 months after the treatment. A total of 241 patients (89%) were stone free, 121 who had undergone pretreatment manoeuvres and 119 who had been treated in situ. 29 patients (11%) were not stone free: 23 patients subsequently underwent endoscopic lithotripsy, 2 surgery and 4 stone removal by Dormia probe. The possibility of performing treatment without anesthesia, the absence of complications and the high proportion of successes make extracorporeal lithotripsy, particularly the in situ procedure, the treatment of choice for ureteral stones. Ureterorenoscopy has been proposed by some authors as the first treatment for mid and pelvic ureteral stones which are difficult to localize with the lithotripter. However, although this method is very efficacious and less expensive, the percentage of complications is greater and patient compliance is less.

Evaluation Studies as Topic↗
PubMed1997

Contemporary clinical practice of shock wave lithotripsy: a reevaluation of contraindications.

PURPOSE: The current clinical practice of shock wave lithotripsy is reviewed, specifically regarding patients in whom the presence of presumed absolute or relative contraindications may preclude treatment. MATERIALS AND METHODS: Peer reviewed basic scientific and clinical studies on shock wave lithotripsy in patients with urinary stones and concomitant conditions that might contraindicate treatment reported between 1982 and 1996 were critically reviewed. RESULTS: The exclusion of patients with conditions previously believed to contraindicate shock wave lithotripsy has almost always been empiric rather than based on experimental or clinical studies showing adverse effects in those settings. The contemporary literature suggests that shock wave lithotripsy in patients with proximate calcified aneurysms, implanted cardiac pacemakers and defibrillators, and bleeding diatheses can be accomplished safely and effectively with careful treatment and monitoring before, during and after shock wave lithotripsy. Likewise, patients with morbid obesity, children, and those with mid and distal ureteral calculi can also be treated successfully, even with first generation lithotriptors, with minor modifications that allow for appropriate positioning of the patient and stone. CONCLUSIONS: The designation of most conditions as absolute or relative contraindications to shock wave lithotripsy has been empiric. A review of experimental and clinical studies pertinent to these issues clearly shows that most concomitant conditions previously precluding shock wave treatment can be circumvented to allow safe and effective use of this minimally invasive technology. Currently, pregnancy is the only condition that should remain an absolute contraindication to this treatment.

Aneurysm↗
PubMedDate not supplied

[Extracorporeal shock-wave lithotripsy in patients with manifestations of urinary tract infection].

The urinary tract infection is very frequent, especially if calculosis of the urinary tract is present. Urinary infection is widespread, and it appears during the year. The people of all ages and both sexes are affected by urinary infection. In the last few years a reliable progress in the understanding and management of urinary tract infection is achieved. Numerous articles published in professional journals are a good proof of it. The urinary tract infection is frequent and is responsible for the use of large quantities of antibiotics which provoke great costs and make other problems. The role of laboratory tests in the diagnosis of infection is predominant. The clinician is completely dependent on his collegue, a bacteriologist, with regard to the results of urine culture. It is known that microorganisms grow better if they have good nourishment. Infections of the urinary tract were always a significant problem. However, over the last few decades, they became, according to some authors, the most frequent bacterial infection in humans, requiring the frequent administration of immunosuppressive agents, corticosteroids and cytostatics; and at the same time a great number of elder people and chronic patients with reduced immunity are involved. Taking into account that significant and insignificant infections of the urinary tract are frequent in nephropathology, particularly in renal and canalicular calculosis, the aim of the study was to point to extracorporeal shock wave lithotripsy without risk of impairment of already existing infections with and without administration of antibiotic and uroantiseptic agents for prophylactic purposes. A group of 5,078 patients with calculosis of the urinary tract was studied. Extracorporeal shock wave lithotripsy was performed in all patients by Siemens lithotriptor Lithostar (Germany). In patients with calculosis of the urinary tract subjected to extracorporeal lithotripsy bacteriuria was regularly followed. A group of 1,836 (36 percent) patients with urinary tract obstruction and 3,242 (64 percent) patients without urinary tract obstruction were treated (Table 1). In 895 (18 percent) patients with urinary tract obstruction infection was serious. In 321 (6 percent) patients without urinary tract infection, serious urinary tract infection was detected (Table 2). The most frequent causes of urinary tract infection are presented in Table 3. Table 4 shows a review of patients to whom antibiotic therapy, prior to extracorporeal lithotripsy, was prescribed. Infection of the urinary tract is responsible for great morbidity. The treatment of any type of urinary tract infection must include the examination of the effect of antibiotic agents. During the treatment of urinary tract infection with calculosis resistant microorganisms are also developed because of repeated administration of antibiotics to patients in health institutions, and especially to patients with ureteral catheters. The treatment of any type of urinary tract infection must include the examination of the effect of antibiotic agents used. The fundamental aims of the treatment of urinary tract infection are: the eradication of causes of infection and concurrent prevention or optimal control of recurrent infection. As long as the patients with urinary tract calculosis are susceptible of permanent infections. It is indispensable to perform sterilization, and thereafter to remove the stone from the urinary tract, because infection of the urinary tract may cause a series of sequelae in the function of the kidney. Frequently the successful urinary sterilization with antibiotic agents cannot be achieved, and consequently, the carrying out of extracorporeal lithotripsy together with administration of antibiotics, is impossible. Good results can be obtained by a combined therapy of antibiotics and extracorporeal lithotripsy in patients with urinary tract calculosis. (ABSTRACT TRUNCATED)

Humans↗
PubMed1998

Holmium:YAG lithotripsy of uric acid calculi.

PURPOSE: Holmium:YAG lithotripsy of uric acid calculi produces cyanide. We review our experience with holmium:YAG lithotripsy of uric acid calculi to determine if there is any clinical evidence of cyanide toxicity. MATERIALS AND METHODS: A retrospective analysis of all of our cases of holmium:YAG lithotripsy of uric acid calculi was done. Anesthetic and postoperative data were reviewed. RESULTS: A total of 18 patients with uric acid calculi were treated with holmium:YAG lithotripsy by ureteroscopy (5), retrograde nephroscopy (2), percutaneous nephrolithotomy (5) or cystolithotripsy (6). No patient had increased end-tidal carbon dioxide, changes in electrocardiogram or significant decrease in postoperative serum bicarbonate. An 84-year-old woman had decreased diastolic pressure of 30 mm. Hg while under general anesthesia. No cyanide related neurological, cardiac or respiratory complications were noted. CONCLUSIONS: There were no obvious cyanide related complications from holmium:YAG lithotripsy of uric acid calculi. These data suggest no significant cyanide toxicity from holmium:YAG lithotripsy of uric acid calculi in typical clinical settings. Animal studies are warranted to characterize the risk.

Adolescent↗