PREDICTIVE FACTORS OF THE OUTCOME OF EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY FOR UPPER TRACT UROLITHIASIS

Extracorporeal Shock Wave Lithotripsy (ESWL) is one of the treatment options for renal and upper ureteric calculus; however, the outcome depends on multiple factors. Our study aims to evaluate the factors that may inuence ESWL outcomes in Indian patients with upper urinary tract calculi. Between 2018 and 2020, a total of 300 adult patients who underwent ESWL for renal and upper ureteral calculus sizing 5 to 20 mm were included in the study program. Patients with

A Randomised Prospective Analysis of Effectivness of ESWL vs PCNL in Renal Stone Size 1-2 cm and Review of Literature

Introduction: Majority of renal stones diagnosed todayare below 2 cm. The preferred treatment of <1cm stone isextracorporeal shockwave lithotripsy (ESWL) while standardof care for renal stone >2 cm is percutaneous nephrolithotomy (PCNL). The procedure of choice for 1-2 cm renalstones is still a subject of debate. This study was undertakento formulate a better understanding of management of renalstones of size 1-2cm in this patient populationMaterial and methods: A prospective study was carried outto evaluate clearance of ESWL vs PCNL in patients with renalstones of size 1-2 cm. Complete follow up data were availablefor 281 patients 140 in PCNL and 141 in ESWL group, 12patients were lost to follow up.Results: Both the groups were well matched with regards toage and sex distribution. 141 patients underwent ESWL and103/141(73%) patients had stone clearance in 1-3 months. 140patients underwent PCNL out of which 133 (95%) patientshad stone clearance. Complications were mostly minor andfound in 9.7% in patients undergoing ESWL while same wereseen in 30% of those undergoing PCNL.Conclusion: The primary objective in stone management istotal stone clearance. Considering this as priority PCNL hasproved superior to ESWL in our study for renal stones 1-2 cmin size. It has also got lower auxiliary and retreatment rates buthas its own share of complications and longer hospital stay areother important factors in PCNL.

Clinical study on severe infection caused by ureteral calculus in 12 patients / 中国基层医药

Objective@#To explore comprehensive treatment for severe infection caused by ureteral calculus.@*Methods@#The clinical data of 12 patients with severe infection caused by ureteral calculus in the Second People's Hospital of Lianyungang from January 2016 to December 2017 were reviewed.The patients cured by anti-infective therapy received one-stage surgical treatment.The patients with ineffective anti-infective therapy received one-stage cystoscopic retrograde double J tube or B ultrasound-guided percutaneous nephrostomy first, then ureteral calculus was treated.@*Results@#Two patients were cured by empirical antimicrobial agents.One patient was successfully cured by extracorporeal shock wave lithotripsy (ESWL) and the other by retroperitoneoscopic ureterolithotomy.Ten patients were not responsive to empirical antimicrobial agents.Two patients refused treatment and requested discharge from the hospital.The other 8 patients received two-stage treatment.In the stage I, cystoscopic retrograde double J tube was accomplished in 3 patients, and 5 patients were treated successfully by percutaneous nephrostomy guided by B ultrasound.In the stage II, one patient with ureter stone-street was cured by lithagogue drugs, 2 patients were successfully cured by ESWL, one patient by holmium laser lithotripsy under ureteroscope, 2 patients by ureterolithotomy and 2 patients by percutaneous nephrolithotomy by endoscopy and holmium laser.@*Conclusion@#The therapy of retrograde double J tube at cystoscopy or percutaneous nephrostomy guided by B ultrasound combined with empirical antimicrobial agents in the satae I, combined with lithotripsy according to guidelines in the stage II in treating severe infection caused by ureteral calculus have more advantage such as simple, less injury, rapid control of infection, less complication and satisfactory effect.It is an ideal method.

Clinical study on severe infection caused by ureteral calculus in 12 patients / 中国基层医药

Objective To explore comprehensive treatment for severe infection caused by ureteral calculus.Methods The clinical data of 12 patients with severe infection caused by ureteral calculus in the Second People's Hospital of Lianyungang from January 2016 to December 2017 were reviewed.The patients cured by anti-infective therapy received one-stage surgical treatment.The patients with ineffective anti-infective therapy received one-stage cystoscopic retrograde double J tube or B ultrasound-guided percutaneous nephrostomy first,then ureteral calculus was treated.Results Two patients were cured by empirical antimicrobial agents.One patient was successfully cured by extracorporeal shock wave lithotripsy (ESWL) and the other by retroperitoneoscopic ureterolithotomy.Ten patients were not responsive to emnpirical antimicrobial agents.Two patients refused treatment and requested discharge from the hospital.The other 8 patients received two-stage treatment.In the stage Ⅰ,cystoscopic retrograde double J tube was accomplished in 3 patients,and 5 patients were treated successfully by percutaneous nephrostomy guided by B ultrasound.In the stage Ⅱ,one patient with ureter stone-street was cured by lithagogue drugs,2 patients were successfully cured by ESWL,one patient by holmium laser lithotripsy under ureteroscope,2 patients by ureterolithotomy and 2 patients by percutaneous nephrolithotomy by endoscopy and holmium laser.Conclusion The therapy of retrograde double J tube at cystoscopy or percutaneous nephrostomy guided by B ultrasound combined with empirical antimicrobial agents in the satae Ⅰ,combined with lithotripsy according to guidelines in the stage Ⅱ in treating severe infection caused by ureteral calculus have more advantage such as simple,less injury,rapid control of infection,less complication and satisfactory effect.It is an ideal method.

Extracorporeal Shock Wave Lithotripsy (ESWL) Versus Uretero–Renoscopic Lithotripsy (URSL) For Management Of Upper Ureteric Calculi, Our Experience At Tertiary Care Hospital.

Background: Urinary stones are the third most common affliction of urinary tract, exceeded only by urinary tract infections and pathological conditions of prostate (BPH and Prostate cancer). Extracorporeal Shock Wave Lithotripsy (ESWL) and Uretero-renoscopic Lithotripsy (URSL) are among various treatment options available. Aims and Objectives:To compare ESWLand URSLprocedural and post procedural characteristics including outcome. Methods: A Prospective study was conducted in the department of Urology, SKIMS, on 100 patients with proximal Ureteric stone, from September 2015 to July 2017.By random selection, fifty patients were subjected to ESWL and another fifty to URSL. Various parameters were recorded on preformed proforma designed for the comparative study. Results: In our study, Parameters like Age and Gender distribution, symptoms at presentation and duration of symptoms, number of stones, laterality of stones (right/left) and grade of Hydronephrosis or Hydroureteronephrosis were uniformly distributed in the two groups (URSL VS ESWL). Spinal anaesthesia (SA) or General Anaesthesia(GA) was required in URSL group only, while as local anaesthesia and sedation was required in some patients in ESWLgroup. 72% and 88% patients achieved stone clearance in ESWLand URSLgroup respectively, (p=0.046). DJ stent was used in 20% of URSL patients and none in ESWL group. Procedure time was relatively less for URSL (p=0.001). Although statistically insignificant, Post procedure hematuria and urosepsis were higher in URSL group, where as pain/colic and fever was slightly higher in ESWL group. Steinstrasse was significantly higher in ESWL group (p=0.008). Hospital stay was significantly higher in URSL group (p<0.001). Cost involvement was higher in ESWLgroup (p=0.016). Conclusion: Although ESWL is regarded as the preferred choice of treatment for upper Ureteric stone, URSL is a safe alternative, with an advantage of obtaining an earlier or immediate stone free status in patients with stone size >10mm. In patients with smaller stones (<10mm), ESWL may be considered a reasonable alternative to URSL.

CT density Is it a predictor in renal calculus clearance with extracorporeal shock wave lithotripsy

Background: Computed tomography of the kidneys, ureters and bladder (CT-KUB) is increasingly used for urinary lithiasis. Its higher sensitivity in detecting small, radiolucent calculi with the avoidance of intravenous contrast media is very beneficial and replacing the traditional intravenous urography. Materials and methods: A Prospective study at Gandhi Hospital, Hyderabed was conducted from August 2013 to January 2016. Study Group I: calculus CT density less than 900 HU and study Group II: calculus CT density more than 900 HU. Results: Most of the stones were located in lower calix, followed by renal pelvis in both the groups. Hematuria persisted more than 24 hours among 6 (6%) patients in group 1 while18 (22.5%) in group 2. Steinstrasse was seen in 8 patients among group 1 which was managed medically in 6 patients where as ureteric stenting required in 2 patients .Where it was 3 patients in group 2 among them 1 required ureteric stenting, which appears to be significantly low but it was not when calculated among successful fragmentation as it is secondary complication to fragmented caliculi drainage. Conclusion: In patients with CT density <900 HU the ESWL was successful in 88%, with 58% of the patients required only one session and two or three ESWL sessions in remaining; with mean no 1.58 ESWL sessions are required. In patients CT density >900 HU, ESWL was successful in fewer than half of the patients (44%), only13% of them in a single session, and 76% requiring three sessions with failure rate of 80% in that group.

Comparative Study between Slow Shock Wave Lithotripsy and Fast Shock Wave Lithotripsy in the Management of Renal Stone.

Background: Renal calculi are frequent causes of ureteric colic. Extracorporeal shock wave lithotripsy is the most common treatment of these stones. It uses focused sound waves to break up stones externally. Objective: To compare the efficiency of slow and fast delivery rate of shock waves on stone fragmentation and treatment outcome in patients with renal calculi. Materials and Methods: This prospective study was done in the department of Urology, National Institute of Kidney diseases and Urology, Sher-e-Bangla Nagar, Dhaka from July 2006 to June 2007. Total 90 patients were treated using the Storz Medical Modulith ® SLX lithotripter. Patients were divided into Group A, Group B and Group C – each group having 30 subjects. Group A was selected for extracorporeal shockwave lithotripsy (ESWL) by 60 shock waves per minute, Group B by 90 shock waves per minute and Group C by 120 shock waves per minute. Results: Complete clearance of stone was observed in 24 patients in Group A and 13 patients in both Group B and Group C in first session. In Group A only 3 patients needed second session but in Group B and Group C, 12 and 8 patients needed second session. In Group A only one patient needed third session but third session was required for 3 patients in Group B and 5 patients in Group C for complete clearance of stone. In Group A, subsequent sessions were performed under spinal anesthesia and in Group B under sedation and analgesia (p>0.001). Mean number of sessions for full clearance of stones in group A was 1.37 ± 0.85, in Group B was 1.8 ± 0.887 and in Group C was 2.0 ± 1.083. Significant difference was observed in term of sessions among groups (p>0.05). In first follow-up, complete clearance of stones was seen in 24 patients in Group A and 13 in both Group B and Group C. In second follow-up, 3 patients in Group A, 12 in Group B and 8 in Group C showed complete clearance of stones. It was observed that rate of stone clearance was higher in Group A than in Group B and Group C. Multiple logistic regression analyses revealed that slow delivery rate (60 SW/min) as well as age (younger), symptom (painful) at onset, stone location (upper and middle calyx) and size (small) were independent prognostic factors determining stone clearance after ESWL of renal stone. Conclusion: Slow rate shock wave delivery improves efficacy of ESWL treatments of renal stone and decreased number of sessions, shock waves and treatment time.

Numerical simulation on an improved electro-hydraulic extracorporeal shock wave lithotripsy / 医用生物力学

Objective To simulate the pressure field for extracorporeal shock wave lithotripsy (ESWL) by attaching additional reflector with different angles at the side of the ellipsoidal reflector edge in the Dornier HM3 lithotripter. Methods Based on axisymmetric Euler equations and hybrid grid improved CE/SE numerical scheme, the pressure field of shock wave changed by the additional reflector in ESWL was simulated. Results Pressures of the additional reflector with different angles near the focus were compared. There were significant 50% increases of both the positive and negative pressure peaks in the pressure field as compared to ESWL without additional reflector. The peak pressures were gradually decreased with the reflector angle increasing. The peak pressure of 45° reflector angle was about 25% less than that 0° reflector angle. Conclusions At the initial stage of stone comminution, stones were broken into smaller pieces due to the more concentrated energy produced by the additional reflector, which could reduce the firing frequency to achieve the same or higher stone comminution efficiency. The numerical simulation results provide a reliable numerical calculation result and useful reference for the improvement and clinical application of ESWL lithotripter.

Low-Intensity Shock Wave Therapy and Its Application to Erectile Dysfunction

Although phosphodiesterase type 5 inhibitors (PDE5Is) are a revolution in the treatment of erectile dysfunction (ED) and have been marketed since 1998, they cannot restore pathological changes in the penis. Low-energy shock wave therapy (LESWT) has been developed for treating ED, and clinical studies have shown that LESWT has the potential to affect PDE5I non-responders with ED with few adverse effects. Animal studies have shown that LESWT significantly improves penile hemodynamics and restores pathological changes in the penis of diabetic ED animal models. Although the mechanisms remain to be investigated, recent studies have reported that LESWT could partially restore corpus cavernosum fibromuscular pathological changes, endothelial dysfunction, and peripheral neuropathy. LESWT could be a novel modality for treating ED, and particularly PDE5I non-responders with organic ED, in the near future. However, further extensive evidence-based basic and clinical studies are needed. This review intends to summarize the scientific background underlying the effect of LESWT on ED.

Removal of Kidney Stones by Extracorporeal Shock Wave Lithotripsy Is Associated with Delayed Progression of Chronic Kidney Disease

PURPOSE: This study aimed to elucidate whether stone removal by extracorporeal shock wave lithotripsy (ESWL) is associated with delayed chronic kidney disease (CKD) progression. MATERIALS AND METHODS: We conducted a retrospective analysis of 131 nephrolithiasis patients with stage 3 and 4 CKD. We collected baseline clinical and laboratory data, kidney stone characteristics, and history of receiving ESWL. We classified study patients into two groups according to whether they underwent ESWL or not (Non-ESWL group vs. ESWL group). We initially compared annual estimated glomerular filtration rate (eGFR) changes of Non-ESWL group with those of ESWL group before undergoing ESWL. In the next step, we sought to compare annual eGFR changes in the same patients before and after ESWL. Finally, we compared annual eGFR changes between success and failure groups among patients undergoing ESWL. RESULTS: The mean age of the patients was 62 years and 72.5% were male. The mean observation period was 3.2 years. Non-ESWL group and ESWL group before undergoing ESWL showed similar annual eGFR changes (-1.75+/-6.5 vs. -1.63+/-7.2 mL/min/1.73 m2/year, p=0.425). However, eGFR declined slower after undergoing ESWL than before ESWL (annual eGFR changes, -0.29+/-6.1 vs. -1.63+/-7.2 mL/min/1.73 m2/year, p<0.05). In addition, among patients in ESWL group, eGFR declined faster in the failure group than in the success group (annual eGFR change, -1.01+/-4.7 vs. -0.05+/-5.2 mL/min/1.73 m2/year, p<0.05). CONCLUSION: Our results suggest that stone removal by ESWL is associated with delayed deterioration of renal function in CKD patients with nephrolithiasis.

Analyzing the Effect of Distance from Skin to Stone by Computed Tomography Scan on the Extracorporeal Shock Wave Lithotripsy Stone-Free Rate of Renal Stones

PURPOSE: To determine whether the distance from skin to stone, as measured by computed tomography (CT) scans, could affect the stone-free rate achieved via extracorporeal shock wave lithotripsy (ESWL) in renal stone patients. MATERIALS AND METHODS: We retrospectively reviewed the records 573 patients who had undergone ESWL at our institution between January 2006 and January 2010 for urinary stones sized from about 5 mm to 20 mm and who had no evidence of stone movement. We excluded patients with ureteral catheters and percutaneous nephrostomy patients; ultimately, only 43 patients fulfilled our inclusion criteria. We classified the success group as those patients whose stones had disappeared on a CT scan or simple X-ray within 6 weeks after ESWL and the failure group as those patients in whom residual stone fragments remained on a CT scan or simple X-ray after 6 weeks. We analyzed the differences between the two groups in age, sex, size of stone, skin-to-stone distance (SSD), stone location, density (Hounsfield unit: HU), voltage (kV), and the number of shocks delivered. RESULTS: The success group included 33 patients and the failure group included 10. In the univariate and multivariate analysis, age, sex, size of stone, stone location, HU, kV and the number of shocks delivered did not differ significantly between the two groups. Only SSD was a factor influencing success: the success group clearly had a shorter SSD (78.25+/-12.15 mm) than did the failure group (92.03+/-14.51 mm). The results of the multivariate logistic regression analysis showed SSD to be the only significant independent predictor of the ESWL stone-free rate. CONCLUSIONS: SSD can be readily measured by CT scan; the ESWL stone-free rate was inversely proportional to SSD in renal stone patients. SSD may therefore be a useful clinical predictive factor of the success of ESWL on renal stones.

Numerical simulation of electro-hydraulic extracorporeal shock wave lithotripsy with single-pulse or dual-pulse / 医用生物力学

Objective To study the pressure field with the single-pulse and the dual-pulse for extracorporeal shock wave lithotripsy (ESWL) by numerical simulation, and to compare and analyze the results. Methods2D axisymmetric Euler equations and hybrid grids improved CE/SE numerical scheme were employed to simulate the pressure field of underwater shock wave in ESWL. Results The CE/SE shock wave dynamics method could successfully track the transmission of shock wave front, and the simulation solution could preferably reveal the focusing properties near the focus of ESWL: the pressure of dual-pulse was about the twice that of the single-pulse near the focus, and the higher lithotriptic efficiency could be achieved when the dual-pulse was much closer to the focus than the single pulse. A negative pressure with high absolute value was observed after the positive pressure occurred near the focus. ConclusionsThe adoption of electro hydraulic lithotripter could effectively improve the efficiency of stone comminution and the cavitation of shock wave focus was unavoidable, which provided a reliable numerical simulation result for the design and application of ESWL lithotripter in clinic.

Extracorporeal shock wave lithotripsy in the treatment of pediatric urolithiasis: a single institution experience

PURPOSE: To compare the efficacy and safety of the electromagnetic lithotripter in the treatment of pediatric lithiasis to that of the earlier electrohydraulic model. MATERIALS AND METHODS: Two groups of children with lithiasis aged between 10 and 180 months who underwent extracorporeal shock wave lithotripsy (ESWL). In the first group (26 children), ESWL was performed by using the electrohydraulic MPL 9000X Dornier lithotripter between 1994 and 2003 while in the second group (19 children) the electromagnetic EMSE 220 F-XP Dornier lithotripter was used from April 2003 to May 2006. RESULTS: In the first group, 21/26 children (80.7 percent) were stone free at first ESWL session. Colic pain resolved by administration of an oral analgesic in 6 (23 percent), brief hematuria (< 24 h) resolved with increased fluid intake in 5 (19.2 percent), while slightly elevated body temperature (< 38°C) occurred in 4 (15.3 percent). Four children (15.3 percent) failed to respond to treatment and were treated with ureteroscopy. In the second group 18/19 children were completely stone free at first ESWL session (94.7 percent). Complications were infrequent and of minor importance: colic pain treated with oral analgesic occurred in 1 (5.26 percent), brief hematuria (< 24 h), resolved with increased fluid intake in 4 (21 percent) and slightly elevated body temperature (< 38°C) monitored for 48 hours occurred in 6 (31.5 percent). Statistical analysis showed that electromagnetic lithotripter is more efficacious and safer than the earlier electrohydraulic model. CONCLUSIONS: Technological development not only has increased efficacy and safety of lithotripter devices in treating pediatric lithiasis, but it also provided less painful lithotripsy by eliminating the need for general anesthesia.

Delayed Splenic Rupture and Pancreatic Pseudocyst Following Extracorporeal Shock Wave Lithotripsy for a Urolithiasis

Extracorporeal shock wave lithotripsy (ESWL) has revolutionized the management of urolithiasis since 1980. Although it has proved to be a safe, effective treatment modality, it is not free of complications. As this procedure has become more widely available, complications as a result of injury to the kidney and the surrounding organs are being increasingly recognized. Those reported complications include hepatic hematoma, biliary obstruction, pancreatitis, colonic and splenic injury, bowel perforation, psoas abscess, aortic aneurysm rupture, portal and iliac vein thrombosis, retroperitoneal and brain hemorrhage, gastric erosions, pulmonary contusions and cardiac arrhythmias. Physicians caring for these patients should be mindful of these complications and keep an eye open to spot them. We report here on a case of a young male patient who developed splenic rupture and a pancreatic pseudocyst after undergoing extracorporeal shock wave lithotripsy (ESWL) for treating a left upper ureter stone.

Ureteroscopy Combined with ESWL for Ureteral Calculus:Report of 256 Cases / 中国微创外科杂志

Objective To investigate the clinical value of ureteroscopy combined with ESWL for the treatment of ureteral stone.Methods From October 2005 to June 2007,a total of 256 patients with ureteral stones were treated in our hospital.The calculus in the middle and lower ureter were removed by ureteroscopy,while the stones in the upper ureter was treated by ESWL.For the cases that failed ureteroscopy or those who had residual stones after the treatment,ESWL was performed as a supplement.ResultsIn the patients with lower ureteral stones,the one-stage cure rate was 98.2%(167/170),while in those with middle and upper ureteral calculi,the rate was 89.2%(50/56) and 73.3%(22/30) respectively.Three patients developed perforation of the ureter during the surgery,and one had mucosal injury of the ureter.One case was converted to open surgery because of perforation of the ureter resulted from ureteral twist.Twelve patients were failed ureteroscopy or had residual stones,and received ESWL as the second-stage treatment,11(91.7%) of them were cured afterwards.Conclusions Ureteroscopy is effective for middle and lower ureteral stones.For the cases failed the operation or have residual calculi,ESWL is a good choice.

A Case of Urinary Calculus in Transplanted Kidney Treated with Extracorporeal Shock Wave Lithotripsy / 대한이식학회지

Urinary calculi are a rare clinical problem in kidney transplantation; the reported incidence is about 0.2% to 1.7%. The incidence is decreasing due to the use of absorbable suture stitches and the early treatment of hyperparathyroidism. Symptoms of renal transplant lithiasis are absent typical abdominal pain due to the denervated renal transplant. We experienced a case of obstructive uropathy due to urinary calculus in transplanted kidney. The stone was 9.8 mm sized and removed by ESWL. No further calculi have developed during observational period and renal function improved.

Effects of Intravenous Fluid and Diuretics on Stone Fragmentation and Passage during Extracorporeal Shock Wave Lithotripsy (ESWL) of Upper Ureteral Stone / 대한비뇨기과학회지

PURPOSE: A prospective randomized controlled trial was performed to investigate the effects of intravenous hydration, both with and without diuretics, on the fragmentation and passage of an upper ureteral stone during ESWL. MATERIALS AND METHODS: We analyzed 65 patients with upper ureteral stones, primarily treated with piezoelectric LT-02 lithotripter, between November, 2001 and March, 2002. The patients were divided in 3 groups; the 20 patients in group A were injected with 500ml of normal saline for intravenous hydration, and 20mg of furosemide for diuretic effect during the ESWL; the 20 patients in group B were injected with normal saline without furosemide, and the remaining 25, group C, were used as controls. The same energy settings for the shockwaves in one session were equally applied to all the patients during the ESWL, with a 4Hz shockwave frequency, 100% power, a 50 minute treatment and 43 minute storage time. After 2 weeks, the degrees of stone fragmentation, and the residual fragments, were evaluated on the post-ESWL KUB and compared with the pre-ESWL KUB. RESULTS: After a single ESWL treatment, the stone-free rate was 70% (14 of 20 patients) in group A, 60% (12 of 20 patients) in group B and 28% (7 of 25 patients) in group C (p0.05). CONCLUSIONS: Intravenous hydration with normal saline, both with and without a furosemide injection for diuretic effect, during ESWL would be an effective method to facilitate the fragmentation and passage of upper ureteral stones smaller than 10mm.

Treatment Effects of Piezoelectric Shock Wave Lithotripsy (EDAP LT01 & LT02): Experience of 5,000 Cases / 대한비뇨기과학회지

PURPOSE: Shock Wave Lithotripsy (SWL) has revolutionized the management of urinary stones. However, exceptions and complications have occasionally been observed. Therefore, we evaluated the success rate, indications, complications and clinical characteristics of 5,000 patients that treated with SWL. MATERIALS AND METHODS: We evaluated 5,000 patients were a SWL was performed using the EDAP LT01 and 02 piezoelectric lithotriptors, between 1987 and 2001. The study group comprised of 2,942 men and 2,058 women (1.43:1) with a mean age of 46.7 years. We evaluated the success rate of the SWL by the sizes and locations of the stones and by treatment sessions. RESULTS: The total success rate of the SWL was 91.5%. For renal stones, the success rates ranged from 95.9, for stones 0.5-1.0cm in size, to 60.0%, for stones 1.6-2.0cm in size. For upper ureter stones, the success rates ranged from 87.1, for stones 0.5-1.0cm in size, to 54.5%, for stones 1.6-2.0cm in size. For lower ureter stones, regardless of stone size, the SWL was 100% successful. The mean success rate was 99.3%. With the complications, gross hematuria was observed, with septicemia in 10 patients. CONCLUSIONS: The success rate of SWL was 91.5%. In our 14 years of experience, SWL has proved to be an effective and safe method to treat the urinary stones.

Experience of Extracorporeal Shock Wave Lithotripsy with Piezolith 2300 Device in 2077 Patients with Urinary Tract Calculi / 대한비뇨기과학회지

PURPOSE: An experience of extracorporeal shock wave lithotripsy (ESWL) using the Piezolith 2300 lithotriptor in 2077 (2223 renal units) patients with urinary tract calculi is presented. MATERIALS AND METHODS: The records of 2077 patients who underwent an ESWL between April 1990 and March 2001 were reviewed retrospectively. The ESWL treatment sessions, success rate, auxiliary procedures, and complications according to the stone size and location were analyzed. RESULTS: Of 2223 renal units (2077 patients), 781 (35.1%) had renal, 1150 (51.7%) had ureteral and 292 (13.2%) had multiple stones. Of these cases 1116 (50.2%) had stones 3.0cm in size, with an 86.4% overall success rate. For auxiliary measures, the push back procedure was done in 23 cases. The treatment modalities of the unsuccessful cases were open surgery in 95 cases and ureteroscopic stone removal in 31. A stone street developed in 93 patients. However, there were no other significant complications. CONCLUSIONS: Extracorporeal shock wave lithotripsy with a piezolith 2300 lithotriptor is to be a safe and efficient outpatient procedure for the initial treatment of properly selected urinary tract calculi.

Deep Vein Thrombosis after ESWL in Patient with Protein S Deficiency / 대한비뇨기과학회지

ESWL is an effective treatment for renal and ureteral calculi with few serious side effects. Most complications are related to an obstruction from stone fragments lodged within the ureter with an accompanying colic and/or infection and subcapsular or perirenal hematoma. Here we report a patient with a protein S deficiency sustaining a deep vein thrombosis following an ESWL for a mid ureter stone.