[Extracorporeal piezoelectric lithotripsy in the treatment of calculi of the ureter. Apropos of a series of 143 cases]. / La lithotritie piézo-électrique extra-corporelle dans le traitement des calculs de l'uretère. A propos d'une série de 143 cas.

The results obtained in 143 cases or ureteral stones treated by EDAP LT-01 were analysed concerning stone location, ureteral manipulation, and treatment position. The ureter was divided into six segments: ureteropelvic junction (UPJ), proximal ureter higher than the lower pole of the kidney (PU1), proximal ureter between the lower pole and the iliac crest (PU2), mid-ureter between the iliac crest and the lower end of the sacroiliac joint (MU), distal ureter between the lower end of the sacroiliac joint and the ischial spine (DU1), and the distal ureter below the ischial spine to the meatus (DU2). The overall fragmentation rate (FR) was 72%, as detailed below: (table; see text) Anesthesia or iv sedation was never used for EPL. 28% of the patients underwent retrograde ureteral manipulation (29/103). For PU1, the FR was twice as high after retrograde manipulation (push back/in situ = 5/8). For UPJ, the supine position was most common. For PU1 and PU2, it was often better to have the patient lie on his side. For DU1 and DU2, a prone position was necessary. For all stones in DU1, the bladder had to be well filled and the FR was higher in DU2 than in DU1. DU2 stones appeared to adhere to the bladder wall or were intravesical (stone in the meatus). The stone-free rate for successfully manipulated ureteral calculi (3 month follow-up) is 93% (27/29). The stone-free rate for in situ stones at 3 months is 94% (70/74). Extracorporeal piezoelectric lithotripsy combined with stone manipulation is highly efficient in the management of UPJ, PU1 and DU2 stones.(ABSTRACT TRUNCATED AT 250 WORDS)

[Extracorporeal piezoelectric lithotripsy (EDAP LT 01) in the treatment of ureteral calculi. Apropos of a series of 143 cases]. / La lithotritie piézo-électrique extra-corporelle (EDAP LT 01) dans le traitement des calculs de l'uretère. A propos d'une série de 143 cas.

The results for 143 cases of ureteral stones treated by EDAP LT01 were analyzed concerning stone location, ureteral manipulation and treatment position. The ureter was divided into six segments: ureteropelvic junction (UPJ), proximal ureter (PU1 and PU2), mid-ureter (MU), distal ureter (D1 and D2). The overall fracturization rate (FR) was 72%, as detailed below: UPJ (89%, 26/29), PU1 (86%, 13/15), PU2-MU (62%, 15/24), DU1 (59%, 25/42), DU2 (72%, 24/33). Anesthesia or iv sedation were never used for PEL. 24% of the patients underwent retrograde ureteral manipulation (in situ/push back = 108/35). For PU1, the FR was twice as high after retrograde manipulation (in situ/push back = 5/8). For PU2 and MU, the supine position was most common. For UPJ and PU1, it was often better to have the patient lie on his side. For DU1 and DU2, a prone position was necessary. For all stones in DU1, the bladder must be well filled; the FR was higher in DU2 than in DU1. DU2 stones appeared to adhere to the bladder wall or were intravesical (stone in the meatus). The stone-free rate for successfully manipulated ureteral calculi (3 month's follow-up) was 93% (27/29). The stone-free rate for in situ stones at 3 months was 94% (70/74). Extracorporeal piezoelectric lithotripsy combined with stone manipulation is highly efficient in the management of UPJ, PU1 and DU2 stones. The success rate of in situ PEL improves after the operator becomes skilled with the procedure. The advantages of the EDAP LT01 are the absence of pain, no need for anesthesia, and the mobility of the shock wave unit.

[Exclusive piezo-electric lithotripsy (EDAP LT 01) in the treatment of calculi larger than 30 mm. Pyelic, partial or total staghorn]. / La lithotritie piézo-électrique exclusive (EDAP LT 01) dans le traitement des calculs de plus de 30 mm. Pyéliques, coralliformes partiels ou totaux.

Thirty patients with partial of total staghorn calculi or pyelic calculi greater than 30 mm were treated by extracorporal piezo-electric lithotripsy (PEL) exclusively with an EDAP LT 01 lithotripter equipped with an ultrasound localisation system. Nineteen patients had a pyelic calculus and the others a partial (n = 9) or total (n = 2) staghorn calculus. All patients first underwent extracorporal lithotripsy (ECL). None of the patients received IV sedation or anesthesia. When fragmentation of the calculus was observed after the first session, a double J stent was inserted before the second ELC session. Before the first session, urine samples were sterile in 18 of the 30 patients; 12 of the 30 patients presented major distention of the urinary tract. Results were analysed to identify factors affecting results of this type of treatment. Patients whose calculus had completely disappeared on plain films three months after the first session were considered to be cured clinically and radiologically (14/30 = 46%). Seven patients (23.3%) were clinically cured (absence of pain and sterile urine) but there were residual fragments (1 to 3 fragments less than or equal to 4 mm). No fragmentation was obtained after the first session in 9 patients (30.7%) (1 total staghorn, 8 pyelic calculi). The mean number of sessions was 5 (range 1-15). Only 10% of the patients (3/30) presented a complication: 2 steinstrasses and 1 acute pyelonephritis. 83% of the patients without urinary tract distention and 55% of the patients whose urines were initially sterile were cured.(ABSTRACT TRUNCATED AT 250 WORDS)

Piezoelectric lithotripsy monotherapy for partial or total staghorn lithiasis and calculi larger than thirty millimeters.

Thirty patients with partial or total staghorn lithiasis or calculi larger than 30 mm were treated by piezoelectric lithotripsy (PEL) monotherapy using an EDAP LT-01 lithotripter with ultrasound guidance. Nineteen of these patients had a pelvic stone; the other 11 had partial (nine) or total (two) staghorn lithiasis. All patients first underwent an initial lithotripsy session. No anesthesia or intravenous sedation was required in any case. If stone fracturization was achieved after this first session, a double J stent was inserted before the second lithotripsy session. Prior to the first session, 18 of 30 patients had a sterile urine culture; 12 of 30 presented major distention of the excretory tract. Results were analyzed to determine those factors influencing the outcome of this therapy. Three months after the first session, patients were considered cured if their stone had completely disappeared on abdominal plain films (14/30 = 46%). In seven patients (23.3%), fracturization had occurred but residual fragments remained (1-3 fragments less than or equal to 4 mm). No fracturization was obtained after the first session in nine patients (30.7%) (one total staghorn lithiasis, eight pelvic stones). The mean number of treatment sessions was five (range 1-15). Complications occurred in only 10% of patients (3/30): two steinstrasse and one acute pyelonephritis. Eighty-three percent of patients without major excretory tract distention and 55% of patients whose initial urine culture was sterile, achieved a stone-free state.(ABSTRACT TRUNCATED AT 250 WORDS)

[Intraprostatic spiral for the treatment of benign prostatic hypertrophy. A new method of insertion with sonographic monitoring. Apropos of 35 patients]. / La spirale intra-prostatique dans le traitement de l'hypertrophie bénigne de la prostate. Nouvelle méthode de mise en place sous contrôle échographique. A propos de 35 patients.

The treatment of subvesical obstruction with a spiral endoprostatic prosthesis is now well-known since Fabian's initial work (1980). A new method of insertion of the spiral with a releasable catheter and under sonographic monitoring has been proposed recently. This article is a report of a series of 35 patients. These patients presented with an adenoma of the prostate and were fitted with a permanent urethral catheter due to an absolute contraindication for anesthesia. The spiral was inserted with US monitoring in 25 patients. In 5 patients, the spiral had to be inserted under classical endoscopic control. The average follow-up period is 7.2 months. In 25 patients (75%), the spiral remained in place; the maximum flow rate of urine after the insertion averages 12.8 ml/s and 76% of these patients report an improvement of their comfort during urination. The position of the spiral had to be changed in 8 cases. No infectious complication was noted. Hematuric complications are reported in 2 cases. The spiral endoprostatic prosthesis seems to be an elegant alternative to the permanent catheter in patients at high anesthetic risk.