A study of 3000 cases of urinary calculi treated by extracorporeal shock wave lithotripsy (ESWL) (original) (raw)
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Journal of Endourology, 2000
Purpose: We analyzed the successes and failures of SWL in the treatment of 2016 urinary calculi stratified according to size and position in the urinary tract. Methods: All the patients were treated with a Modulith SL-20 (Storz Medical). Results: The overall stone-free rate, regardless of the size and position of the stone, was 87.4%. The rate was different for kidney and ureteral stones. The stone-free rate observed for the different positions of the calculi within the kidney was upper calix 89.2%, middle calix 90.5% lower calix 84.8%, and renal pelvis 86.0%. For staghorn calculi, the stone-free rate was 60.0%. The stone-free rate for the different positions of calculi within the ureter was: upper ureter 84.3%, iliac ureter 82.4%, and pelvic ureter 91.0%. For calculi >24 mm, the retreatment rate increased, and the success rate dropped sharply. Conclusion: Extracorporal Shockwave lithotripsy should be the first therapeutic option for urinary calculi of <24 mm regardless of their position in the urinary tract.
Open Journal of Urology, 2014
The purpose of this study was to define factors that have a significant impact on the stone-free rate after ESWL. Methods: A total of 417 patients harboring renal or ureteral stones underwent extracorporeal shock wave lithotripsy (ESWL) between October 2008 and July 2012. Eighty five patients were lost on follow up. The remaining (n = 332). All patients were >18 yr of age. Siemens and SLX-F2 electromagnetic machines were used to impart shock waves. Patients were stratified according to localization (pelvic, calyceal, or ureteral stones) and stone size (up to 10 mm, 10-20 mm, and >20 mm). Result: The overall success rate was 251/332 (75.6%) achieve stone free status. Repeated ESWL sessions were needed in 258 (61.9%). Of eleven variables were studied including age, sex, side, location (pelvic, calyx, ureter), ureteric stent, previous renal surgery, stone size, number of shock waves, opacity of stone, renal system state, and type of lithotripter, three variables were significantly affect the success rate namely stone size, number of shock waves and location of stone. Conclusions: ESWL remains one of the most commonly utilized treatments for patients with upper urinary tract calculi; Stone diameter, location, and number of shock waves, are the most important predictors determining stone clearance after ESWL of renal and ureteric calculi. To optimize treatment outcomes with ESWL the presence of treating urologist is essential to optimize the final result.
Outcomes of Extra Corporeal Shock Wave Lithotripsy in Renal and Ureteral Calculi
Kathmandu University Medical Journal, 2015
Background Since the introduction in early 1980s, Extracorporeal Shockwave Lithotripsy (ESWL) became the accepted first line treatment modality for renal and upper ureteric stones. It is simple, safe and effective noninvasive procedure which can be performed without anaesthesia in outpatient basis. The objective of this study was to determine the efficacy of ESWL to achieve complete stone clearance in the patients with different sizes of renal and upper ureteric stones.
Extracorporeal Shock Wave Lithotripsy of Distal-Ureteral Calculi: Is It Worthwhile?
Journal of Endourology, 1987
Among 44 patients with distal-ureteral stones, 32 had no contraindications to extracorporeal shock wave lithotripsy (ESWL); i.e., they were not women of childbearing age and did not have ipsilateral renal stones. All these patients underwent simulation for ESWL. In 18 patients, it proved possible to localize the stone, and in 16 of these ESWL was successful. In the other two, localization was not possible at the start of ESWL, and ureteroscopy was used to remove the stones. In the 15 patients in whom simulation failed, the stone was moved up the ureter for ESWL in eight and was removed ureteroscopically in seven. In the eight women of childbearing age, the stone was moved out of the pelvis for ESWL in five and removed ureteroscopically in three. All three of the patients with ipsilateral renal stones underwent ESWL after manipulation of the stone. Thus stones were ultimately removed by ESWL in 32 of the 44 patients. ESWL can be used for distal-ureteral stones, although it is less straightforward than for stones elsewhere in the urinary tract.
Extracorporeal Shock-Wave Lithotripsy for Distal Ureteric Calculi
ANZ Journal of Surgery, 1992
Objective To compare the safety and efficacy of different approaches using ESWL for management of distal ureteric stone in an attempt to select the ideal one. Patients and methods This is a prospective randomized single-center study conducted on patients with lower third single radiopaque ureteric stone with size less than 15 mm. Patients were randomized into three groups, group A: Supine transgluteal, group B: Modified prone and group C: Prone position (80 patients each). The success of the procedure was assessed by NCCT and is defined as complete stone removal or had only clinically insignificant fragments (< 3 mm) for a maximum of three sessions. The success rate, rate of complications, pain intensity by visual pain scale and patients' satisfaction rate were compared among the three study groups. Results Data of 240 patients were analyzed (80 in each group). Overall, no significant difference has been observed among all groups regarding demographic data, stone and treatment characteristics. The overall success rates for treatment after the last session were 86.3%, 65% and 62.5% in the three study groups, respectively, with a statistically significant difference for group A. Regarding pain perception and complication rate, all groups were comparable. Patient satisfaction is significantly better in group A versus the other two groups. Conclusion Our study has confirmed better efficacy profile and patients' satisfaction rate of ESWL in the supine position (transgluteal approach) than other different known approaches for the treatment of distal ureteral stones.
Journal of Endourology, 1988
The treatment options for large renal calculi are controversial. We report on our experience with 65 treatments of renal calculi >3 cm using extracorporeal Shockwave lithotripsy (SWL) monotherapy. We stratified our results according to stone and collecting system surface areas (measured by computer image analyses), stone location, and stone type. The overall success rate of SWL monotherapy was 27% at 3 months. The best stone-free rate (60%) was obtained for stones <500 mm2 and located primarily within the renal pelvis. The stone-free rate for stones with surface areas >1000 mm2 was only 8%. None of the cystine stones was treated successfully, whereas 80% of patients with uric acid stones became stone free. We estimated an average cost of $67,048 to render a patient with a large renal calculus stone free using SWL monotherapy. We recommend that other treatment options, such as percutaneous nephrolithotomy, be considered as first-line therapy for large renal calculi.
Comparative Results of Shockwave Lithotripsy for Renal Calculi in Upper, Middle, and Lower Calices
Journal of Endourology, 2007
Patient and Methods: A series of 52 female and 66 male patients with a mean age of 47.8 years and isolated single caliceal stones who underwent SWL monotherapy were enrolled. Stone burden, stone location, number of sessions/shockwaves, and auxiliary procedures were noted for each patient. Stones were located in the upper, middle, and lower calices of 35, 43, and 40, patients respectively, with mean stone burdens of 81.4 mm 2 , 75.2 mm 2 , and 96.3 mm 2 , respectively. Patients were evaluated with intravenous urography, plain film, or ultrasonography. Success was determined 3 months after the last session. Re-treatment rates were calculated. The effect of anatomic factors on the success of treatment for lower-caliceal stones also was determined.
Treatment of Renal Stones by Extracorporeal Shockwave Lithotripsy
European Urology, 2001
Aim: Despite the extensive experience with minimal invasive stone therapy, there are still different views on the ideal management of renal stones. Materials and Methods: Analysis of the literature includes more than 14,000 patients. We have compared these data with long-term results of two major stone centers in Germany. The results have been compared concerning the anatomical kidney situation, stone size, stone localization and observation time. Results: According to the importance of residual fragments following extracorporeal shock wave lithotripsy (ESWL), we have to distinguish between clinically insignificant residual fragments and clinically significant residual fragments (CIRF). 24 months following ESWL stone passage occurs as a continous process, and if there are no clinical symptoms, any endoscopic procedure should be considered as overtreatment. According to these results, stone-free rates of patients increase in longer follow-up periods. Newer ESWL technology has increased the percentage of CIRF. Conclusion: We consider ESWL in most patients with renal calculi as first-line treatment, except in patients with renal calculi bigger than 30 mm in diameter.