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Sample records for wave lithotripsy swl

  1. Damage mechanisms in shock wave lithotripsy (SWL)

    NASA Astrophysics Data System (ADS)

    Lokhandwalla, Murtuza

    Shock wave lithotripsy is a 'non-invasive' therapy for treating kidney stones. Focused shock waves fragment stones to a size that can be passed naturally. There is, however, considerable tissue injury, and the mechanisms of stone fragmentation and tissue injury are not well understood. This work investigates potential tissue damage mechanisms, with an aim towards enhancing stone fragmentation and minimizing tissue damage. Lysis of red blood cells (RBC's) due to in vitro exposure to shock waves was investigated. Fluid flow-fields induced by a non-uniform shock wave, as well as radial expansion/implosion of a bubble was hypothesized to cause cell lysis. Both the above flow-fields constitute an unsteady extensional flow, exerting inertial as well as viscous forces on the RBC membrane. The resultant membrane tension and the membrane areal strain due to the above flow-fields were estimated. Both were found to exert a significantly higher inertial force (50--100 mN/m) than the critical membrane tension (10 mN/m). Bubble-induced flow-field was estimated to last for a longer duration (˜1 microsec) compared to the shock-induced flow (˜1 ns) and hence, was predicted to be lytically more effective, in typical in vitro experimental conditions. However, in vivo conditions severely constrain bubble growth, and cell lysis due to shock-induced shear could be dominant. Hemolysis due to shock-induced shear, in absence of cavitation, was experimentally investigated. The lithotripter-generated shock wave was refocused by a parabolic reflector. This refocused wave-field had a tighter focus (smaller beam-width and a higher amplitude) than the lithotripter wave-field. Cavitation was eliminated by applying overpressure to the fluid. Acoustic emissions due to bubble activity were monitored by a novel passive cavitation detector (HP-PCD). Aluminum foils were also used to differentiate cavitational from non-cavitational mode of damage. RBC's were exposed to the reflected wave-field from

  2. Shock wave lithotripsy (SWL) induces significant structural and functional changes in the kidney

    NASA Astrophysics Data System (ADS)

    Evan, Andrew P.; Willis, Lynn R.; Lingeman, James E.

    2003-10-01

    The foundation for understanding SWL-injury has been well-controlled renal structural and functional studies in pigs, a model that closely mimics the human kidney. A clinical dose (2000 shocks at 24 kV) of SWL administered by the Dornier HM3 induces a predictable, unique vascular injury at F2 that is associated with transient renal vasoconstriction, seen as a reduction in renal plasma flow, in both treated and untreated kidneys. Unilateral renal denervation studies links the fall in blood flow in untreated kidneys to autonomic nerve activity in the treated kidney. SWL-induced trauma is associated with an acute inflammatory process, termed Lithotripsy Nephritis and tubular damage at the site of damage that leads to a focal region of scar. Lesion size increases with shock number and kV level. In addition, risk factors like kidney size and pre-existing renal disease (e.g., pyelonephritis), can exaggerate the predicted level of renal impairment. Our new protection data show that lesion size can be greatly reduced by a pretreatment session with low kV and shock number. The mechanisms of soft tissue injury probably involves shear stress followed by acoustic cavitation. Because of the perceived enhanced level of bioeffects from 3rd generation lithotripters, these observations are more relevant than ever.

  3. The success of shock wave lithotripsy (SWL) in treating moderate-sized (10-20 mm) renal stones.

    PubMed

    Chung, Vera Y; Turney, Benjamin W

    2016-10-01

    Many centres favour endourological management over shock wave lithotripsy (SWL) in the management of moderate-sized (10-20 mm) renal stones. International guidelines support all available modalities for the treatment of these stones. The aim of this study was to evaluate the efficacy of SWL in the treatment of 10- to 20-mm renal stones. From January 2013 to October 2014, all patients with a renal stone measuring between 10 and 20 mm in maximum diameter on CT scan that were eligible for lithotripsy were included. 130 consecutive patients were evaluated. Demographics, location of stone within the kidney, number of SWL sessions and treatment outcomes were analysed. Treatment success was classified into complete stone clearance and the presence of clinically insignificant residual fragments <4 mm (CIRF). 119 patients (92 %) completed treatment and radiological follow-up. Eleven patients were excluded due to incomplete follow-up data. The mean age was 56.8 (23-88). Male to female ratio was 1.9:1 (78:41) and the mean BMI was 28.4 (17.9-58). The mean stone size was 12.8 mm (10-14 mm: n = 87; 15-20 mm: n = 32). The mean number of treatments was 2.14 and 2.82 for stones 10-14 and 15-20 mm, respectively. Overall treatment success was 66.4 % (combined complete stone clearance and CIRFs). Subdivided by stone size <15 mm and ≥15 mm, the success rate was 70.4 and 53.1 %, respectively. The treatment success by stone location was 65, 64 and 70 % for upper, middle and lower pole stones, respectively and 67 % for PUJ stones. For those who failed SWL treatment, the majority 50 % (n = 20) were managed expectantly, 42.5 % (n = 17) required URS, and 7.5 % (n = 3) required PNL. This study suggests that SWL has an efficacy for treating larger renal stones (10-20 mm) that is equivalent to success rates for smaller stones in other series. As a low-risk and non-invasive procedure SWL should be considered a first-line treatment for these stones. PMID:26743071

  4. Using Helical CT to Predict Stone Fragility in Shock Wave Lithotripsy (SWL)

    SciTech Connect

    Williams, James C. Jr.; Zarse, Chad A.; Jackson, Molly E.; McAteer, James A.; Lingeman, James E.

    2007-04-05

    Great variability exists in the response of urinary stones to SWL, and this is true even for stones composed of the same mineral. Efforts have been made to predict stone fragility to shock waves using computed tomography (CT) patient images, but most work to date has focused on the use of stone CT number (i.e., Hounsfield units). This is an easy number to measure on a patient stone, but its value depends on a number of factors, including the relationship of the size of the stone to me resolution (i.e., the slicewidth) of the CT scan. Studies that have shown a relationship between stone CT number and failure in SWL are reviewed, and all are shown to suffer from error due to stone size, which was not accounted for in the use of Hounsfield unit values. Preliminary data are then presented for a study of calcium oxalate monohydrate (COM) stones, in which stone structure-rather than simple CT number values-is shown to correlate with fragility to shock waves. COM stones that were observed to have structure by micro CT (e.g., voids, apatite regions, unusual shapes) broke to completion in about half the number of shock waves required for COM stones that were observed to be homogeneous in structure by CT. This result suggests another direction for the use of CT in predicting success of SWL: the use of CT to view stone structure, rather than simply measuring stone CT number. Viewing stone structure by CT requires the use of different viewing windows than those typically used for examining patient scans, but much research to date indicates that stone structure can be observed in the clinical setting. Future clinical studies will need to be done to verify the relationship between stone structure observed by CT and stone fragility in SWL.

  5. Complementary approaches to decreasing discomfort during shockwave lithotripsy (SWL).

    PubMed

    Ngee-Ming, Goh; Tamsin, Drake; Rai, B P; Somani, B K

    2014-06-01

    Shock wave lithotripsy (SWL) is an established treatment for renal stones. Although non-invasive, it can cause significant pain and anxiety during the procedure. Our purpose was to review the literature to look at the effect of complimentary therapy in patients undergoing SWL and whether it led to a reduction in the requirement of analgesics and anxiolytics. A systematic review was performed on the use of acupuncture, auricular acupressure, transcutaneous electrical nerve stimulation (TENS) and music during SWL. Only prospective randomized controlled trials were selected. Two reviewers independently extracted the data from each study. Outcomes relating to analgesia requirement, anxiety and stone-free rates (SFR) were compared. Seven papers were identified reporting on 591 patients (acupuncture-3, TENS-1 and music-3). Pain control/analgesia requirement was significantly better in four studies (music-2, acupuncture-1, TENS-1). Significantly lower anxiety was noted in one study with music and two using acupuncture. No difference in SFR was noted with the use of complementary therapy. No major or minor side effects were noted. Complementary therapy for SWL can help lower analgesia requirement and the anxiety associated with it. However, it does not have any effect on the SFR.

  6. Is the gravity effect of radiographic anatomic features enough to justify stone clearance or fragments retention following extracorporeal shock wave lithotripsy (SWL).

    PubMed

    Mustafa, Mahmoud

    2012-08-01

    We determined whether the gravity effect of radiographic anatomic features on the preoperative urography (IVP) are enough to predict fragments clearance after shock wave lithotripsy (SWL). A Total of 282 patients with mean age 45.8 ± 13.2 years (189 male, 93 female), who underwent SWL due to renal calculi between October 2005 and August 2009 were enrolled. The mean calculi load was 155.72 ± 127.66 mm². The patients were stratified into three groups: patients with pelvis calculi (group 1); patients with upper or middle pole calculi (group 2) and patients with lower pole calculi (group 3). Three angles on the pretreatment IVP were measured: the inner angle between the axis of the lower pole infundibular and ureteropelvic axis (angle I); the inner angle between the lower pole infundibular axis and main axis of pelvis-ureteropelvic (UP) junction point (angle II) and the inner angle between the lower pole infundibular axis and perpendicular line (angle III). Multivariate analysis was used to define the significant predictors of stone clearance. The overall success rate was 85.81%. All angles, sessions number, shock waves number and stone burden were significant predictors of success in patients in group 1. However, in group 2 only angle II and in group 3 angles I and II had significant effect on stone clearance. Radiographic anatomic features have significant role in determining the stone-free rate following satisfactory fragmentation of renal stones with SWL. The measurement of infundibulopelvic angle in different manner helps to predict the stone-free status in patients with renal calculi located not only in lower pole, but also in renal pelvis and upper or middle pole. Gravity effect is not enough to justify the significant influence of the radiographic anatomic features on the stone clearance and fragments retention after SWL.

  7. The Efficacy of Medical Expulsive Therapy (MET) in Improving Stone-free Rate and Stone Expulsion Time, After Extracorporeal Shock Wave Lithotripsy (SWL) for Upper Urinary Stones: A Systematic Review and Meta-analysis.

    PubMed

    Skolarikos, Andreas; Grivas, Nikolaos; Kallidonis, Panagiotis; Mourmouris, Panagiotis; Rountos, Thomas; Fiamegos, Alexandros; Stavrou, Sotirios; Venetis, Chris

    2015-12-01

    In this meta-analysis, we included randomized studies on medical expulsive therapy implemented following shock wave lithotripsy for renal and ureteral stones. Pooled results demonstrated the efficacy of α-blockers, nifedipine, Rowatinex, and Uriston in increasing stone clearance. In addition, the time to stone elimination, the intensity of pain, the formation of steinstrasse, and the need for auxiliary procedures were reduced mainly with α-blockers. Expulsion rate was not correlated with the type of α-blocker, the diameter, and the location of stone. Our results show that medical expulsive therapy for residual fragments after shock wave lithotripsy should be implemented in clinical practice. PMID:26383613

  8. Extracorporeal shock wave lithotripsy today.

    PubMed

    Tailly, Geert G

    2013-07-01

    Even 32 years after its first introduction shockwave lithotripsy (SWL) remains a matter of discussion and controversy. Since the first SWL in 1980, millions of treatments have been performed worldwide. To this day SWL remains the least invasive of all stone treatments and is considered the treatment modality of first choice for the majority of urinary stones. Despite the massive scale on which SWL is performed in a wide range of indications, complication rate has always remained very low and usually limited to minor side effects and complications. The introduction of affordable multifunctional lithotripters has made SWL available to more and more departments of urology worldwide. Still many centers are disappointed with the treatment results and concerned about the adverse tissue effects. In this SWL proves to be the victim of its uninvasiveness and its apparent ease of practice. Urologists need proper skill and experience; however, to adequately administer shockwaves in order to improve outcome. This aspect is too often minimized and neglected. Apart from this the power of shockwaves often is underestimated by operators of shockwave machines. Basic knowledge of the physics of shockwaves could further reduce the already minimal adverse tissue effects. Good training and coaching in the administration of shockwaves would no doubt lead to a renaissance of SWL with better treatment results and minimal adverse tissue effects.

  9. The use of extra-corporeal shockwave lithotripsy for obstructing ureteric stones.

    PubMed

    Porfyris, O T; Cutress, M L; Tolley, D A

    2011-06-01

    Extracorporeal shock wave lithotripsy (SWL) is a non-invasive treatment for urinary tract stones. This review presents the role of SWL for treating specifically ureteric calculi. The impact of hydronephrosis on SWL success, the use of SWL as emergency treatment (eSWL) for acute ureteric colic, the influence of ureteric stent placement on SWL outcome and the use of medical expulsive therapy to augment SWL success are discussed.

  10. Herpes zoster reactivation after extracorporeal shock wave lithotripsy: A case report.

    PubMed

    Hariharan, Krishnamoorthy; Pillai, Biju S; Bansal, Devesh

    2016-01-01

    Herpes zoster is a reactivated varicella-zoster virus (VZV) infection of the sensory nerve ganglion, peripheral nerve, and its branches. Mechanical trauma to the nervous system can reactivate VZV. It is well known that extracorporeal shock wave lithotripsy (SWL) can produce mechanical damage to the tissue. We report a rare case of herpes zoster reactivation after SWL for treatment of 1.2 cm size renal stone in a 63-year-old male patient.

  11. Herpes zoster reactivation after extracorporeal shock wave lithotripsy: A case report

    PubMed Central

    Hariharan, Krishnamoorthy; Pillai, Biju S.; Bansal, Devesh

    2016-01-01

    Herpes zoster is a reactivated varicella-zoster virus (VZV) infection of the sensory nerve ganglion, peripheral nerve, and its branches. Mechanical trauma to the nervous system can reactivate VZV. It is well known that extracorporeal shock wave lithotripsy (SWL) can produce mechanical damage to the tissue. We report a rare case of herpes zoster reactivation after SWL for treatment of 1.2 cm size renal stone in a 63-year-old male patient. PMID:27555686

  12. Herpes zoster reactivation after extracorporeal shock wave lithotripsy: A case report.

    PubMed

    Hariharan, Krishnamoorthy; Pillai, Biju S; Bansal, Devesh

    2016-01-01

    Herpes zoster is a reactivated varicella-zoster virus (VZV) infection of the sensory nerve ganglion, peripheral nerve, and its branches. Mechanical trauma to the nervous system can reactivate VZV. It is well known that extracorporeal shock wave lithotripsy (SWL) can produce mechanical damage to the tissue. We report a rare case of herpes zoster reactivation after SWL for treatment of 1.2 cm size renal stone in a 63-year-old male patient. PMID:27555686

  13. Shock wave lithotripsy in patients requiring anticoagulation or antiplatelet agents.

    PubMed

    Alsaikhan, Bader; Andonian, Sero

    2011-02-01

    Extracorporeal shockwave lithotripsy (SWL) remains the only truly minimally invasive procedure for the treatment of upper tract nephrolithiasis. Recently, there has been a recent rise in the patients on antiplatelet agents. Therefore, the aim of the present study is to review the literature available regarding SWL in these high-risk patients requiring anti-coagulation therapy. Alternative therapies to SWL are also presented.

  14. Shock Wave Injury to the Kidney in SWL: Review and Perspective

    NASA Astrophysics Data System (ADS)

    McAteer, James A.; Evan, Andrew P.; Willis, Lynn R.; Connors, Bret A.; Williams, James C.; Pishchalnikov, Yuri A.; Lingeman, James E.

    2007-04-01

    Shock wave lithotripsy (SWL) is a first-line option for treatment for urinary calculi—particularly effective for the removal of uncomplicated stones from the upper urinary tract. The success of lithotripsy is tempered, however, by the occurrence of acute injury that has been reported to progress to long-term complications. SW trauma to the kidney is a vascular lesion characterized by parenchymal and subcapsular bleeding. The acute lesion is dose-dependent, and typically localized to the focal volume of the lithotripter. Cavitation has been implicated in vessel rupture, but SW-shear has the potential to be a primary mechanism for damage as well. Possible chronic adverse effects of SWL may include new-onset hypertension, development of diabetes, and exacerbation of stone disease. If acute trauma could be reduced, it seems likely that serious long-term effects could be minimized, or even eliminated. Reducing the dose of SW's needed for stone breakage is one option. Improved coupling improves stone breakage, and slowing SW rate significantly improves stone-free outcomes. Experiments with animals now show that treatment protocols can be designed to protect against tissue injury. Initiating treatment with low energy SW's dramatically reduces lesion size, and reducing the rate of SW delivery virtually eliminates SW trauma altogether. SWL stands to gain from new advances in technology, as lithotripters become safer and more effective. Perhaps the greatest progress will be made when we have determined the physical mechanisms of SW action both for stone breakage and tissue damage, and have better characterized the biological response to SW's—as this will provide the principles needed to achieve the best combination of safety and efficiency with whatever lithotripter is at hand.

  15. Observation of cavitation during shock wave lithotripsy

    NASA Astrophysics Data System (ADS)

    Bailey, Michael R.; Crum, Lawrence A.; Pishchalnikov, Yuri A.; McAteer, James A.; Pishchalnikova, Irina V.; Evan, Andrew P.; Sapozhnikov, Oleg A.; Cleveland, Robin O.

    2005-04-01

    A system was built to detect cavitation in pig kidney during shock wave lithotripsy (SWL) with a Dornier HM3 lithotripter. Active detection, using echo on B-mode ultrasound, and passive cavitation detection (PCD), using coincident signals on confocal, orthogonal receivers, were equally sensitive and were used to interrogate the renal collecting system (urine) and the kidney parenchyma (tissue). Cavitation was detected in urine immediately upon SW administration in urine or urine plus X-ray contrast agent, but in tissue, cavitation required hundreds of SWs to initiate. Localization of cavitation was confirmed by fluoroscopy, sonography, and by thermally marking the kidney using the PCD receivers as high intensity focused ultrasound sources. Cavitation collapse times in tissue and native urine were about the same but less than in urine after injection of X-ray contrast agent. Cavitation, especially in the urine space, was observed to evolve from a sparse field to a dense field with strong acoustic collapse emissions to a very dense field that no longer produced detectable collapse. The finding that cavitation occurs in kidney tissue is a critical step toward determining the mechanisms of tissue injury in SWL. [Work sup ported by NIH (DK43881, DK55674, FIRCA), ONRIFO, CRDF and NSBRI SMS00203.

  16. Retroperitoneal laparoscopic pyelolithotomy versus extra corporeal shock-wave lithotripsy for management of renal stones

    PubMed Central

    Chander, Jagdish; Gupta, Nikhil; Lal, Pawanindra; Lal, Pawan; Ramteke, Vinod K

    2010-01-01

    AIM: The purpose of this study was to evaluate the role of retroperitoneal laparoscopic pyelolithotomy (RPPL) and its comparison with extra corporeal shock wave lithotripsy in the management of renal calculi. MATERIALS AND METHODS: The study was carried out in the Department of surgery, Maulana Azad Medical College, New Delhi, India. The study included 86 cases of solitary renal calculi in the retroperitoneoscopic (RPPL) group and 82 cases in the shock wave lithotripsy (SWL) group. The parameters compared were stone clearance, hospital stay, number of postoperative visits, mean time to resume normal activities, number of man days lost, and analgesic requirement. RESULTS: The RPPL group showed better stone clearance, fewer hospital visits, low analgesic requirement, fewer number of man days lost, and early resumption of normal activities, as compared to the SWL group. CONCLUSIONS: Shock wave lithotripsy, being a noninvasive modality, is an established procedure all over the world. However RPPL achieves comparable or better results in high volume centers. PMID:21120067

  17. Kidney stones - lithotripsy - discharge

    MedlinePlus

    Extracorporeal shock wave lithotripsy - discharge; Shock wave lithotripsy - discharge; Laser lithotripsy - discharge; Percutaneous lithotripsy - discharge; Endoscopic lithotripsy - discharge; ESWL - ...

  18. Shock wave lithotripsy: advances in technology and technique

    PubMed Central

    Lingeman, James E.; McAteer, James A.; Gnessin, Ehud; Evan, Andrew P.

    2010-01-01

    Shock wave lithotripsy (SWL) is the only noninvasive method for stone removal. Once considered as a primary option for the treatment of virtually all stones, SWL is now recognized to have important limitations that restrict its use. In particular, the effectiveness of SWL is severely limited by stone burden, and treatment with shock waves carries the risk of acute injury with the potential for long-term adverse effects. Research aiming to characterize the renal response to shock waves and to determine the mechanisms of shock wave action in stone breakage and renal injury has begun to suggest new treatment strategies to improve success rates and safety. Urologists can achieve better outcomes by treating at slower shock wave rate using a step-wise protocol. The aim is to achieve stone comminution using as few shock waves and at as low a power level as possible. Important challenges remain, including the need to improve acoustic coupling, enhance stone targeting, better determine when stone breakage is complete, and minimize the occurrence of residual stone fragments. New technologies have begun to address many of these issues, and hold considerable promise for the future. PMID:19956196

  19. Hepatic haematoma after shockwave lithotripsy for renal stones.

    PubMed

    Ng, Chi-Fai; Law, Vincent T T; Chiu, Peter K F; Tan, Chong-Boon; Man, Chi-Wai; Chu, Peggy S K

    2012-12-01

    Extracorporeal shock wave lithotripsy (SWL) is a non-invasive procedure for urolithiasis. Only a very small portion of patients suffer from post-SWL haematoma and most of them have perinephric haematoma formation. We present two patients who developed subcapsular hepatic haematomas after SWL, followed by a review of the literature on the condition.

  20. 3D dynamic simulation of crack propagation in extracorporeal shock wave lithotripsy

    NASA Astrophysics Data System (ADS)

    Wijerathne, M. L. L.; Hori, Muneo; Sakaguchi, Hide; Oguni, Kenji

    2010-06-01

    Some experimental observations of Shock Wave Lithotripsy(SWL), which include 3D dynamic crack propagation, are simulated with the aim of reproducing fragmentation of kidney stones with SWL. Extracorporeal shock wave lithotripsy (ESWL) is the fragmentation of kidney stones by focusing an ultrasonic pressure pulse onto the stones. 3D models with fine discretization are used to accurately capture the high amplitude shear shock waves. For solving the resulting large scale dynamic crack propagation problem, PDS-FEM is used; it provides numerically efficient failure treatments. With a distributed memory parallel code of PDS-FEM, experimentally observed 3D photoelastic images of transient stress waves and crack patterns in cylindrical samples are successfully reproduced. The numerical crack patterns are in good agreement with the experimental ones, quantitatively. The results shows that the high amplitude shear waves induced in solid, by the lithotriptor generated shock wave, play a dominant role in stone fragmentation.

  1. Comparison of High, Intermediate, and Low Frequency Shock Wave Lithotripsy for Urinary Tract Stone Disease: Systematic Review and Network Meta-Analysis

    PubMed Central

    Kang, Dong Hyuk; Cho, Kang Su; Ham, Won Sik; Lee, Hyungmin; Kwon, Jong Kyou; Choi, Young Deuk

    2016-01-01

    Objectives To perform a systematic review and network meta-analysis of randomized controlled trials (RCTs) to determine the optimal shock wave lithotripsy (SWL) frequency range for treating urinary stones, i.e., high-frequency (100–120 waves/minute), intermediate-frequency (80–90 waves/minute), and low-frequency (60–70 waves/minute) lithotripsy. Materials and Methods Relevant RCTs were identified from electronic databases for meta-analysis of SWL success and complication rates. Using pairwise and network meta-analyses, comparisons were made by qualitative and quantitative syntheses. Outcome variables are provided as odds ratios (ORs) with 95% confidence intervals (CIs). Results Thirteen articles were included in the qualitative and quantitative synthesis using pairwise and network meta-analyses. On pairwise meta-analyses, comparable inter-study heterogeneity was observed for the success rate. On network meta-analyses, the success rates of low- (OR 2.2; 95% CI 1.5–2.6) and intermediate-frequency SWL (OR 2.5; 95% CI 1.3–4.6) were higher than high-frequency SWL. Forest plots from the network meta-analysis showed no significant differences in the success rate between low-frequency SWL versus intermediate-frequency SWL (OR 0.87; 95% CI 0.51–1.7). There were no differences in complication rate across different SWL frequency ranges. By rank-probability testing, intermediate-frequency SWL was ranked highest for success rate, followed by low-frequency and high-frequency SWL. Low-frequency SWL was also ranked highest for low complication rate, with high- and intermediate-frequency SWL ranked lower. Conclusions Intermediate- and low-frequency SWL have better treatment outcomes than high-frequency SWL when considering both efficacy and complication. PMID:27387279

  2. Do anxiety, stress, or depression have any impact on pain perception during shock wave lithotripsy?

    PubMed Central

    Altok, Muammer; Akpinar, Abdullah; Güneş, Mustafa; Umul, Mehmet; Demirci, Kadir; Baş, Ercan

    2016-01-01

    Introduction: The most important adverse effect during shock wave lithotripsy (SWL) is pain perception. In this study, we evaluated the effect of anxiety, stress, and depression on pain perception during SWL. Methods: From November 2013 to December 2014, 189 consecutive patients undergoing SWL for kidney stones were evaluated prospectively. Patient characteristics (age, sex, body mass index [BMI], urologic intervention history, the presence of a double-j catheter, and stone-related parameters) were also recorded. Anxiety, stress, and depression states were assessed before the first procedure using the Depression, Anxiety, and Stress Scales (DASS-42), which is a self-report scale. The degree of pain perception was evaluated with a 10-point Visual Analogue Scale (VAS) at the end of the first SWL session. Results: There were no statistically significant differences in terms of VAS scores during SWL between patients with and without anxiety, stress, or depression (p >0.05). Furthermore, no statistically significant relationships were found between VAS scores and patient age, sex, side of the stone, presence of a double-j stent, number of stones, and SWL experience (p >0.05). Conclusions: According to our findings, anxiety, stress, or depression seemed to have no impact on pain perception during SWL.

  3. The role of energy density and acoustic cavitation in shock wave lithotripsy.

    PubMed

    Loske, Achim M

    2010-02-01

    Today a high percentage of urinary stones are successfully treated by extracorporeal shockwave lithotripsy (SWL); however, misconceptions regarding fragmentation mechanisms, as well as treatment parameters like dose, applied energy and focal area are still common. A main stone comminution mechanism during SWL is acoustic cavitation. The objective of this study was to analyze the influence of cavitation and energy density on stone fragmentation. A research lithotripter was used to expose a large set of artificial kidney stones to shock waves varying different parameters. Hundreds of pressure records were used to calculate the energy density of the lithotripter at different settings. Results indicate that energy density is a crucial parameter and that better SWL treatment outcomes could be obtained placing the calculus at a prefocal position.

  4. Effect of urine pH on the effectiveness of shock wave lithotripsy: A pilot study

    PubMed Central

    Majzoub, Ahmad; Al-Ani, Ammar; Gul, Tawiz; Kamkoum, Hatem; Al-Jalham, Khalid

    2016-01-01

    Aim: Shock wave lithotripsy (SWL) is a well-established modality in the treatment of urolithiasis. Studying the effect of urine pH on SWL success is appealing as pH can be manipulated before SWL to insure a better outcome. Materials and Methods: This is a prospective study performed at a tertiary medical center. Patients presenting to the SWL unit with a single renal stone <2 cm in size were included in this study. In addition to standard laboratory and radiologic investigations, urine pH measurement was performed on all patients before their procedure. The number of sessions performed, and the stone-free rate (SFR) were assessed. Patients were divided into two groups according to stone clearance. Group 1 was stone-free, whereas Group 2 had residual stones after three sessions of SWL. Data was also classified according to different pH ranges. Influential factors were compared among the study groups and pH ranges. Results: A total of 175 patients were included in this study. The SFR was 54.3%. The mean number of sessions performed was 2.2 ± 0.8. Group 1 included 95 patients, whereas Group 2 had eighty patients. Among all studied factors, stone size (P = 0.03) and skin to stone distance (P = 0.04) significantly affected SFR with SWL. Urine pH was not found to have a statistically significant influence on SWL outcome (P = 0.51). Conclusion: Urine pH was not found in this study population to influence the effectiveness of SWL. Further experimental studies are required to help investigate this notion. PMID:27453649

  5. A heuristic model of stone comminution in shock wave lithotripsy.

    PubMed

    Smith, Nathan B; Zhong, Pei

    2013-08-01

    A heuristic model is presented to describe the overall progression of stone comminution in shock wave lithotripsy (SWL), accounting for the effects of shock wave dose and the average peak pressure, P+(avg), incident on the stone during the treatment. The model is developed through adaptation of the Weibull theory for brittle fracture, incorporating threshold values in dose and P+(avg) that are required to initiate fragmentation. The model is validated against experimental data of stone comminution from two stone types (hard and soft BegoStone) obtained at various positions in lithotripter fields produced by two shock wave sources of different beam width and pulse profile both in water and in 1,3-butanediol (which suppresses cavitation). Subsequently, the model is used to assess the performance of a newly developed acoustic lens for electromagnetic lithotripters in comparison with its original counterpart both under static and simulated respiratory motion. The results have demonstrated the predictive value of this heuristic model in elucidating the physical basis for improved performance of the new lens. The model also provides a rationale for the selection of SWL treatment protocols to achieve effective stone comminution without elevating the risk of tissue injury.

  6. A heuristic model of stone comminution in shock wave lithotripsy

    PubMed Central

    Smith, Nathan B.; Zhong, Pei

    2013-01-01

    A heuristic model is presented to describe the overall progression of stone comminution in shock wave lithotripsy (SWL), accounting for the effects of shock wave dose and the average peak pressure, P+(avg), incident on the stone during the treatment. The model is developed through adaptation of the Weibull theory for brittle fracture, incorporating threshold values in dose and P+(avg) that are required to initiate fragmentation. The model is validated against experimental data of stone comminution from two stone types (hard and soft BegoStone) obtained at various positions in lithotripter fields produced by two shock wave sources of different beam width and pulse profile both in water and in 1,3-butanediol (which suppresses cavitation). Subsequently, the model is used to assess the performance of a newly developed acoustic lens for electromagnetic lithotripters in comparison with its original counterpart both under static and simulated respiratory motion. The results have demonstrated the predictive value of this heuristic model in elucidating the physical basis for improved performance of the new lens. The model also provides a rationale for the selection of SWL treatment protocols to achieve effective stone comminution without elevating the risk of tissue injury. PMID:23927195

  7. Poly(methyl methacrylate) particles for local drug delivery using shock wave lithotripsy: In vitro proof of concept experiment.

    PubMed

    Shaked, Eliav; Shani, Yoav; Zilberman, Meital; Scheinowitz, Mickey

    2015-08-01

    To leverage current local drug delivery systems methodology, there is vast use of polymeric particles serving as drug carriers to assure minimal invasive therapy with little systemic distribution of the released drug. There is an increasing interest in poly(methyl methacrylate) (PMMA) serving as carriers in drug delivery. The study aims to develop PMMA carriers for localized drug delivery and release system, combining innovative biomaterial technology and shock wave lithotripsy (SWL), and to study the effect of SWL on various concentrations of PMMA particles. We prepared PMMA particles that contain horseradish peroxidase (HRP) using a double emulsion technique, and investigated the mechanism of in vitro drug release from the carriers following exposure to SWL. We investigated the correlation between production method modifications, concentrations of the carriers subjected to SWL, and shock wave patterns. We successfully produced PMMA particles as drug carriers and stimulated the release of their contents by SWL; their polymeric shell can be shattered externally by SWL treatment, leading to release of the encapsulated drug. HRP enzyme activity was maintained following the encapsulation process and exposure to high dose of SWL pulses. Increased shock wave number results in increased shattering and greater fragmentation of PMMA particles. The results demonstrate a dose-response release of HRP; quantitation of the encapsulated HRP from the carriers rises with the number of SWL. Moreover, increased concentration of particles subjected to the same dose of SWL results in a significant increase of the total HRP release. Our research offers novel technique and insights into new, site-specific drug delivery and release systems.

  8. Extracorporeal shock wave lithotripsy in infants less than 12-month old.

    PubMed

    Turna, Burak; Tekin, Ali; Yağmur, İsmail; Nazlı, Oktay

    2016-10-01

    There is a lack of literature on children compared to adults regarding the long-term effects of extracorporeal shock wave lithotripsy (SWL), specifically in infants. The aim of the present study was to analyze the efficacy and safety of SWL in infants and also evaluate its potential adverse effects in the mid-term. Between May 1999 and December 2013, 36 infants with 39 renal units underwent SWL treatment for kidney stones with an electrohydraulic lithotripter (Dornier MPL 9000/ELMED Multimed Classic). All children were less than 12-month old. The mid-term effects of SWL were examined at the last follow-up by measuring arterial blood pressure, random blood glucose level and ipsilateral kidney size. Evaluation of treatment and its consequences was based on clinical examination, blood tests and conventional imaging (plain abdominal radiography and ultrasound). Overall stone-free rate was 84.6 % after 3-month follow-up without any major complications. Mid-term follow-up was available in 20 of 36 children with a mean follow-up of 3.2 ± 2.8 years (range 0.5-15.3). None of the infants were found to develop new onset of hypertension or diabetes. All treated infant kidneys' sizes were in the normal percentile range. SWL for management of infant kidney stones is effective and safe in the mid-term.

  9. Experience with EDAP LT02 extracorporeal shockwave lithotripsy in 1363 patients: comparison with results of LT01 SWL in 1586 patients.

    PubMed

    Kim, S C; Moon, Y T

    1997-04-01

    A new piezoelectric lithotripter, the EDAP LT02, differs from the earlier LT01 in two important respects: a stone-localization system consisting of ultrasound and fluoroscopy and more energy per shockwave. The results of SWL monotherapy with the LT02 in 1363 patients and with the LT01 in 1586 patients who completed SWL treatment were compared. All of the stones could be localized by ultrasound (62.7%), fluoroscopy (0.3%), or both (37%) on the LT02, but the renal stones of three patients who had a history of open renal surgery and 29 upper ureteral stones could not be localized by real-time ultrasound on the LT01. The success rate (stone free or residual fragments < 4 mm in diameter) with the LT02 and LT01 according to stone location was not significantly different: 86.4% and 88.5%, respectively, for renal stones, 89.1% and 88.9% for ureteral stones, and 87.0% and 89.0% overall. The overall stone-free rate of LT02 and LT01 SWL was 78.8% and 87.9%, respectively. For mid-ureteral stones, the success rate with LT02 SWL was 76.8%. (Such stones were not an indication for LT01 SWL.) The mean number of treatment sessions with the LT02 (1.9) was much less (P < 0.001) than with the LT01 (3.3). The retreatment rates of LT02 and LT01 SWL were 68.2% and 198.2%, and the auxiliary treatment rates were 3.4% and 6.3%, respectively. Thus, the efficiency quotient was 45.9% in LT02 SWL, which was much higher than the 28.9% of the LT01. There was no significant difference in the occurrence of complications between LT02 and LT01 SWL. Therefore, LT02 piezoelectric lithotripsy is more efficient than the LT01 in localizing stones and can lessen the number of treatment sessions.

  10. Matched pair analysis of ureteroscopy vs. shock wave lithotripsy for the treatment of upper ureteric calculi.

    PubMed

    Stewart, G D; Bariol, S V; Moussa, S A; Smith, G; Tolley, D A

    2007-05-01

    There is controversy over whether shock wave lithotripsy (SWL) or ureteroscopy (URS) is the best management of ureteric calculi, especially for stones located in the upper ureter. This study compares URS and SWL management of upper ureteric stones directly for the first time using a different analysis tool, the matched pair analysis study design. This method enables meaningful comparisons to be made on a small number of matched patients, using precise like-for-like matching. Adult patients undergoing primary treatment of solitary radiopaque proximal ureteric stones were identified. Patients with stents, nephrostomies or stones at the pelvi-ureteric junction were excluded. Patients had a minimum of 3 months follow-up. Patients treated by primary URS were matched using four parameters (sex, laterality, stone size and location) to patients treated on a Dornier Compact Delta Lithotriptor. A total of 1479 patients had URS or SWL from which 27 upper ureteric stone matched pairs were identified. Three-month stone free rates were 82% for URS and 89% for SWL (McNemar's test, p=0.625). Re-treatment was required in 11% and 26% following URS and SWL respectively (p=0.219). Forty-one per cent of URS patients required an ancillary treatment, such as stent removal, compared with only 22% of SWL patients (p=0.227). Introduction of a holmium:YAG laser for use with URS improved the stone free rate for URS to 100%. Using a robust like-for-like comparison of similar patients with very similar upper ureteric stones the outcomes following SWL and URS were comparable. Choice of treatment should therefore be based on parameters such as availability of equipment, waiting times and patient preference.

  11. Prospective randomized trial comparing shock wave lithotripsy and flexible ureterorenoscopy for lower pole stones smaller than 1 cm.

    PubMed

    Sener, Nevzat Can; Imamoglu, M Abdurrahim; Bas, Okan; Ozturk, Ufuk; Goktug, H N Goksel; Tuygun, Can; Bakirtas, Hasan

    2014-04-01

    In this study, we aimed to compare the success and complications of flexible ureterorenoscopy (F-URS) with its advanced technology and the accomplished method of shock wave lithotripsy (SWL) in the treatment of lower pole stones smaller than 1 cm. One hundred and forty patients were randomized as 70 undergoing SWL (Group 1) and 70 undergoing F-URS (Group 2). Patients were evaluated by plain X-ray and urinary ultrasound 1 week and after 3 months following SWL. The same procedure was done for F-URS patients 1 week after surgery and after 3 months. Success rates were established the day following the procedure and after 3 months. Fragmentation less than 3 mm was considered success. Mean operative time was 44 ± 7.4 min for Group 2 and mean fluoroscopy duration was 51 ± 12 s. In F-URS group, all the patients were stone free after 3 months (100 %). Group 1 had 2.7 ± 0.4 sessions of SWL. Sixty-four patients were stone free in that group after 3 months (91.5 %). The procedure yielded significant success in FURS group, even though patients underwent SWL for 2.7 ± 0.4 sessions and F-URS for 1 session (p < 0.05). With higher success and similar complication rates, fewer sessions per treatment, and advances in technology and experience, we believe F-URS has a potential to be the first treatment option over SWL in the future.

  12. Is flexible ureterorenoscopy and laser lithotripsy the new gold standard for lower pole renal stones when compared to shock wave lithotripsy: Comparative outcomes from a University hospital over similar time period

    PubMed Central

    Burr, Jacob; Ishii, Hiro; Simmonds, Nick

    2015-01-01

    Introduction Renal lower pole stones pose difficulty in management due to anatomical variation, stone size, hardness and patient demographics. Flexible ureterorenoscopy and laser lithotripsy (FURSL) and shock wave lithotripsy (SWL) are preferred for stones 1-2 cm in size. We wanted to compare the outcomes of FURSL and SWL for lower pole stones during the same time period. Material and methods All patients who were treated for lower pole stones with FURSL and SWL during a 19-month period were included. The stone free rate (SFR) was defined as ≤3 mm fragments on follow-up imaging or stone free endoscopically. Data was recorded in an excel spreadsheet with SPSS version 21 used for statistical analysis. Results A total of 161 lower pole procedures were done (93 SWL and 63 FURSL). The mean stone size for SWL (7.4 mm; range: 4-16 mm) was significantly smaller than for FURSL (13.4 mm; 4-53 mm). The mean operating time and hospital stay for FURSL was 65 minutes (range: 30-160 minutes) and 0.5 days (range: 0-7 days) respectively. The SFR was significantly better (p <0.001) for FURSL (n = 63, 93%) compared to SWL (n = 23, 25%). There were 4 (6%) complications (3 Clavien II and 1 Clavien I) in the FURSL group (2 urosepsis, 1 UTI and 1 stent pain). Three patients in the SWL group (Clavien I) were readmitted with renal colic but there were no other complications. Conclusions FURSL for lower pole stones seems to be a much better alternative than SWL with a high SFR even for larger stones and seems to be the new gold standard for lower pole stone management. PMID:26251738

  13. Extra-corporeal shock wave lithotripsy.

    PubMed Central

    Pemberton, J.

    1987-01-01

    Extra-corporeal shock wave lithotripsy (ESWL) has proved to be a revolutionary advance in the treatment of renal stone disease. It, itself, is non-invasive but may necessitate or be used as an adjunct to more invasive auxiliary procedures. The basic principles of lithotripsy, the clinical experience thus far and probable future applications are discussed. Images Figure 2 Figure 4 Figure 5 Figure 7 Figure 8 PMID:3330235

  14. Mechanism by which shock wave lithotripsy can promote formation of human calcium phosphate stones.

    PubMed

    Evan, Andrew P; Coe, Fredric L; Connors, Bret A; Handa, Rajash K; Lingeman, James E; Worcester, Elaine M

    2015-04-15

    Human stone calcium phosphate (CaP) content correlates with higher urine CaP supersaturation (SS) and urine pH as well as with the number of shock wave lithotripsy (SWL) treatments. SWL does damage medullary collecting ducts and vasa recta, sites for urine pH regulation. We tested the hypothesis that SWL raises urine pH and therefore Cap SS, resulting in CaP nucleation and tubular plugging. The left kidney (T) of nine farm pigs was treated with SWL, and metabolic studies were performed using bilateral ureteral catheters for up to 70 days post-SWL. Some animals were given an NH4Cl load to sort out effects on urine pH of CD injury vs. increased HCO3 (-) delivery. Histopathological studies were performed at the end of the functional studies. The mean pH of the T kidneys exceeded that of the control (C) kidneys by 0.18 units in 14 experiments on 9 pigs. Increased HCO3 (-) delivery to CD is at least partly responsible for the pH difference because NH4Cl acidosis abolished it. The T kidneys excreted more Na, K, HCO3 (-), water, Ca, Mg, and Cl than C kidneys. A single nephron site that could produce losses of all of these is the thick ascending limb. Extensive injury was noted in medullary thick ascending limbs and collecting ducts. Linear bands showing nephron loss and fibrosis were found in the cortex and extended into the medulla. Thus SWL produces tubule cell injury easily observed histopathologically that leads to functional disturbances across a wide range of electrolyte metabolism including higher than control urine pH. PMID:25656372

  15. Comparison of two different running models for the shock wave lithotripsy machine in Taipei City Hospital: self-support versus outsourcing cooperation.

    PubMed

    Huang, Chi-Yi; Chen, Shiou-Sheng; Chen, Li-Kuei

    2009-10-01

    To compare two different running models including self-support and outsourcing cooperation for the extracorporeal shock wave lithotripsy (SWL) machine in Taipei City Hospital, we made a retrospective study. Self-support means that the hospital has to buy an SWL machine and get all the payment from SWL. In outsourcing cooperation, the cooperative company provides an SWL machine and shares the payment with the hospital. Between January 2002 and December 2006, we used self-support for the SWL machine, and from January 2007 to December 2008, we used outsourcing cooperation. We used the method of full costing to calculate the cost of SWL, and the break-even point was the lowest number of treatment sessions of SWL to make balance of payments every month. Quality parameters including stone-free rate, retreatment rate, additional procedures and complication rate were evaluated. When outsourcing cooperation was used, there were significantly more treatment sessions of SWL every month than when utilizing self-support (36.3 +/- 5.1 vs. 48.1 +/- 8.4, P = 0.03). The cost of SWL for every treatment session was significantly higher using self-support than with outsourcing cooperation (25027.5 +/- 1789.8 NT$ vs. 21367.4 +/- 201.0 NT$). The break-even point was 28.3 (treatment sessions) for self-support, and 28.4 for outsourcing cooperation, when the hospital got 40% of the payment, which would decrease if the percentage increased. No significant differences were noticed for stone-free rate, retreatment rate, additional procedures and complication rate of SWL between the two running models. Besides, outsourcing cooperation had lower cost (every treatment session), but a greater number of treatment sessions of SWL every month than self-support.

  16. Unilateral versus bilateral ultrasound-guided transversus abdominis plane blocks during ureteric shock wave lithotripsy: A prospective randomized trial

    PubMed Central

    Elnabtity, Ali Mohamed Ali; Shabana, Waleed Mansour

    2016-01-01

    Background: Ultrasound-guided transversus abdominis plane (TAP) block has been used for intra- and post-operative analgesia during abdominal operations and for ureteric shock wave lithotripsy (SWL) as well. Aim: This study aimed at comparing ultrasound-guided unilateral versus bilateral TAP blocks as analgesic techniques for unilateral ureteric SWL. Settings and Design: Prospective randomized comparative study. Patients and Methods: Sixty patients scheduled for unilateral ureteric SWL were randomly allocated into two groups: Group (U) received unilateral TAP block in the form of 25 ml of bupivacaine 0.25% (i.e., 62.5 mg), and Group (B) received bilateral TAP blocks in the form of 25 ml of bupivacaine 0.25% (i.e., 62.5 mg) on each side. Statistical Analysis: This was performed using SPSS program version 19 ((IBM Corp., Armonk, NY, USA) and EP 16 program. Results: The mean values of intra- and post-procedural visual analog scale at different time intervals were around (30), which was statistically insignificant between groups (P > 0.05). There were no significant differences between groups regarding cardiopulmonary stability, postanesthesia care unit time, the total amount of rescue fentanyl and patient satisfaction scores (P > 0.05). There were no significant side effects in both groups. Conclusion: Ultrasound-guided unilateral TAP block is as safe and effective analgesic technique as bilateral TAP blocks during unilateral ureteric SWL. It can be used as the sole analgesic technique during ureteric SWL. PMID:27453645

  17. Shock Wave Lithotripsy: Effects on the Pancreas and Recurrent Stone Disease

    NASA Astrophysics Data System (ADS)

    Krambeck, Amy E.; Rohlinger, Audrey L.; Lohse, Christine M.; Patterson, David E.; Gettman, Matthew T.

    2007-04-01

    Long-term effects of shockwave lithotripsy (SWL) are unknown; however, we recently found an association between SWL and diabetes mellitus in a population based case control cohort. To further study the association between SWL and diabetes mellitus, we determined the immediate impact of SWL on the pancreas as well as the long-term natural history of stone disease following treatment. Chart review identified 630 patients treated with SWL at our institution in 1985. Questionnaires focusing on recurrent stone episodes after SWL were sent to 578 patients alive in 2004. To further assess impact of SWL on the pancreas, pancreatic enzyme measurements were performed on 24 symptomatic stone patients treated in 2006 with ureteroscopy (n=12) and SWL (n=12). Serum amylase and lipase were evaluated pre and post SWL. A⩾5 U/L increase in either lab value was considered significant. Among patients in the long-term SWL treatment group, the questionnaire response rate was 58.9% (288/489). Recurrent stone events were noted in 154 (53.5%) of the survey respondents. Characteristics associated with stone recurrences were: gender (p=0.004), age at SWL (p=0.022), BMI (p=0.007), SWL complications (p=0.009), and lower pole SWL (p=0.025). Recurrent stone disease was also associated with the development of diabetes mellitus (p=0.020). In the contemporary group of treated stone patients, pancreatic enzyme analysis demonstrated an increase in serum amylase and lipase in 3 (25.0%) SWL patients and 1 (8.3%) ureteroscopy patient (p=0.273). In conclusion, over half of the patients treated with SWL will develop recurrent stone events. We found a strong association between recurrent stone disease and the development of diabetes mellitus at long-term follow-up. Although not statistically significant due to small number, data in a contemporary treatment cohort suggest the possibility that the pancreas can be adversely affected by SWL.

  18. New-onset diabetes mellitus after shock wave lithotripsy for urinary stone: a systematic review and meta-analysis.

    PubMed

    Deng, Tuo; Liao, Banghua; Tian, Ye; Luo, Deyi; Liu, Jiaming; Jin, Tao; Wang, Kunjie

    2015-06-01

    The purpose of the study was to evaluate the association between shock wave lithotripsy (SWL) for urinary stone and new-onset diabetes mellitus (DM). A comprehensive data collection was performed in the Pubmed database, Embase database, Chinese Biomedical database, Chinese National Knowledge Infrastructure database and VIP database. Difference in incidence of new-onset DM after SWL between cases and controls was evaluated by odds ratio (OR) with its 95% confidence interval (CI). And summary adjusted risk ratios (RRs) and 95% CIs were calculated to assess the strength of association between SWL and new-onset DM, and then subgroup analyses were conducted. Five studies were included in this meta-analysis. The incidence of new-onset DM after SWL is not higher than that in the population who do not receive SWL [OR = 1.59, 95% CI (0.92, 2.74), P = 0.10]. And statistical association between SWL and new-onset DM could not be found significantly [RR = 1.33, 95% CI (0.83, 2.13), P = 0.24], either. However, body mass index (BMI) [RR = 1.09, 95% CI (1.04, 1.14), P < 0.001] and family history of DM (FHx DM) [RR = 0.35, 95% CI (0.15, 0.80), P = 0.013] were found significantly associated with the development of DM in subgroup analyses. Our data suggests that there is no association between SWL for urinary stone and new-onset DM. PMID:25753541

  19. New-onset diabetes mellitus after shock wave lithotripsy for urinary stone: a systematic review and meta-analysis.

    PubMed

    Deng, Tuo; Liao, Banghua; Tian, Ye; Luo, Deyi; Liu, Jiaming; Jin, Tao; Wang, Kunjie

    2015-06-01

    The purpose of the study was to evaluate the association between shock wave lithotripsy (SWL) for urinary stone and new-onset diabetes mellitus (DM). A comprehensive data collection was performed in the Pubmed database, Embase database, Chinese Biomedical database, Chinese National Knowledge Infrastructure database and VIP database. Difference in incidence of new-onset DM after SWL between cases and controls was evaluated by odds ratio (OR) with its 95% confidence interval (CI). And summary adjusted risk ratios (RRs) and 95% CIs were calculated to assess the strength of association between SWL and new-onset DM, and then subgroup analyses were conducted. Five studies were included in this meta-analysis. The incidence of new-onset DM after SWL is not higher than that in the population who do not receive SWL [OR = 1.59, 95% CI (0.92, 2.74), P = 0.10]. And statistical association between SWL and new-onset DM could not be found significantly [RR = 1.33, 95% CI (0.83, 2.13), P = 0.24], either. However, body mass index (BMI) [RR = 1.09, 95% CI (1.04, 1.14), P < 0.001] and family history of DM (FHx DM) [RR = 0.35, 95% CI (0.15, 0.80), P = 0.013] were found significantly associated with the development of DM in subgroup analyses. Our data suggests that there is no association between SWL for urinary stone and new-onset DM.

  20. Lithotripsy

    MedlinePlus

    ... Laser lithotripsy; Percutaneous lithotripsy; Endoscopic lithotripsy; ESWL; Renal calculi-lithotripsy ... Lingeman JE. Surgical management of upper urinary tract calculi. In: Wein AJ, ed. Campbell-Walsh Urology . 10th ...

  1. [Extracorporeal shock-wave lithotripsy for children].

    PubMed

    Wakabayashi, A; Matsuda, H; Uemura, T; Kohri, K; Kurita, T; Kanbara, N; Tamura, M

    1988-06-01

    We performed extracorporeal shock wave lithotripsy (ESWL) on a 5-year-old and 8-year-old. Ureteral calculi in both patients were disintegrated, and all fragments were passable spontaneously. The 5-year-old girl was the youngest of the cases of ESWL reported in Japan. As this patient was 107 cm in height, we put a styrofoam layer on the back of this patient. This protected her lung from the shock wave, and the height limit was released from the ESWL treatment. These cases and the peculiarities and devices for ESWL in the pediatric field are discussed. PMID:3223460

  2. Ordnance gelatine as an in vitro tissue simulation scaffold for extracorporeal shock wave lithotripsy.

    PubMed

    Mendez-Probst, C E; Vanjecek, M; Razvi, H; Cadieux, P A

    2010-12-01

    In vitro shock wave lithotripsy (SWL) research is typically performed utilizing wet coupling lithotriptors with a mesh basket model. This model does not take into account shock wave energy attenuation through tissue. Models using dry coupling lithotriptors rely on immersion chambers and face similar limitations. Ordnance gelatin (OG) displays strength and viscous properties similar to human tissue and is therefore widely used for ballistic tissue injury research. We present our initial experience using an OG tissue simulating scaffold for dry coupling SWL research. Using 10% OG prepared in a disc-shaped mold (five stone wells/gel), we tested the model using a Modulith SLX-F2 lithotriptor and artificial stone phantoms. Following a test of concept run on an empty gel mold and a material integrity check for leakage, we shocked 60 stones (30 narrow focus [NF], 30 wide focus [WF]) in human pooled urine. Half were shocked using gels containing open-ended wells with the remainder closed-ended wells. Fragmentation coefficients (FC) were calculated across both foci and gel models. All gels successfully completed 5,000 shocks (1,000/well) without loss of gel integrity or fluid leakage. The mean FC using open-ended wells was 77.9 ± 7.6% NF and 74.4 ± 4.8% WF, and for closed wells 75.9 ± 8.0% NF and 67.1 ± 3.5% WF. The total model cost including the preparation of gels and begostones was assessed at approximately $1 per stone (Canadian). Ordnance gel serves as an excellent surrogate tissue shockwave scaffold providing an easily manufactured, reproducible and inexpensive model for dry coupling SWL research.

  3. Ordnance gelatine as an in vitro tissue simulation scaffold for extracorporeal shock wave lithotripsy.

    PubMed

    Mendez-Probst, C E; Vanjecek, M; Razvi, H; Cadieux, P A

    2010-12-01

    In vitro shock wave lithotripsy (SWL) research is typically performed utilizing wet coupling lithotriptors with a mesh basket model. This model does not take into account shock wave energy attenuation through tissue. Models using dry coupling lithotriptors rely on immersion chambers and face similar limitations. Ordnance gelatin (OG) displays strength and viscous properties similar to human tissue and is therefore widely used for ballistic tissue injury research. We present our initial experience using an OG tissue simulating scaffold for dry coupling SWL research. Using 10% OG prepared in a disc-shaped mold (five stone wells/gel), we tested the model using a Modulith SLX-F2 lithotriptor and artificial stone phantoms. Following a test of concept run on an empty gel mold and a material integrity check for leakage, we shocked 60 stones (30 narrow focus [NF], 30 wide focus [WF]) in human pooled urine. Half were shocked using gels containing open-ended wells with the remainder closed-ended wells. Fragmentation coefficients (FC) were calculated across both foci and gel models. All gels successfully completed 5,000 shocks (1,000/well) without loss of gel integrity or fluid leakage. The mean FC using open-ended wells was 77.9 ± 7.6% NF and 74.4 ± 4.8% WF, and for closed wells 75.9 ± 8.0% NF and 67.1 ± 3.5% WF. The total model cost including the preparation of gels and begostones was assessed at approximately $1 per stone (Canadian). Ordnance gel serves as an excellent surrogate tissue shockwave scaffold providing an easily manufactured, reproducible and inexpensive model for dry coupling SWL research. PMID:20967432

  4. Clinical Nomograms to Predict Stone-Free Rates after Shock-Wave Lithotripsy: Development and Internal-Validation

    PubMed Central

    Kim, Jung Kwon; Ha, Seung Beom; Jeon, Chan Hoo; Oh, Jong Jin; Cho, Sung Yong; Oh, Seung-June; Kim, Hyeon Hoe; Jeong, Chang Wook

    2016-01-01

    Purpose Shock-wave lithotripsy (SWL) is accepted as the first line treatment modality for uncomplicated upper urinary tract stones; however, validated prediction models with regards to stone-free rates (SFRs) are still needed. We aimed to develop nomograms predicting SFRs after the first and within the third session of SWL. Computed tomography (CT) information was also modeled for constructing nomograms. Materials and Methods From March 2006 to December 2013, 3028 patients were treated with SWL for ureter and renal stones at our three tertiary institutions. Four cohorts were constructed: Total-development, Total-validation, CT-development, and CT-validation cohorts. The nomograms were developed using multivariate logistic regression models with selected significant variables in a univariate logistic regression model. A C-index was used to assess the discrimination accuracy of nomograms and calibration plots were used to analyze the consistency of prediction. Results The SFR, after the first and within the third session, was 48.3% and 68.8%, respectively. Significant variables were sex, stone location, stone number, and maximal stone diameter in the Total-development cohort, and mean Hounsfield unit (HU) and grade of hydronephrosis (HN) were additional parameters in the CT-development cohort. The C-indices were 0.712 and 0.723 for after the first and within the third session of SWL in the Total-development cohort, and 0.755 and 0.756, in the CT-development cohort, respectively. The calibration plots showed good correspondences. Conclusions We constructed and validated nomograms to predict SFR after SWL. To the best of our knowledge, these are the first graphical nomograms to be modeled with CT information. These may be useful for patient counseling and treatment decision-making. PMID:26890006

  5. Treatment of small lower pole calculi--SWL vs. URS vs. PNL?

    PubMed

    Knoll, Thomas; Tasca, Andrea; Buchholz, Noor P

    2011-03-01

    According to current guideline recommendations extracorporeal shock wave lithotripsy (SWL) remains the first choice treatment for small and mid-sized renal calculi. However, the results of SWL treatment for lower pole stones can be disappointing whilst more invasive endoscopic modalities, such as flexible ureterorenoscopy (fURS) and percutaneous nephrolithotomy (PNL) are often considered more effective. This article summarizes a point-counterpoint discussion at the 9th eULIS symposium in Como, Italy, and discusses the potential advantages and disadvantages of the different therapeutic approaches.

  6. Is scoring system of computed tomography based metric parameters can accurately predicts shock wave lithotripsy stone-free rates and aid in the development of treatment strategies?

    PubMed Central

    Badran, Yasser Ali; Abdelaziz, Alsayed Saad; Shehab, Mohamed Ahmed; Mohamed, Hazem Abdelsabour Dief; Emara, Absel-Aziz Ali; Elnabtity, Ali Mohamed Ali; Ghanem, Maged Mohammed; ELHelaly, Hesham Abdel Azim

    2016-01-01

    Objective: The objective was to determine the predicting success of shock wave lithotripsy (SWL) using a combination of computed tomography based metric parameters to improve the treatment plan. Patients and Methods: Consecutive 180 patients with symptomatic upper urinary tract calculi 20 mm or less were enrolled in our study underwent extracorporeal SWL were divided into two main groups, according to the stone size, Group A (92 patients with stone ≤10 mm) and Group B (88 patients with stone >10 mm). Both groups were evaluated, according to the skin to stone distance (SSD) and Hounsfield units (≤500, 500–1000 and >1000 HU). Results: Both groups were comparable in baseline data and stone characteristics. About 92.3% of Group A rendered stone-free, whereas 77.2% were stone-free in Group B (P = 0.001). Furthermore, in both group SWL success rates was a significantly higher for stones with lower attenuation <830 HU than with stones >830 HU (P < 0.034). SSD were statistically differences in SWL outcome (P < 0.02). Simultaneous consideration of three parameters stone size, stone attenuation value, and SSD; we found that stone-free rate (SFR) was 100% for stone attenuation value <830 HU for stone <10 mm or >10 mm but total number SWL sessions and shock waves required for the larger stone group were higher than in the smaller group (P < 0.01). Furthermore, SFR was 83.3% and 37.5% for stone <10 mm, mean HU >830, SSD 90 mm and SSD >120 mm, respectively. On the other hand, SFR was 52.6% and 28.57% for stone >10 mm, mean HU >830, SSD <90 mm and SSD >120 mm, respectively. Conclusion: Stone size, stone density (HU), and SSD is simple to calculate and can be reported by radiologists to applying combined score help to augment predictive power of SWL, reduce cost, and improving of treatment strategies. PMID:27141192

  7. Predictive value of low tube voltage and dual-energy CT for successful shock wave lithotripsy: an in vitro study.

    PubMed

    Largo, Remo; Stolzmann, Paul; Fankhauser, Christian D; Poyet, Cédric; Wolfsgruber, Pirmin; Sulser, Tullio; Alkadhi, Hatem; Winklhofer, Sebastian

    2016-06-01

    This study investigates the capabilities of low tube voltage computed tomography (CT) and dual-energy CT (DECT) for predicting successful shock wave lithotripsy (SWL) of urinary stones in vitro. A total of 33 urinary calculi (six different chemical compositions; mean size 6 ± 3 mm) were scanned using a dual-source CT machine with single- (120 kVp) and dual-energy settings (80/150, 100/150 Sn kVp) resulting in six different datasets. The attenuation (Hounsfield Units) of calculi was measured on single-energy CT images and the dual-energy indices (DEIs) were calculated from DECT acquisitions. Calculi underwent SWL and the number of shock waves for successful disintegration was recorded. The prediction of required shock waves regarding stone attenuation/DEI was calculated using regression analysis (adjusted for stone size and composition) and the correlation between CT attenuation/DEI and the number of shock waves was assessed for all datasets. The median number of shock waves for successful stone disintegration was 72 (interquartile range 30-361). CT attenuation/DEI of stones was a significant, independent predictor (P < 0.01) for the number of required shock waves with the best prediction at 80 kVp (β estimate 0.576) (P < 0.05). Correlation coefficients between attenuation/DEI and the number of required shock waves ranged between ρ = 0.31 and 0.68 showing the best correlation at 80 kVp (P < 0.001). The attenuation of urinary stones at low tube voltage CT is the best predictor for successful stone disintegration, being independent of stone composition and size. DECT shows no added value for predicting the success of SWL.

  8. [Extracorporeal shockwave lithotripsy in the treatment of gallstone patients].

    PubMed

    Kolesnikov, B D; Chubenko, S S; Romankova, V A

    1993-04-01

    Stroke-wave lithotripsy (SWL) was used for the treatment of patients with cholelithiasis. Indications and contraindications were strictly observed. This method provides destruction calculi down to a size of 2-3 mm which enables them to enter the intestine without local injury. Subsequent choleritics, exercises, duodenal to reduce time of gallbladder emptying and intake of litholytics.

  9. Drugs for Pain Management in Shock Wave Lithotripsy

    PubMed Central

    Bach, Christian; Zaman, Faruquz; Kachrilas, Stefanos; Kumar, Priyadarshi; Buchholz, Noor; Masood, Junaid

    2011-01-01

    Objective. With this review, we provide a comprehensive overview of the main aspects and currently used drugs for analgesia in shockwave lithotripsy. Evidence Acquisition. We reviewed current literature, concentrating on newer articles and high-quality reviews in international journals. Results. No standardized protocols for pain control in SWL exist, although it is crucial for treatment outcome. General and spinal anaesthesia show excellent pain control but are only recommended for selected cases. The newer opioids and nonsteroidal anti-inflammatory drugs are able to deliver good analgesia. Interest in inhalation anaesthesia with nitrous oxide, local anaesthesia with deep infiltration of the tissue, and dermal anaesthesia with EMLA or DMSO has recently rekindled, showing good results in terms of pain control and a favourable side effect profile. Tamsulosin and paracetamol are further well-known drugs being currently investigated. Conclusion. Apart from classically used drugs like opioids and NSARs, medicaments like nitrous oxide, paracetamol, DMSA, or refined administration techniques for infiltration anaesthesia show a good effectiveness in pain control for SWL. PMID:22135735

  10. Drugs for pain management in shock wave lithotripsy.

    PubMed

    Bach, Christian; Zaman, Faruquz; Kachrilas, Stefanos; Kumar, Priyadarshi; Buchholz, Noor; Masood, Junaid

    2011-01-01

    Objective. With this review, we provide a comprehensive overview of the main aspects and currently used drugs for analgesia in shockwave lithotripsy. Evidence Acquisition. We reviewed current literature, concentrating on newer articles and high-quality reviews in international journals. Results. No standardized protocols for pain control in SWL exist, although it is crucial for treatment outcome. General and spinal anaesthesia show excellent pain control but are only recommended for selected cases. The newer opioids and nonsteroidal anti-inflammatory drugs are able to deliver good analgesia. Interest in inhalation anaesthesia with nitrous oxide, local anaesthesia with deep infiltration of the tissue, and dermal anaesthesia with EMLA or DMSO has recently rekindled, showing good results in terms of pain control and a favourable side effect profile. Tamsulosin and paracetamol are further well-known drugs being currently investigated. Conclusion. Apart from classically used drugs like opioids and NSARs, medicaments like nitrous oxide, paracetamol, DMSA, or refined administration techniques for infiltration anaesthesia show a good effectiveness in pain control for SWL.

  11. Sciaticum majus foramen and sciaticum minus foramen as the path of SWL in the supine position to treat distal ureteral stone.

    PubMed

    Lu, Jianlin; Sun, Xizhao; He, Lei

    2010-12-01

    The purpose of the study is to evaluate the efficacy and safety of shock wave lithotripsy (SWL) using sciaticum majus foramen and sciaticum minus foramen as the path to treat distal ureteral stone in supine position. Between December 2006 and November 2008, 243 cases of distal urinary calculi were treated in our department using SWL or ureteroscopy. 189 cases for SWL were treated in supine position. The shockwave target on the stone in distal ureter via sciaticum majus foramen and sciaticum minus foramen, avoiding the sacroiliac joint. 54 cases were underwent ureteroscopy combined with holmium:YAG laser lithotripsy. The stone-free rate and the efficacy quotient (EQ) for SWL and ureteroscopy was 81.5%, 0.68; 94.4%, 0.78; respectively (p = 0.02). The retreatment rate for SWL and ureteroscopy was 14.6%, 0, respectively. The number of the shocks ranged from 600 to 3,000 (mean 2,566.3 ± 378.8). The energy per pulse of SWL ranged from 8 to 12 kV (mean 10.7). SWL in the supine position using sciaticum majus foramen and sciaticum minus foramen as the path is a choice of the treatment of distal ureteral stones with an excellent success rate and low side effect.

  12. Age-related delay in urinary stone clearance in elderly patients with solitary proximal ureteral calculi treated by extracorporeal shock wave lithotripsy.

    PubMed

    Ichiyanagi, Osamu; Nagaoka, Akira; Izumi, Takuji; Kawamura, Yuko; Kato, Tomoyuki

    2015-10-01

    We investigated the effects of aging on the stone-free rate (SFR) after shock wave lithotripsy (SWL) for the treatment of proximal ureteral calculi. A total of 247 consecutive patients were retrospectively selected, classified into seven groups set at 10 year increments (from 20 to 90 years), and examined for SFR after SWL. According to our final analysis, 185 male and 62 female patients with an average age of 54.1 years had stones with a diameter of 11.5 mm and a density of 893.1 Hounsfield units. On average, SFR was 74.9 % at 3 months after 1.7 SWL sessions. SFR gradually reached ≥ 90 % for each age-group after 1.5-2 years. Median durations to achieve 50 % SFR were estimated to be 21 and 86 days for those in their 20 and 80 s, respectively. However, the difference between the two estimates was not significant (p = 0.064). The durations to achieve 50 % SFR for the other groups lay between these two estimates. Aging does not affect long-term SFR, but patients aged ≥ 80 years might experience delayed stone clearance within the first 12 months after SWL.

  13. Optimization of pressure waveform, distribution and sequence in shock wave lithotripsy

    NASA Astrophysics Data System (ADS)

    Zhou, Yufeng

    This work aims to improve shock wave lithotripsy (SWL) technology by increasing stone comminution efficiency while reducing simultaneously the propensity of tissue injury. First, the mechanism of vascular injury in SWL was investigated. Based on in vitro vessel phantom experiment and theoretical calculation, it was found that SWL-induced large intraluminal bubble expansion may constitute a primary mechanism for the rupture of capillaries and small blood vessels. However, when the large intraluminal bubble expansion is suppressed by inversion of the pressure waveform of the lithotripter shock wave (LSW), rupture of a 200-mum cellulose hollow fiber vessel phantom can be avoided. Based on these experimental observations and theoretical assessment of bubble dynamics using the Gilmore model an in situ pulse superposition technique was developed to reduce tissue injury without compromising stone comminution in SWL. A thin shell ellipsoidal reflector insert was fabricated to fit snugly with the original HM-3 reflector. Using the Hamilton model, the effects of reflector geometry on the pulse profile and sequence of the shock waves were evaluated qualitatively. Guided by this analysis, the design of the reflector insert had been refined to suppress the intraluminal bubble expansion, which was confirmed by high-speed imaging of bubble dynamics both in free field and inside a vessel phantom. The pulse pressure, beam size and stone comminution efficiency of the upgraded reflector were all found to be comparable to those of the original reflector. However, the greatest difference lies in the propensity for tissue injury. At the lithotripter focus, about 30 shocks are needed to cause a rupture of the vessel phantom using the original reflector, but no rupture can be produced after 200 shocks by the upgraded reflector. Overall, the upgraded reflector could significantly reduce the propensity of vessel rupture while maintaining satisfactory stone comminution. Second, to improve

  14. Perspective on Lithotripsy Adverse Effects

    NASA Astrophysics Data System (ADS)

    Knoll, Thomas; Wendt-Nordahl, Gunnar

    2008-09-01

    Shock wave lithotripsy (SWL) is an effective and without any doubt the least invasive procedure to treat upper urinary tract calculi. Acute complications are rarely reported and do not require specific treatment in most cases. However, one should be aware that energy levels sufficient for stone breakage are capable of damaging tissue as well, and significant hematoma—not only in the kidney but as well in surrounding organs—has been observed. Furthermore, only little is known about the long-term effects of SWL. Some authors have reported an increased incidence of hypertension and possibly also diabetes mellitus. Such chronic diseases—if indeed related to prior SWL—may be a late result of acute SWL-related trauma but the discussion on the underlying pathogenesis is controversial. Many factors have to be considered, such as the natural history of recurrent stone formers, technical principles of SWL, and differences in treatment protocols. Promising studies are currently underway to optimize stone breakage while limiting potential collateral damage. With this progress, SWL remains a safe treatment option for most urinary calculi.

  15. Stone heterogeneity index as the standard deviation of Hounsfield units: A novel predictor for shock-wave lithotripsy outcomes in ureter calculi.

    PubMed

    Lee, Joo Yong; Kim, Jae Heon; Kang, Dong Hyuk; Chung, Doo Yong; Lee, Dae Hun; Do Jung, Hae; Kwon, Jong Kyou; Cho, Kang Su

    2016-01-01

    We investigated whether stone heterogeneity index (SHI), which a proxy of such variations, was defined as the standard deviation of a Hounsfield unit (HU) on non-contrast computed tomography (NCCT), can be a novel predictor for shock-wave lithotripsy (SWL) outcomes in patients with ureteral stones. Medical records were obtained from the consecutive database of 1,519 patients who underwent the first session of SWL for urinary stones between 2005 and 2013. Ultimately, 604 patients with radiopaque ureteral stones were eligible for this study. Stone related variables including stone size, mean stone density (MSD), skin-to-stone distance, and SHI were obtained on NCCT. Patients were classified into the low and high SHI groups using mean SHI and compared. One-session success rate in the high SHI group was better than in the low SHI group (74.3% vs. 63.9%, P = 0.008). Multivariate logistic regression analyses revealed that smaller stone size (OR 0.889, 95% CI: 0.841-0.937, P < 0.001), lower MSD (OR 0.995, 95% CI: 0.994-0.996, P < 0.001), and higher SHI (OR 1.011, 95% CI: 1.008-1.014, P < 0.001) were independent predictors of one-session success. The radiologic heterogeneity of urinary stones or SHI was an independent predictor for SWL success in patients with ureteral calculi and a useful clinical parameter for stone fragility. PMID:27035621

  16. Tracking kidney stones with sound during shock wave lithotripsy

    NASA Astrophysics Data System (ADS)

    Kracht, Jonathan M.

    The prevalence of kidney stones has increased significantly over the past decades. One of the primary treatments for kidney stones is shock wave lithotripsy which focuses acoustic shock waves onto the stone in order to fragment it into pieces that are small enough to pass naturally. This typically requires a few thousand shock waves delivered at a rate of about 2 Hz. Although lithotripsy is the only non-invasive treatment option for kidney stories, both acute and chronic complications have been identified which could be reduced if fewer shock waves were used. One factor that could be used to reduce the number of shock waves is accounting for the motion of the stone which causes a portion of the delivered shock waves to miss the stone, yielding no therapeutic benefit. Therefore identifying when the stone is not in focus would allow tissue to be spared without affecting fragmentation. The goal of this thesis is to investigate acoustic methods to track the stone in real-time during lithotripsy in order to minimize poorly-targeted shock waves. A relatively small number of low frequency ultrasound transducers were used in pulse-echo mode and a novel optimization routine based on time-of-flight triangulation is used to determine stone location. It was shown that the accuracy of the localization may be estimated without knowing the true stone location. This method performed well in preliminary experiments but the inclusion of tissue-like aberrating layers reduced the accuracy of the localization. Therefore a hybrid imaging technique employing DORT (Decomposition of the Time Reversal Operator) and the MUSIC (Multiple Signal Classification) algorithm was developed. This method was able to localize kidney stories to within a few millimeters even in the presence of an aberrating layer. This would be sufficient accuracy for targeting lithotripter shock waves. The conclusion of this work is that tracking kidney stones with low frequency ultrasound should be effective clinically.

  17. Controlled Cavitation to Augment SWL Stone Comminution: Mechanistic Insights In-Vitro

    PubMed Central

    Duryea, Alexander P.; Roberts, William W.; Cain, Charles A.; Hall, Timothy L.

    2013-01-01

    Stone comminution in shock wave lithotripsy (SWL) has been documented to result from mechanical stresses conferred directly to the stone, as well as the activity of cavitational microbubbles. Studies have demonstrated that the presence of this cavitation activity is crucial for stone subdivision; however, its exact role in the comminution process remains somewhat weakly defined, in part due to the fact that it is difficult to isolate the cavitational component from the shock waves themselves. In this study, we further explored the importance of cavitation in SWL stone comminution through the use of histotripsy ultrasound therapy. Histotripsy was utilized to target model stones designed to mimic the mid-range tensile fracture strength of naturally occurring cystine calculi with controlled cavitation at strategic time points in the SWL comminution process. All SWL was applied at a peak-positive pressure (p+) of 34 MPa and a peak-negative pressure (p−) of 8 MPa; a shock rate of 1 Hz was used. Histotripsy pulses had a p− of 33 MPa and were applied at a pulse repetition frequency (PRF) of 100 Hz. Ten model stones were sonicated in-vitro with each of five different treatment schemes: A. 10 minutes SWL (600 shocks) with 0.7 seconds of histotripsy interleaved between successive shocks (totaling to 42,000 pulses); B. 10 minutes SWL (600 shocks) followed by 10 minutes histotripsy applied in 0.7 second bursts (1 burst per second, totaling to 42,000 pulses); C. 10 minutes histotripsy applied in 0.7 second bursts (42,000 pulses) followed by 10 minutes SWL (600 shocks); D. 10 minutes SWL-only (600 shocks); E. 10 minutes histotripsy-only applied in 0.7 second bursts (42,000 pulses). Following sonication, debris was collected and sieved through 8, 6, 4, and 2 mm filters. It was found that SWL-only generated a broad range of fragment sizes, with an average of 14.9 ± 24.1% of the original stone mass remaining >8 mm. Histotripsy-only eroded the surface of stones to tiny

  18. Use of image enhancement during lithotripsy.

    PubMed

    Dawson, C; Corry, D A; Bowsher, W G; Nockler, I B; Whitfield, H N

    1996-08-01

    Renal excursion during breathing is inevitable and is a cause of poor localization during extracorporeal shock-wave lithotripsy (SWL), which in theory might lead to poor treatment results. Eighty-one patients underwent lithotripsy treatment with and without the use of an image enhancement system designed for use with the Dornier MPL9000 lithotripter. This device contains a memory incorporated into a separate differential grayscale monitor, which allows the stone image to be stored. Shockwave release is enabled only when this image corresponds to the real-time image on the lithotripter ultrasound monitor. No improvement in success rates was found using this system, although upper-pole stones appeared to be fragmented more successfully. Overall, the results were favorable in both groups after a single treatment. Further work is needed to establish whether image enhancement is capable of improving the success rates and reducing the side effects of lithotripsy by better targeting.

  19. Adverse effects of shock waves and strategies for improved treatment in shock wave lithotripsy

    NASA Astrophysics Data System (ADS)

    McAteer, James A.; Evan, Andrew P.; Connors, Bret A.; Williams, James C.; Willis, Lynn R.

    2005-04-01

    Lithotripter SWs rupture blood vessels in the kidney. This acute trauma, accompanied by a fall in renal function, can lead to significant long-term effects such as profound scarring of the kidney cortex and renal papillaea permanent loss of functional renal mass. SWL has been linked to new-onset hypertension in some patients, and recent studies suggest that multiple lithotripsies can actually alter a patient's stone disease leading to formation of stones (brushite) that are harder to break. Cavitation and shear appear to play a role in stone breakage and tissue damage. Progress in understanding these mechanisms, and the renal response to SWs, has led to practical strategies to improve treatment. Slowing the SW-rate, or initiating treatment at low kV/power both improve stone breakage and reduce the number of potentially tissue-damaging SWs needed to achieve comminution. The observation that SWs cause transient vasoconstriction in the kidney has led to studies in pigs showing that a pre-conditioning dose of low-energy SWs significantly reduces trauma from subsequent high-energy SWs. Thus, SWs can induce adverse effects in the kidney, but what we have learned about the mechanisms of SW action suggests strategies that could make lithotripsy safer and more effective. [Work supported by NIH-DK43881, DK55674.

  20. [Extracorporeal shock-wave lithotripsy of a salivary stone].

    PubMed

    Iro, H; Schneider, T; Nitsche, N; Waitz, G; Marienhagen, J; Ell, C

    1990-01-01

    Ultrasonography revealed a 12 mm concrement in the left parotid duct of a 67-year-old man with an acute exacerbation of a left-sided purulent parotitis. After the acute phase had subsided under antibiotic therapy it was not possible to remove the stone either by bougie or cutting into the duct close to the papilla. Piezoelectric shockwave lithotripsy with a total of 1000 shock-waves fragmented the stone, and sonography 48 hours and four weeks later demonstrated that the parotid gland was free of stone.

  1. [Extracorporeal shock-wave lithotripsy in horseshoe kidney].

    PubMed

    Blasco Casares, F J; Ibarz Servio, L; Ramón Dalmau, M; Ruiz Marcellán, F J

    1994-05-01

    Presentation of our experience in the use of extracorporeal shock wave lithotripsy (ESWL) for the treatment of lithiasis that occurred in 34 renal units from 28 patients with horseshoe kidneys. All patients but one were placed in supine decubitus with the calculus positioned in F2. A total of 47 sessions were performed for 34 treatments apart from 3 ureteroscopies for ureteral voiding. The results of the follow-up is absence of lithiasis in 13 renal units, debris of less than 3 mm in six, non-removable debris in 13 cases and relapse in two.

  2. Effective radiation exposure evaluation during a one year follow-up of urolithiasis patients after extracorporeal shock wave lithotripsy

    PubMed Central

    Tekinarslan, Erdem; Keskin, Suat; Buldu, İbrahim; Sönmez, Mehmet Giray; Karatag, Tuna; Istanbulluoglu, Mustafa Okan

    2015-01-01

    Introduction To determine and evaluate the effective radiation exposure during a one year follow-up of urolithiasis patients following the SWL (extracorporeal shock wave lithotripsy) treatment. Material and methods Total Effective Radiation Exposure (ERE) doses for each of the 129 patients: 44 kidney stone patients, 41 ureter stone patients, and 44 multiple stone location patients were calculated by adding up the radiation doses of each ionizing radiation session including images (IVU, KUB, CT) throughout a one year follow-up period following the SWL. Results Total mean ERE values for the kidney stone group was calculated as 15, 91 mSv (5.10-27.60), for the ureter group as 13.32 mSv (5.10-24.70), and in the multiple stone location group as 27.02 mSv (9.41-54.85). There was no statistically significant differences between the kidney and ureter groups in terms of the ERE dose values (p = 0.221) (p >0.05). In the comparison of the kidney and ureter stone groups with the multiple stone location group; however, there was a statistically significant difference (p = 0.000) (p <0.05). Conclusions ERE doses should be a factor to be considered right at the initiation of any diagnostic and/or therapeutic procedure. Especially in the case of multiple stone locations, due to the high exposure to ionized radiation, different imaging modalities with low dose and/or totally without a dose should be employed in the diagnosis, treatment, and follow-up bearing the aim to optimize diagnosis while minimizing the radiation dose as much as possible. PMID:26568880

  3. Evaluating the importance of mean stone density and skin-to-stone distance in predicting successful shock wave lithotripsy of renal and ureteric calculi.

    PubMed

    Wiesenthal, Joshua D; Ghiculete, Daniela; D'A Honey, R John; Pace, Kenneth T

    2010-08-01

    Shock wave lithotripsy (SWL) is considered the first line treatment for the majority of patients with renal and ureteric calculi, with success rates from contemporary series varying from 60 to 90%. Success is dependent on many patient and stone-related factors. We conducted a retrospective analysis of mean stone CT density (MSD) and skin-to-stone distance (SSD) to determine their influence on the success of SWL of renal and ureteric calculi. Data from all patients treated at the St. Michael's Hospital Lithotripsy Unit from May 2004 to June 2009 were reviewed. Analysis was restricted to those patients with a pre-treatment non-contrast CT scan conducted at our center demonstrating a solitary renal or ureteric calculus < or =20 mm in maximal diameter. Successful treatment of renal stones was defined as those patients who were stone free or had asymptomatic, clinically insignificant residual fragments < or =4 mm in diameter, as measured by KUB X-ray, 3 months after a single SWL treatment. Successful treatment of ureteric stones was defined as being stone free on KUB X-ray, 2-weeks post-SWL. Demographic, stone, patient, treatment and follow-up data were collected from a prospective database and review of CT and KUB imaging by two independent urologists and one radiologist. Data were analyzed with logistic regression, Chi square analysis and ANOVA where appropriate. 422 patients (69.7% male) with a mean age of 51.4 years (SD 12.9) and mean BMI 27.0 kg/m(2) (SD 4.9) were analyzed. Mean stone size was 78.9 mm(2) (SD 77.3) for ureteral stones and 66.1 mm(2) (SD 63.2) for renal stones, with 95 (43.6%) of the renal stones located in the lower pole. The single-treatment success rates for ureteral and renal stones were 62.3% and 68.8%, respectively. On univariate analysis, predictors of SWL success, regardless of stone location, were age (p = 0.01), BMI (p = 0.01), stone size (p < 0.01), MSD (p < 0.01) and SSD (p < 0.01). On multivariate analysis, MSD >900 HU (OR = 0.49, CI: 0

  4. Turbulent water coupling in shock wave lithotripsy.

    PubMed

    Lautz, Jaclyn; Sankin, Georgy; Zhong, Pei

    2013-02-01

    Previous studies have demonstrated that stone comminution decreases with increased pulse repetition frequency as a result of bubble proliferation in the cavitation field of a shock wave lithotripter (Pishchalnikov et al 2011 J. Acoust. Soc. Am. 130 EL87-93). If cavitation nuclei remain in the propagation path of successive lithotripter pulses, especially in the acoustic coupling cushion of the shock wave source, they will consume part of the incident wave energy, leading to reduced tensile pressure in the focal region and thus lower stone comminution efficiency. We introduce a method to remove cavitation nuclei from the coupling cushion between successive shock exposures using a jet of degassed water. As a result, pre-focal bubble nuclei lifetime quantified by B-mode ultrasound imaging was reduced from 7 to 0.3 s by a jet with an exit velocity of 62 cm s(-1). Stone fragmentation (percent mass <2 mm) after 250 shocks delivered at 1 Hz was enhanced from 22 ± 6% to 33 ± 5% (p = 0.007) in water without interposing tissue mimicking materials. Stone fragmentation after 500 shocks delivered at 2 Hz was increased from 18 ± 6% to 28 ± 8% (p = 0.04) with an interposing tissue phantom of 8 cm thick. These results demonstrate the critical influence of cavitation bubbles in the coupling cushion on stone comminution and suggest a potential strategy to improve the efficacy of contemporary shock wave lithotripters.

  5. Management of lower pole renal calculi: shock wave lithotripsy versus percutaneous nephrolithotomy versus flexible ureteroscopy.

    PubMed

    Preminger, Glenn M

    2006-04-01

    Current ureteroscopic intracorporeal lithotripsy devices and stone retrieval technology allow for the treatment of calculi located throughout the intra-renal collecting system. Difficulty accessing lower pole calculi, especially when the holmium laser fiber is utilized, is often encountered. Herein we review our experience where lower pole renal calculi were ureteroscopically managed by holmium laser fragmentation, either in situ, or by first displacing the stone into a less dependent position with the aid of a nitinol stone retrieval device. Lower pole stones less than 20 mm can be primarily treated by ureteroscopic means in patients: that are obese; have a bleeding diathesis; with stones resistant to shockwave lithotripsy (SWL); with complicated intra-renal anatomy; or as a salvage procedure after failed SWL. Lower pole calculi are fragmented with a 200 microm holmium laser fiber via a 7.5 F flexible ureteroscope. For those patients where the laser fiber reduced ureteroscopic deflection, precluding re-entry into the lower pole calyx, a 1.9 F nitinol basket is used to displace the lower pole calculus into a more favorable position, thus allowing for easier fragmentation. A nitinol device passed into the lower pole, through the ureteroscope, for stone displacement cause only a minimal loss of deflection and no significant impact on irrigation. Eighty-five percent of patients were stone free by IVP or CT scan performed at 3 months. Ureteroscopic management of lower pole calculi is a reasonable alternative to SWL or percutaneous nephrolithotomy (PNL) in patients with low volume stone disease. If the stone cannot be fragmented in situ, nitinol basket or grasper retrieval, through a fully deflected ureteroscope, allows for repositioning of the stone into a less dependant position, thus facilitating stone fragmentation.

  6. Perinephric abscess following extracorporeal shockwave lithotripsy.

    PubMed

    Pautler, Stephen E.; Vallely, John F.; Denstedt, John D.

    1998-10-01

    Since the introduction and widespread use of extracorporeal shockwave lithotripsy (SWL), various complications have been noted. Perinephric hematoma and ureteral obstruction may be anticipated by urologists as potential problems. We report the first case of perinephric abscess encountered after 17 895 SWL treatments at our institution. A 65 year old woman presented 4 months following a second SWL procedure with a perinephric abscess and was successfully treated with percutaneous drainage. A review of the English literature revealed only 3 other cases of perinephric abscess following SWL. This diagnosis should be considered in early and late presentations of flank pain following SWL.

  7. Dynamics of concerted bubble cluster collapse in shock wave lithotripsy

    NASA Astrophysics Data System (ADS)

    Pishchalnikov, Yuri A.; McAteer, James A.; Evan, Andrew P.; Sapozhnikov, Oleg A.; Cleveland, Robin O.; Colonius, Tim; Bailey, Michael R.; Crum, Lawrence A.

    2003-10-01

    Cavitation bubble cluster collapse at the surface of artificial kidney stones during shock wave lithotripsy was investigated in vitro by means of multiframe high-speed photography, passive cavitation detection (PCD), and pressure waveform measurements using a fiber-optic probe hydrophone (FOPH). It was observed that after the passage of the lithotripter shock pulse the stone was covered by numerous individual bubbles. During their growth phase the bubbles coalesced into bubble clusters, with the biggest cluster at the proximal face of the stone. High-speed camera images suggested that cluster collapse started at the periphery and ended with a violent collapse in a small region in the center of the surface of the stone. Shadowgraphy resolved numerous secondary shock waves emitted during this focused collapse. Shock wave emission during cluster collapse was confirmed by PCD. Measurement with the FOPH showed that these shock waves were typically of short duration (0.2 μs). The majority of the shock waves emanating from cluster collapse were low amplitude but some shock waves registered amplitudes on the order of the incident shock pulse (tens of MPa). [Work supported by NIH DK43881, DK55674.

  8. Goodpasture's disease following extracorporeal shock wave lithotripsy: a case report & literature review

    PubMed Central

    Cranfield, Alistair; Mathavakkannan, Suresh

    2015-01-01

    Key Clinical Message Shock wave lithotripsy may unmask epitopes within the glomerular basement membrane, leading to the formation of anti-glomerular basement membrane (GBM) antibodies and clinical disease in susceptible individuals. Although rare, our case highlights the need for vigilant monitoring of renal function following extracorporeal shock wave lithotripsy. This may allow for early recognition, treatment and improved outcome of anti-GBM disease. PMID:25838905

  9. Abdominal Compartment Syndrome and Necrotizing Pancreatitis Following Extracorporeal Shock Wave Lithotripsy.

    PubMed

    Gupta, S; Scambia, J; Gandillon, C; Aversano, F; Batista, R

    2016-09-01

    Extracorporeal shock wave lithotripsy (ESWL) is a common procedure in the treatment of renal calculi. There have been major complications reported with ESWL such as acute pancreatitis, bower perforation, venous thrombosis, and biliary obstruction. There are few reports in the literature of necrotizing pancreatitis secondary to ESWL. We have a case report of a 29-year-old female that developed an abdominal compartment syndrome with an acute necrotizing pancreatitis hours after extracorporeal shock wave lithotripsy. PMID:27462545

  10. Patient information leaflets for extracorporeal shock wave lithotripsy: questionnaire survey

    PubMed Central

    Askari, A; Shergill, I

    2012-01-01

    Objectives To compare the level of information provided in extracorporeal shock wave lithotripsy (ESWL) patient information leaflets in the London and East of England Deaneries Design All trusts in the London and East of England Deanery who offer an ESWL service were contacted and leaflets were compared Setting London and East of England Deanery Participants Alan Askari, Iqbal Shergill Main outcome measures Examination of key information that was communicated to ESWL patients via leaflets Results 12 trusts responded across the two deaneries. There was significant variation in the amount of information provided in the leaflets with some leaflets not containing an adequate level of instruction or information to patients Conclusions The authors propose that a national standardised information leaflet should be incorporated with the British Association of Urological Surgeons (BAUS) procedure specific information leaflet for ESWL procedures PMID:22666532

  11. Case report: scrotal ecchymosis after shockwave lithotripsy.

    PubMed

    Aydur, Emin; Göktas, Serdar; Kibar, Yusuf; Irkilata, Hasan Cem; Ors, Fatih; Peker, A Fuat

    2006-12-01

    Shockwave lithotripsy (SWL) is the treatment of choice for most renal calculi because it is highly effective and relatively noninvasive. Although complications of SWL are relatively few, one that occurs more frequently is perirenal hematoma, usually diagnosed by radiologic procedures. We present an interesting case of scrotal ecchymosis as an unusual presentation of perirenal hematoma causing ipsilateral spermatic-vein thrombosis after SWL for a left renal stone. To our knowledge, this condition has not been reported previously.

  12. Controlled, forced collapse of cavitation bubbles for improved stone fragmentation during shock wave lithotripsy.

    PubMed

    Zhong, P; Cocks, F H; Cioanta, I; Preminger, G M

    1997-12-01

    The feasibility of using controlled, forced collapse of cavitation bubbles for improved stone fragmentation during shock wave lithotripsy was demonstrated using microsecond tandem shockwave pulses. High-speed photography revealed that a secondary shock wave, released in less than 500 microseconds (microsec.) following a lithotripter-generated shock wave, can be used to control and force the collapse of cavitation bubbles toward target concretions. This timely enforced shockwave-bubble interaction was found to greatly enhance the cavitational activity near the stone surface, with a resultant up to 43% increment in stone fragmentation. Since most of the cavitation energy is directed and concentrated toward the target stones and fewer shock waves are needed for successful stone comminution, tissue injury associated with this new lithotripsy procedure may also be reduced. This novel concept of shock wave lithotripsy may be used to improve the treatment efficiency and safety of existing clinical lithotripters, as well as in the design of new shock wave lithotripters.

  13. Ureteral wall thickness at the impacted ureteral stone site: a critical predictor for success rates after SWL.

    PubMed

    Sarica, Kemal; Kafkasli, Alper; Yazici, Özgür; Çetinel, Ali Cihangir; Demirkol, Mehmet Kutlu; Tuncer, Murat; Şahin, Cahit; Eryildirim, Bilal

    2015-02-01

    The aim of the study was to determine the possible predictive value of certain patient- and stone-related factors on the stone-free rates and auxiliary procedures after extracorporeal shock wave lithotripsy in patients with impacted proximal ureteral calculi. A total of 111 patients (86 male, 25 females M/F: 3.44/1) with impacted proximal ureteral stones treated with shock wave lithotripsy were evaluated. Cases were retrieved from a departmental shock wave lithotripsy database. Variables analyzed included BMI of the case, diameter of proximal ureter and renal pelvis, stone size and Hounsfield unit, ureteral wall thickness at the impacted stone site. Stone-free status on follow-up imaging at 3 months was considered a successful outcome. All patients had a single impacted proximal ureteral stone. While the mean age of the cases was 46 ± 13 years (range 26-79 years), mean stone size was 8.95 mm (5.3-15.1 mm). Following shock wave lithotripsy although 87 patients (78.4%) were completely stone-free at 3-month follow-up visit, 24 (21.6%) cases had residual fragments requiring further repeat procedures. Prediction of the final outcome of SWL in patients with impacted proximal ureteral stones is a challenging issue and our data did clearly indicate a highly significant relationship between ureteral wall thickness and the success rates of shock wave lithotripsy particularly in cases requiring additional procedures. Of all the evaluated stone- and patient-related factors, only ureteral wall thickness at the impacted stone site independently predicted shock wave lithotripsy success.

  14. [Subcapsular hematoma of the liver after extracorporeal shock wave lithotripsy].

    PubMed

    Kobayashi, K; Ishizuka, E; Iwasaki, A; Saito, R

    1998-03-01

    We experienced a case of a hepatic subcapsular hematoma after extracorporeal shock wave lithotripsy (ESWL) for a right renal stone. To our knowledge this presentation is the second case in the Japanese literature. A 63-year-old female with a right renal stone received 2,800 shots of 14.0 kilo-volts shockwave with Sonolith 3,000. Preoperative examination of the blood disclosed no abnormalities in the coagulating system except slight reduction of platelet count and slight impairment of liver function. Postoperative routine ultrasound echograms revealed a hepatic subcapsular hematoma although she had no symptom. The size of the hematoma measured 11.0 x 5.0 cm in computed tomograms (CT). She was carefully observed without any treatments because the hematoma did not increase in size. CT scans 6 months after the ESWL treatment demonstrated neither hematoma nor masses in the liver. As a complication of ESWL for urolithiasis a hepatic subcapsular hematoma is very rare. We herein presented the case and discussed the complications of ESWL briefly in the literature.

  15. Pediatric extracorporeal shock wave lithotripsy: Predicting successful outcomes.

    PubMed

    McAdams, Sean; Shukla, Aseem R

    2010-10-01

    Extracorporeal shock wave lithotripsy (ESWL) is currently a first-line procedure of most upper urinary tract stones <2 cm of size because of established success rates, its minimal invasiveness and long-term safety with minimal complications. Given that alternative surgical and endourological options exist for the management of stone disease and that ESWL failure often results in the need for repeat ESWL or secondary procedures, it is highly desirable to identify variables predicting successful outcomes of ESWL in the pediatric population. Despite numerous reports and growing experience, few prospective studies and guidelines for pediatric ESWL have been completed. Variation in the methods by which study parameters are measured and reported can make it difficult to compare individual studies or make definitive recommendations. There is ongoing work and a need for continuing improvement of imaging protocols in children with renal colic, with a current focus on minimizing exposure to ionizing radiation, perhaps utilizing advancements in ultrasound and magnetic resonance imaging. This report provides a review of the current literature evaluating the patient attributes and stone factors that may be predictive of successful ESWL outcomes along with reviewing the role of pre-operative imaging and considerations for patient safety.

  16. Vertebral fracture associated with shockwave lithotripsy in a patient with granulomatous spondylitis.

    PubMed

    Kazimoğlu, H; Mungan, M U; Kirkali, Z

    2001-09-01

    Extracorporeal shockwave lithotripsy (SWL) is an accepted treatment modality in the treatment of urinary stone disease. Many complications have been reported secondary to high-energy shockwaves, but the effects of SWL on the skeletal system have rarely been investigated. We represent the first case of a burst-type vertebral fracture after SWL in an elderly osteoporotic patient with granulomatous spondylitis.

  17. Shifting the Split Reflectors to Enhance Stone Fragmentation of Shock Wave Lithotripsy.

    PubMed

    Wang, Jen-Chieh; Zhou, Yufeng

    2016-08-01

    Shock wave lithotripsy (SWL) has been used widely in urology for about three decades to treat kidney calculi. Technical development to improve performance (i.e., stone fragmentation efficiency) is continuous. Low-pressure wide-focus lithotripters have already achieved promising results. In this study, the lithotripter field and profile of lithotripter shock waves were changed simultaneously using a cost-effective and convenient design. An intact parabolic reflector was split into four pieces, and each part was moved individually. By shifting the split reflectors, the focused acoustic beams were separated. As a result, the beam width in the focal region could be increased. Both numerical models of wave propagation using a k-wave approach and hydrophone measurements showed similar pressure waveforms at the focus and the distributions along and transverse to the lithotripter axis. The increase of the shifting distance from 0 mm to 7 mm resulted in the increase of -6 dB beam width from 7.1 mm to 13.9 mm and location of tensile peak on axis moving from z = -14 mm to 1 mm. The Lithotripters at 10 kV (intact reflector) and at 12 kV with the split reflectors shifted by 5 mm were compared with each other because of their similar peak positive pressures at the focus (8.07 MPa ± 0.05 MPa vs. 7.90 MPa ± 0.11 MPa, respectively). However, there were significant differences in their positive beam width (8.7 mm vs. 10.2 mm), peak negative pressure (-6.34 MPa ± 0.04 MPa vs. -7.13 MPa ± 0.13 MPa), the maximum tensile stress (7.55 MPa vs. 8.95 MPa) and shear stress (6.1 MPa vs. 7.76 MPa) in a 10-mm diameter spherical stone and bubble collapse time (127.6 μs ± 5.4 μs vs. 212.7 μs ± 8.2 μs). As a result, stone fragmentation efficiency was enhanced about 1.8-fold (57.9% ± 4.6% vs. 32.2% ± 5.6%, p < 0.05) when shifting the split reflectors. These results suggest that this new reflector design could change the characteristics of

  18. Shifting the Split Reflectors to Enhance Stone Fragmentation of Shock Wave Lithotripsy.

    PubMed

    Wang, Jen-Chieh; Zhou, Yufeng

    2016-08-01

    Shock wave lithotripsy (SWL) has been used widely in urology for about three decades to treat kidney calculi. Technical development to improve performance (i.e., stone fragmentation efficiency) is continuous. Low-pressure wide-focus lithotripters have already achieved promising results. In this study, the lithotripter field and profile of lithotripter shock waves were changed simultaneously using a cost-effective and convenient design. An intact parabolic reflector was split into four pieces, and each part was moved individually. By shifting the split reflectors, the focused acoustic beams were separated. As a result, the beam width in the focal region could be increased. Both numerical models of wave propagation using a k-wave approach and hydrophone measurements showed similar pressure waveforms at the focus and the distributions along and transverse to the lithotripter axis. The increase of the shifting distance from 0 mm to 7 mm resulted in the increase of -6 dB beam width from 7.1 mm to 13.9 mm and location of tensile peak on axis moving from z = -14 mm to 1 mm. The Lithotripters at 10 kV (intact reflector) and at 12 kV with the split reflectors shifted by 5 mm were compared with each other because of their similar peak positive pressures at the focus (8.07 MPa ± 0.05 MPa vs. 7.90 MPa ± 0.11 MPa, respectively). However, there were significant differences in their positive beam width (8.7 mm vs. 10.2 mm), peak negative pressure (-6.34 MPa ± 0.04 MPa vs. -7.13 MPa ± 0.13 MPa), the maximum tensile stress (7.55 MPa vs. 8.95 MPa) and shear stress (6.1 MPa vs. 7.76 MPa) in a 10-mm diameter spherical stone and bubble collapse time (127.6 μs ± 5.4 μs vs. 212.7 μs ± 8.2 μs). As a result, stone fragmentation efficiency was enhanced about 1.8-fold (57.9% ± 4.6% vs. 32.2% ± 5.6%, p < 0.05) when shifting the split reflectors. These results suggest that this new reflector design could change the characteristics of

  19. Application of Underwater Shock Wave Focusing to the Development of Extracorporeal Shock Wave Lithotripsy

    NASA Astrophysics Data System (ADS)

    Takayama, Kazuyoshi

    1993-05-01

    This paper describes a summary of a research project for the development of extracorporeal shock wave lithotripsy (ESWL), which has been carried out, under close collaboration between the Shock Wave Research Center of Tohoku University and the School of Medicine, Tohoku University. The ESWL is a noninvasive clinical treatment of disintegrating human calculi and one of the most peaceful applications of shock waves. Underwater spherical shock waves were generated by explosion of microexplosives. Characteristics of the underwater shock waves and of ultrasound focusing were studied by means of holographic interferometric flow visualization and polyvinyliden-difluoride (PVDF) pressure transducers. These focused pressures, when applied to clinical treatments, could effectively and noninvasively disintegrate urinary tract stones or gallbladder stones. However, despite clincal success, tissue damage occurs during ESWL treatments, and the possible mechanism of tissue damage is briefly described.

  20. [Shock wave lithotripsy, retrograde intrarenal surgery or percutaneous nephrolithotomy for lower pole renal stones?].

    PubMed

    Rojas, Alejandro; Gallegos, Héctor; Salvadó, José A

    2015-09-09

    Among the therapeutic alternatives available for the treatment of lower pole renal calculi are extracorporeal lithotripsy, percutaneous nephrolithotomy and retrograde intrarenal surgery. There is controversy about which of these techniques is more effective, especially for stones smaller than 20 mm. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified four systematic reviews including 11 pertinent randomized controlled trials overall. We combined the evidence and generated a summary of findings following the GRADE approach. We concluded percutaneous nephrolithotomy probably increases success rate, but it is not clear if it decreases the need of retreatment compared to extracorporeal shock wave lithotripsy. In comparison to retrograde intrarenal surgery, it may increase success rate, but it is not clear if it decreases the need of retreatment. Retrograde intrarenal surgery may increase success rate, and probably decreases need of retreatment compared to extracorporeal shock wave lithotripsy.

  1. Evaluation of long-term side effects after shock-wave lithotripsy for renal calculi using a third generation electromagnetic lithotripter.

    PubMed

    Pirola, Giacomo Maria; Micali, Salvatore; Sighinolfi, Maria Chiara; Martorana, Eugenio; Territo, Angelo; Puliatti, Stefano; Bianchi, Giampaolo

    2016-10-01

    To assess the incidence of long-term side effects after shock-wave lithotripsy treatment performed with an electromagnetic Dornier Lithotripter S device. A specific follow-up was undertaken on a cohort of 100 selected patients that underwent SWL for a single renal stone in our center from 2002 to 2004. Previous and current data were compared using the Student t test. Factors associated with the incidence of hypertension and diabetes mellitus were determined. Ten years after treatment, mean serum creatinine level and glomerular filtration rate remained similar to previous values (serum creatinine level: 0.96 ± 0.22 vs. 0.92 ± 0.19 mg/dL; glomerular filtration rate: 92.8 ± 17.8 vs. 88.1 ± 21.7 mL/min). There were marked increases in blood cholesterol, blood pressure, and blood glucose levels, while smoking decreased. Age, glomerular filtration rate, body mass index, blood glucose and blood pressure at the time of treatment were significantly associated with the presence of hypertension and diabetes mellitus at follow-up; blood cholesterol was associated with diabetes mellitus development. After 10 years, overall renal function appeared to have been unaffected by shock-wave lithotripsy treatment. The increased rate of hypertension and diabetes mellitus were consistent with the incidence in the global population. This is the first report on the long-term safety of a third generation electromagnetic lithotripter, and indicates that there are no long-term sequelae.

  2. Evaluation of long-term side effects after shock-wave lithotripsy for renal calculi using a third generation electromagnetic lithotripter.

    PubMed

    Pirola, Giacomo Maria; Micali, Salvatore; Sighinolfi, Maria Chiara; Martorana, Eugenio; Territo, Angelo; Puliatti, Stefano; Bianchi, Giampaolo

    2016-10-01

    To assess the incidence of long-term side effects after shock-wave lithotripsy treatment performed with an electromagnetic Dornier Lithotripter S device. A specific follow-up was undertaken on a cohort of 100 selected patients that underwent SWL for a single renal stone in our center from 2002 to 2004. Previous and current data were compared using the Student t test. Factors associated with the incidence of hypertension and diabetes mellitus were determined. Ten years after treatment, mean serum creatinine level and glomerular filtration rate remained similar to previous values (serum creatinine level: 0.96 ± 0.22 vs. 0.92 ± 0.19 mg/dL; glomerular filtration rate: 92.8 ± 17.8 vs. 88.1 ± 21.7 mL/min). There were marked increases in blood cholesterol, blood pressure, and blood glucose levels, while smoking decreased. Age, glomerular filtration rate, body mass index, blood glucose and blood pressure at the time of treatment were significantly associated with the presence of hypertension and diabetes mellitus at follow-up; blood cholesterol was associated with diabetes mellitus development. After 10 years, overall renal function appeared to have been unaffected by shock-wave lithotripsy treatment. The increased rate of hypertension and diabetes mellitus were consistent with the incidence in the global population. This is the first report on the long-term safety of a third generation electromagnetic lithotripter, and indicates that there are no long-term sequelae. PMID:26968731

  3. Treatment of Renal Calculi with Extracorporeal Shock Wave Lithotripsy: How applications of this method have expanded.

    PubMed

    Eberwein, P M; Denstedt, J D

    1992-07-01

    In 12 years, extracorporeal shock wave lithotripsy has replaced other treatment techniques for most surgical calculi in the upper urinary tract. Worldwide clinical series have documented its efficacy. Technological advances and modifications have significantly expanded the clinical applications of this technique.

  4. Extracorporeal shockwave lithotripsy for kidney stone on surgical clip.

    PubMed

    Clark, J Y; Kearse, W S

    1997-04-01

    We report the successful use of extracorporeal shockwave lithotripsy for the destruction of a renal stone that had formed around a surgical clip. The SWL led to passage of both the stone and the clip.

  5. [Pain-free piezoelectric extracorporeal shock wave lithotripsy in gallbladder stones. Initial experiences].

    PubMed

    Ackermann, C; Meyer, B; Rothenbühler, J M; Beglinger, C; Stalder, G A; Harder, F

    1989-05-27

    Efficacy and side effects of lithotripsy of gallbladder stones with a piezoelectric lithotriptor are assessed. 16 treatments were performed in 8 patients (1-3 per patient). Patients required no premedication, analgesia, infusion or monitoring. Gallstone fragmentation was achieved with all treatments. Laboratory findings remained unchanged after treatment, with the exception of one patient with mild pancreatitis. With adjuvant oral bile acid treatment, 6 of the 8 patients were stone-free within 3 days to 3 months. Extracorporeal shockwave lithotripsy with piezoelectric shock waves provides painless and efficient gallstone fragmentation. Repeated treatments may speed complete fragment dissolution.

  6. Ureteroscopic lithotripsy.

    PubMed

    Grasso, M

    1999-07-01

    The indications for ureteroscopic lithotripsy have increased with endoscope miniaturization and powerful, precise endoscopic lithotrites like the holmium: yttrium-aluminum-garnet laser. Successful ureteropyeloscopic treatment with the currently available instrumentation and techniques is independent of the size, composition, and location of stones in the upper urinary tract. Extracorporeal shockwave lithotripsy maintains a major role in treating uncomplicated, moderately sized upper urinary tract calculi. Complex upper urinary tract calculi, however, are best treated endoscopically. In addition, the endoscopic treatment of ureteral calculi is efficacious and definitive, albeit more invasive than extracorporeal shock wave lithotripsy.

  7. Management of urinary tract calculi by extracorporeal shock wave lithotripsy.

    PubMed

    Wadhwa, S N; Seth, A; Sood, R; Gupta, N P; Dogra, P N; Hemal, A K

    1994-02-01

    From July 1989 to April 1993, Extracorporeal Shockwave Lithotripsy (ESWL) was performed on 642 patients, of which 21 were from the pediatric age group. All treatments were done on a second generation lithotriptor-Siemens Lithostar, which does not require any modification for positioning of children. Fragmentation was achieved in all the patients (100%). A complete stone free rate was achieved in 17/21 patients (80.9%). Three (14.3%) patients had insignificant residual fragments whereas 1 (4.8%) had a residual fragment approximately 4 mm in size. 5640 shocks were required on an average. We have used low energy shockwaves with good results. General anesthesia was required for lithotripsy in only one child. The average fluoro exposure time was 1.6 minutes. We conclude that ESWL is a safe and effective method for treating urinary tract calculi in children.

  8. Holographic interferometric observation of shock wave focusing to extracorporeal shock wave lithotripsy

    NASA Astrophysics Data System (ADS)

    Takayama, Kazuyoshi; Obara, Tetsuro; Onodera, Osamu

    1991-04-01

    Underwater shock wave focusing is successfully applied to disintegrate and remove kidney stones or gallbladder stones without using surgical operations. This treatment is one of the most peaceful applications ofshock waves and is named as the Extracorporeal Shock Wave Lithotripsy. Ajoint research project is going on between the Institute ofFluid Science, Tohoku University and the School ofMedicine, Tohoku University. The paper describes a result of the fundamental research on the underwater shock wave focusing applied to the ESWL. Quantitatively to visualize the underwater shock waves, various optical flow visualization techniques were successfully used such as holographic interferometry, and shadowgraphs combined with Ima-Con high speed camera. Double exposure holographic interferometric observation revealed the mechanism of generation, propagation and focusing of underwater shock waves. The result of the present research was already used to manufacture a prototype machine and it has already been applied successfully to ESWL crinical treatments. However, despite of success in the clinical treatments, important fundamental questions still remain unsolved, i.e., effects of underwater shock wave focusing on tissue damage during the treatment. Model experiments were conducted to clarify mechanism of the tissue damage associated with the ESWL. Shock-bubble interactions were found responsible to the tissue damage during the ESWL treatment. In order to interprete experimental findings and to predict shock wave behavior and high pressures, a numerical simulation was carried. The numerical results agreed with the experiments.

  9. Recent developments in SWL physics research.

    PubMed

    Zhong, P; Xi, X; Zhu, S; Cocks, F H; Preminger, G M

    1999-11-01

    Two projects in our laboratory highlight some recent developments in shockwave lithotripsy (SWL) physics research. In the first project, we developed a prototype of a piezoelectric annular array (PEAA) shockwave generator that can be retrofitted on a Dornier HM-3 lithotripter for active control of cavitation during SWL. The PEAA generator, operating at 15 kV, produces a peak positive pressure of approximately 8 MPa with a -6-dB beam diameter of 5 mm. The shockwave generated by the PEAA was used to control and force the collapse of cavitation bubbles induced by a laboratory electrohydraulic shockwave lithotripter with a truncated HM-3 reflector. With optimal time delay between the lithotripter pulse and the PEAA-generated shockwave, the collapse of cavitation bubbles near the stone surface could be intensified, and the resultant stone fragmentation in vitro could be significantly improved. In the second project, high-speed shadowgraph imaging was used to visualize the dynamics of lithotripter-induced bubble oscillation in a vascular phantom. Compared with the free bubble oscillation in water, the expansion of cavitation bubble(s) produced in silicone tubes and a 200-microm cellulose hollow fiber by either a Nortech EHL or a Dornier XL-1 lithotripter was found to be significantly constrained. Rupture of the cellulose hollow fiber was observed consistently after about 20 shocks from the XL-1 lithotripter at an output voltage of 20 kV. These results confirm experimentally that SWL-induced cavitation in vivo can be significantly constrained by the surrounding tissue, and large intraluminal bubble expansions could cause rupture of capillaries and small blood vessels.

  10. Comparing non contrast computerized tomography criteria versus dual X-ray absorptiometry as predictors of radio-opaque upper urinary tract stone fragmentation after electromagnetic shockwave lithotripsy.

    PubMed

    Hameed, Diaa A; Elgammal, Mohammed A; ElGanainy, Ehab O; Hageb, Adel; Mohammed, Khaled; El-Taher, Ahmed Mohamed; Mostafa, Mostafa Mohamed; Ahmed, Abdelfatah Ibrahim

    2013-11-01

    The objective of this study was to assess the value of dual X-ray absorptiometry (DXA) in comparison to non contrast computed tomography (NCCT) density as possible predictors of upper urinary tract stone disintegration by shock wave lithotripsy (SWL). This study included 100 consecutive patients, with solitary renal stone 0.5-2 cm or upper ureteral stone up to 1 cm. DXA to calculate stone mineral density (SMD) and stone mineral content (SMC) was done. NCCT was performed to measure Hounsfield units (HU). SWL was performed with an electromagnetic lithotripsy, plain X-ray documented disintegration after SWL. Successful treatment was defined as stone free or complete fragmentation after 1 or 2 sessions of SWL. The impact of patients age, sex, body mass index, stone laterality, location, volume, length, mean SMC and SMD, HU and Hounsfield density (HD), skin to stone distance (SSD) and number of shock waves were evaluated by univariate and multivariate analysis. Only 76 patients were available for follow-up. Success of disintegration was observed in 50 out of 76 patients (65.8 %). On multivariate analysis, SMC and number of shock wave were the significant independent factors affecting SWL outcome (p = 0.04 and p = 0.000, respectively). SMC as detected by DXA is a significant predictor of success of stone disintegration by SWL. SMC measured by DXA is more accurate than HU measured by CT. Patients with high stone mineral content (SMC greater than 0.65 g) should be directly offered another treatment option.

  11. The management of sialolithiasis in 2 children through use of extracorporeal shock wave lithotripsy.

    PubMed

    Escudier, M P; Drage, N A

    1999-07-01

    The management of salivary calculi in children may prove difficult for a number of reasons. Traditional investigations require ionizing radiation and in cases of sialography may be poorly tolerated. Similarly, any surgical treatment is likely to require general anesthesia and, in a number of cases, removal of the affected gland, which is associated with attendant risks. As an alternative, ultrasound and extracorporeal shock wave lithotripsy therapy offers low morbidity and outpatient procedures that are well tolerated, as illustrated by these 2 cases.

  12. Mechanisms of differing stone fragility in extracorporeal shockwave lithotripsy.

    PubMed

    Zhong, P; Preminger, G M

    1994-08-01

    Clinical experience with extracorporeal shockwave lithotripsy (SWL) has demonstrated significant variations in stone fragility. To understand the physical mechanisms of the differences, we quantitatively determined shockwave-stone interaction under clinically relevant SWL conditions for six stone compositions: calcium oxalate monohydrate (COM), struvite (MAPH), calcium apatite (CA), uric acid (UA), brushite, and cystine. We also characterized the acoustic and mechanical properties of the stones using ultrasound and microindentation techniques. Our results show that renal calculi have distinctly different acoustic and mechanical properties. Higher wave speed, Young's modulus, and fracture toughness were measured from COM and cystine stones, whereas lower values of the corresponding properties were found in CA and MAPH, and the values for brushite and UA stones were in between. Computer modeling of shockwave propagation revealed that under the same shockwave intensity, larger deformation was induced in CA and MAPH stones than in COM and cystine stones. In addition, multiple reflected tensile waves were predicted for stones with concentric layer structure, indicating their susceptibility to shockwave fragmentation. These findings elucidate the mechanisms of the differences in stone fragility observed clinically. Their implications to SWL are discussed.

  13. Does respiratory gating improve extracorporeal shockwave lithotripsy results?

    PubMed

    Sade, M; Guler, C; Esen, A A; Kirkali, Z

    1994-10-01

    The reliability and efficacy of extracorporeal shockwave lithotripsy (SWL) has been established in urinary stone disease. Its combination with respiratory gating might be a useful method to increase the effectiveness of treatment and reduce the number of shocks required. For this purpose, the results of SWL combined with respiratory gating were compared with those of SWL without gating. There was no difference in the stone-free rates of the two groups or in the complication rate. It is concluded that this method neither decreases the number of shockwaves needed nor increases the effectiveness of SWL.

  14. [Extracorporeal shock wave lithotripsy: the evolution of a revolution].

    PubMed

    Chaussy, C; Fuchs, G

    1989-05-01

    Extracorporeal shockwave lithotripsy has now been in clinical use for 8 years, and it has replaced other treatment techniques for the majority of surgical calculi in the upper urinary tract. For the first time it provides a completely noninvasive method for the treatment of renal and ureteral calculi. The current range of indications means that approximately 70% of nonselected urinary stone patients can be treated by this method, while 25% of the patients with more complex stones in the upper urinary tract can receive treatment with the lithotripter combined with endourological procedures. The clinical role of this method is determined by a high success rate and minimal complications. This has led to a rapid worldwide acceptance in the urological community, and up to now more than 1.5 million patients with urinary stone disease have been treated.

  15. Extracorporeal shock wave lithotripsy in the treatment of renal and ureteral stones.

    PubMed

    Torricelli, Fábio César Miranda; Danilovic, Alexandre; Vicentini, Fábio Carvalho; Marchini, Giovanni Scala; Srougi, Miguel; Mazzucchi, Eduardo

    2015-01-01

    The use of certain technical principles and the selection of favorable cases can optimize the results of extracorporeal shock wave lithotripsy (ESWL). The aim of this study is to review how ESWL works, its indications and contraindications, predictive factors for success, and its complications. A search was conducted on the Pubmed® database between January 1984 and October 2013 using "shock wave lithotripsy" and "stone" as key-words. Only articles with a high level of evidence, in English, and conducted in humans, such as clinical trials or review/meta-analysis, were included. To optimize the search for the ESWL results, several technical factors including type of lithotripsy device, energy and frequency of pulses, coupling of the patient to the lithotriptor, location of the calculus, and type of anesthesia should be taken into consideration. Other factors related to the patient, stone size and density, skin to stone distance, anatomy of the excretory path, and kidney anomalies are also important. Antibiotic prophylaxis is not necessary, and routine double J stent placement before the procedure is not routinely recommended. Alpha-blockers, particularly tamsulosin, are useful for stones >10mm. Minor complications may occur following ESWL, which generally respond well to clinical interventions. The relationship between ESWL and hypertension/diabetes is not well established. PMID:25909212

  16. Large stone clearance in 2-year-old child with staghorn and calyceal stones using SWL monotherapy.

    PubMed

    Mohamad Al-Ali, Badereddin; Pummer, Karl

    2012-01-01

    Treatment of pediatric urolithiasis requires a thorough metabolic and urological evaluation on an individual basis. The objective of our case report was to determine the efficiency and the role of shockwave lithotripsy (SWL) in the treatment of pediatric urolithiasis. In this case report we reported our own experience in the management of staghorn and calyceal stones in both kidneys with SWL. In our case, clearance of multiple staghorn stones and a calyceal stone was obtained without any complications after 7 sessions of SWL over 2 months.

  17. [Extracorporeal shockwave lithotripsy in cholelithiasis].

    PubMed

    POtashov, L V; Gadzhiev, Sh M

    1993-01-01

    The authors describe their experiences with using stroke-wave lithotripsy in 102 patients with cholelithiasis. Positive results were obtained in 68% of the patients. Indications to lithotripsy are formulated. A description of specific features of the method is given.

  18. Ultrasonography and biliary extracorporeal shock-wave lithotripsy.

    PubMed

    Jakobeit, C; Greiner, L

    1993-05-01

    The results of shock-wave treatment of gallbladder stones depend to a very high degree on the quality and expertise of ultrasonography applied before, during, and after shock-wave disintegration of the stones. Ultrasonography is decisive in evaluating the inclusion criteria; it is the method of choice for directing the shockwave energy at the stones and monitoring the disintegration process. It is the only diagnostic modality to really demonstrate the gallbladder being free from stones.

  19. Laser-induced shock-wave lithotripsy of canine urocystoliths and nephroliths

    NASA Astrophysics Data System (ADS)

    Woods, J. P.; Bartels, Kenneth E.; Stair, Ernest L.; Schafer, Steven A.; Nordquist, Robert E.

    1997-05-01

    Urolithiasis is a common disease affecting dogs which can sometimes be treated with dietary and medical protocols. In many cases, however, medical management cannot be employed because the dietary restrictions are contraindicated, effective medical dissolution protocols for the calculi (uroliths) do not exist, or obstruction by the calculi may result in deterioration of renal function during the time required for medical dissolution. At present, the management of medically untreatable calculi has been surgical removal which may result in temporary but dramatic decrease in renal function, irreversible loss of damaged nephrons, and significant risk, particularly for bilateral or recurrent nephroliths. An innovative technique for the removal of these uroliths would involve laser lithotripsy which transforms light energy into acoustical energy generating a shock wave sufficient to fragment stones (photoacoustic ablation). The laser is transmitted via quartz fibers which are small and flexible and can be used under direct vision through endoscopes resulting in effective fragmentation with little surrounding tissue damage. Lasers are becoming increasingly more utilized in veterinary medicine, in contrast to the limited availability of other non-invasive methods of treatment of nephroliths (i.e. extracorporeal shock-wave lithotripsy).

  20. Patient-controlled sedation and analgesia during SWL.

    PubMed

    Uyar, M; Uyar, M; Uğur, G; Bílge, S; Ozyar, B; Ozyurt, C

    1996-10-01

    Sixty unpremedicated outpatients undergoing elective extracorporeal shockwave lithotripsy (SWL) using a Dornier MPL 9000 lithotripter were randomly assigned to receive either propofol-alfentanil (PA group; N = 30) or midazolam-alfentanil (MA group; N = 30) by a patient-controlled analgesia (PCA) device for sedation and analgesia. Although pain intensity scores were lower after 20 minutes and sedation was more pronounced in the MA group, both drug regimens produced satisfactory sedation and analgesia and allowed the maximum number of shockwaves to be given. Alfentanil consumption was less in the MA group (P < 0.05). Both groups were hemodynamically stable. The patients in the MA group had slower ventilation rates, lower oxygen saturation, and higher end-tidal carbon dioxide levels. Use of MA was associated with more episodes of oxygen desaturation to < 90% (30% vs. 11%; P < 0.05). One patient in the PA group and three patients in the MA group developed bradypnea (< 10 breaths/min). Patient satisfaction was very high with the two sedative-analgesic techniques. Propofol and midazolam, when given in combination with alfentanil using a PCA pump, may provide safe, effective analgesia and sedation during lithotripsy. Patient-controlled sedation and analgesia may provide optimal conditions for SWL of urinary tract stones and is a useful alternative to other forms of anesthesia and analgesia.

  1. Disseminated tuberculosis after extracorporeal shock-wave lithotripsy in an AIDS patient presenting with urosepsis.

    PubMed

    Tourchi, Ali; Ebadi, Maryam; Hosseinzadeh, Alireza; Shabaninia, Mahsa

    2014-03-01

    Haematogenous dissemination of undiagnosed urinary tuberculosis after performing extracorporeal shock-wave lithotripsy (ESWL) is extremely rare. Herein, we report a 41-year-old male who presented with urosepsis to the emergency room; catheterization was performed and retention resolved. He had a tattoo on his left arm and a five-year history of intravenous drug use. Blood tests indicated anaemia, leukocytosis, elevated CRP and ESR and mild hyponatraemia; haematuria, moderate bacteriuria and 2+ proteinuria on urinanalysis were observed. Chest X-ray revealed lesions suggestive of miliary tuberculosis, which was confirmed by chest CT scan. Brain CT and MRI suggested brain involvement in the setting of tuberculosis. On further investigations, HIV infection and hepatitis C seropositivity were detected and the patient remained in a coma for five days with a Glasgow Coma Scale of 6/15. Finally, the diagnosis of haematogenous dissemination of tuberculosis following lithotripsy was established. Anti-tuberculosis and anti-retroviral therapy were prescribed and monthly follow-up visits were scheduled. In conclusion, in a patient diagnosed with ureterolithiasis, a thorough history and physical examination, with specific attention to HIV and tuberculosis predisposing factors, should be carried out and preoperative screening tests considering the possibility of urinary tuberculosis are required. Finally, if urinary tuberculosis is detected, ESWL must be postponed until after appropriate treatment of tuberculosis. PMID:23970650

  2. Development of a new diagnostic sensor for extra-corporeal shock-wave lithotripsy

    NASA Astrophysics Data System (ADS)

    Fedele, F.; Coleman, A. J.; Leighton, T. G.; White, P. R.; Hurrell, A. M.

    2004-01-01

    Extracorporeal shock-wave lithotripsy is the leading technique used in urology for the non-invasive treatment of kidney and ureteric stones. The stone is comminuted by thousands of ultrasound shocks, into fragments small enough to be naturally passed. Since the technique was introduced in the 1980 different generations of lithotripters have been developed. Nevertheless the alignment systems (x-ray, ultrasound) still have some limitations (indeed, the tighter focusing of newer lithotripter reduces the tolerance for misalignment) and there is no capability for on-line monitoring of the degree of fragmentation of the stone. There is 50% incidence of re-treatments, possibly due to these deficiencies. The objective of this research is to design a new passive acoustic sensor, exploiting the secondary acoustic emission generated during the treatment, which could be used as a diagnostic device for lithotripsy. With a passive cylindrical cavitation detector, developed by the National Physical Laboratory, it was possible to detect these emissions in a laboratory lithotripter, and it was shown that they contain information on the degree of stone fragmentation and stone location. This information could be used to perform the desired monitoring and to improve the stone targeting. In collaboration with Precision Acoustic Ltd, some clinical prototypes were developed and tested to verify the relevance of these preliminary results. Clinical results are presented.

  3. Short-term bioeffects of extracorporeal shockwave lithotripsy.

    PubMed

    Akdaş, A; Türkeri, L N; Ilker, Y; Simşek, F; Emerk, K

    1994-06-01

    Safety guidelines for shockwave delivery during extracorporeal shockwave lithotripsy (SWL) are not yet clear. Renal functions were assessed by using urinary N-acetyl-beta-D-glucosaminidase (NAG), lactate dehydrogenase (LDH), alanine aminotransferase (ALT; EC.2.6.1.2), aspartate aminotransferase (AST; EC. 2.6.1.1), and gamma-glutamyltransferase (GGT) as well as sodium, potassium, and calcium concentrations in respect to tubular functions after SWL with the Dornier MFL 5000 unit in 32 patients. In order to monitor glomerular function, we determined microalbuminuria. Transient glomerular and tubular damage occurs in SWL-treated kidneys. The minimum interval between two shockwave treatments should be at least 7 days.

  4. [Extracorporeal shock wave lithotripsy of urolithiasis in patients with urinary diversion].

    PubMed

    Vega Vega, A; García Alonso, D; Parra Muntaner, L; Sánchez Merino, J M; García Alonso, J

    2004-05-01

    We evaluate the efficacy of ESWL in the management of calculi in patients with urinary diversion. We treated 5 patients who suffered from urinary lithiasis after urinary diversion post cistectomy. We managed the patients with extracorporeal shock wave lithotripsy in monotherapy with a Siemens Lithostar Modularis device. Mean stone size (long axis) was 1.95 cm (range 1 to 3.5 cm). The mean shockwave number per session was 2.6 per patient. Stone free result was 100%. We conclude that ESWL technique can provide acceptable results in patients with urinary diversion and can be used as first choice treatment in these type of patients due to its minimal morbidity and excellent results, equivalent to those achieved in patients without urinary diversion.

  5. Histological and ultrastructural evaluation of extracorporeal shock wave lithotripsy-induced acute renal lesions: preliminary report.

    PubMed

    Rigatti, P; Colombo, R; Centemero, A; Francesca, F; Di Girolamo, V; Montorsi, F; Trabucchi, E

    1989-01-01

    Biopsy material taken from kidneys of 14 patients with renal stones before performing extracorporeal shock wave lithotripsy (ESWL) and an average of 15 days after was examined histologically and ultrastructurally. In the post-ESWL specimens, light microscopy revealed edema and extravasation of urine and blood into the interstitial spaces, blocking of cortical tubules by hemorrhagic streaks and widespread dilatation of the veins, with signs of endothelial destruction and partial organization of thrombi. By using the electron microscope, abnormalities of the endothelium and glomerular epithelium, hemosiderin accumulations in the tubular cells and small linear patches of fibrosis at the corticomedullary junction and in the cortical interstitial spaces were seen. This preliminary report indicates that renal damage can be shown soon after ESWL on histological and ultrastructural studies and that the lesions observed can be either reversible or permanent.

  6. Inertial cavitation and associated acoustic emission produced during electrohydraulic shock wave lithotripsy.

    PubMed

    Zhong, P; Cioanta, I; Cocks, F H; Preminger, G M

    1997-05-01

    The inertial cavitation and associated acoustic emission generated during electrohydraulic shock wave lithotripsy were studied using high-speed photography and acoustic pressure measurements. The dynamics of cavitation bubble clusters, induced in vitro by an experimental laboratory lithotripter, were recorded using a high-speed rotating drum camera at 20,000 frames/s. The acoustic emission, generated by the rapid initial expansion and subsequent violent collapse of the cavitation bubbles, was measured simultaneously using a 1-MHz focused hydrophone, The expansion duration of the cavitation bubble cluster was found to correlate closely with the time delay between the first two groups of pressure spikes in the acoustic emission signal. This correlation provides an essential physical basis to assess the inertial cavitation produced by a clinical Dornier HM-3 shock wave lithotripter, both in water and in renal parenchyma of a swine model. In the clinical output voltage range (16-24 kV), the expansion duration of the primary cavitation bubble cluster generated by the HM-3 lithotripter in water increases from 158 to 254 microseconds, whereas the corresponding values in renal parenchyma are much smaller and remain almost unchanged (from 71 to 72 microseconds). In contrast, subsequent oscillation of the bubble following its primary collapse is significantly prolonged (from 158-235 microseconds in water to 1364-1373 microseconds in renal parenchyma). These distinctive differences between lithotripsy-induced inertial cavitation in vitro and that in vivo are presumably due to the constraining effect of renal tissue on bubble expansion. PMID:9165740

  7. Lipid peroxidation induced by shockwave lithotripsy.

    PubMed

    Cohen, T D; Durrani, A F; Brown, S A; Ferraro, R; Preminger, G M

    1998-06-01

    To determine the relation between high-energy shockwaves (HESW) and the presence of lipid peroxidation produces, juvenile pigs were subjected to shockwave lithotripsy (SWL). After lithotripsy, both treated and control kidneys were analyzed, along with urine samples collected before, during, and after SWL. Thiobarbituric acid-reactive substance (TBARS) and lipid-conjugated diene (CD) concentrations, used as markers for membrane lipid peroxidation, were determined in the kidney and urine samples. Significantly increased mean TBARS concentrations (146%) were associated with homogenates of lithotripsy-treated kidneys, 77.8 +/- 14.4 (SD) mmol/g v the controls, 31.4 +/- 14.9 mmol/g. Lithotripsy induction of lipid peroxidation products in the cortex, the gross damage site, and the respective medulla were also examined. In HESW-treated cortex samples, increased TBARS concentrations were seen--75.0 +/- 21.3 mmol/g--compared with untreated controls-- 45.2+/- 5.6 mmol/g--while increased CD concentrations (168%) were observed in the medulla of HESW-treated samples. No significant differences were observed in TBARS or CD concentrations in urine samples from control or treated kidneys, yet specific lipid hydroperperoxides were detected in the urine of HESW-treated kidneys. We conclude that HESW lithotripsy of swine kidneys is associated with increased lipid peroxidation products that may cause further cellular damage. Lipid peroxidation induced by SWL may be one of several mechanisms that lead to other potential bioeffects. Finally, analysis of specific lipid hydroperoxides in the urine of HESW-treated kidneys may serve as a noninvasive marker of renal injury after clinical SWL.

  8. Redistribution of renal blood flow after SWL evaluated by Gd-DTPA-enhanced magnetic resonance imaging.

    PubMed

    Mostafavi, M R; Chavez, D R; Cannillo, J; Saltzman, B; Prasad, P V

    1998-02-01

    Extracorporeal shockwave lithotripsy (SWL) is currently accepted as an effective noninvasive treatment for a wide variety of urinary tract calculi. However, the bioeffects of high-energy shockwaves on renal parenchyma have yet to be fully elucidated. The objective of this study was to measure the acute changes in regional renal hemodynamics associated with SWL utilizing dynamic gadolinium-DTPA-enhanced magnetic resonance imaging (MRI). Seven patients who underwent SWL for renal calculi had an MRI study within 4 hours after the treatment. To assess renal hemodynamics, a bolus of Gd DTPA (0.03 mmol/kg) was administered, and dynamic contrast enhanced images was obtained. Regions of interest (ROI) were defined over the cortex and medulla to obtain signal intensity-v-time curves. The contralateral kidney in each patient was used as the control. The initial slope of the contrast-enhanced signal intensity-v-time curve was used as a measure of the perfusion index (PI). In six patients, perfusion imaging showed a consistent trend of decreased cortical flow (29+/-8%) and a concomitant increase in medullary flow (34+/-14%) in the region of the kidney that was targeted with SWL in six patients (86%). This study shows that renal hemodynamics are modified by SWL. We hypothesize that this change represents a shunting of flow from cortex to medulla in an attempt to prevent ischemia of the medulla.

  9. Incidence of urinary tract infection in patients without bacteriuria undergoing SWL: comparison of stone types.

    PubMed

    Dinçel, C; Ozdiler, E; Ozenci, H; Tazici, N; Koşar, A

    1998-02-01

    Extracorporeal shockwave lithotripsy (SWL) currently is accepted as the preferred treatment for most renal and upper ureteral calculi. However, little is known about the infection risks of SWL. In this study, the incidence and severity of urinary tract infection in 117 patients with renal calculi undergoing SWL were evaluated and the stone characteristics of those with and without infection were compared. The patients were followed clinically and bacteriologically 1 and 14 days after the procedure. Bacteriuria was noted in six patients within 24 hours after SWL. No bacteriuria was noted 2 weeks later. Of these patients, three were symptomatic (including dysuria, burning, and fever >38 degrees C). No patient was hospitalized. We found no significant correlation between the occurrence of bacteriuria and the number or size of the stones (P > 0.05), nor was there any correlation between bacteriuria and the stone-free rate or the location of the calculi (P > 0.05). However, there was a significantly higher risk of urinary tract infection in patients with struvite stones than in those with other types of stones (17.3% v 2.1%). In patients with infection stones, prophylactic antimicrobial chemotherapy is necessary even if bacteriuria is not present before SWL.

  10. Extracorporeal shock wave lithotripsy in children: experience using a mpl-9000 lithotriptor.

    PubMed

    Aksoy, Yilmaz; Ozbey, Isa; Atmaca, Ali Fuat; Polat, Ozkan

    2004-06-01

    Our objectives were to assess the value of extracorporeal shock wave lithotripsy (ESWL) in treating pediatric urolithiasis, and to determine the factors that may affect treatment success. Between January 1993 and August 2002, 129 children with upper urinary tract calculi (134 renoureteral units) were treated using a Dornier MPL-9000 lithotriptor. The series consisted of 77 boys and 52 girls with an age range from 20 months to 14 years (average age: 8.7 years). All ESWL procedures took place under general anaesthesia or sedation with ketamin or fentanyl. Under ultrasonic or fluoroscopic guidance, children were treated with a maximum 2,550 shocks at an average of 19.5 kV. Success was defined as the lack of any visible stone fragments on post-treatment radiological evaluation. The patients were assessed 3 months after ESWL treatment and the results were compared using chi(2)-tests to detect factors that might be associated with treatment success. There were 105 renal, 20 ureteral, four bilateral renal and one unilateral renal plus contralateral ureteral calculi. The mean sizes were 15.7 mm for pelvic, 17.8 mm for renal and 10.2 mm for ureteral stones. One or two lithotripsy sessions were sufficient in most cases (71.6%). In 15 (11.6%) patients, double J stents introduced before lithotripsy were left indwelling until all stone fragments were voided. Overall success rates were 89.5% for pelvic, 85.5% for renal and 75% for ureteral stones. Complications such as urinary tract infection, Steinstrasse and small subcapsular hematoma occurred in 19 (14.7%) patients. The only significant factor associated with the stone-free rate was the diameter of the stone ( P=0.022). This study confirmed that the stone-free rate is significantly influenced by stone size. Because children with stone disease are at risk for a longer period than adults, their cumulative likelihood of stone recurrences may be higher. Thus, we agree with other authorities that minimally invasive treatment, such

  11. An FDTD-based computer simulation platform for shock wave propagation in electrohydraulic lithotripsy.

    PubMed

    Yılmaz, Bülent; Çiftçi, Emre

    2013-06-01

    Extracorporeal Shock Wave Lithotripsy (ESWL) is based on disintegration of the kidney stone by delivering high-energy shock waves that are created outside the body and transmitted through the skin and body tissues. Nowadays high-energy shock waves are also used in orthopedic operations and investigated to be used in the treatment of myocardial infarction and cancer. Because of these new application areas novel lithotriptor designs are needed for different kinds of treatment strategies. In this study our aim was to develop a versatile computer simulation environment which would give the device designers working on various medical applications that use shock wave principle a substantial amount of flexibility while testing the effects of new parameters such as reflector size, material properties of the medium, water temperature, and different clinical scenarios. For this purpose, we created a finite-difference time-domain (FDTD)-based computational model in which most of the physical system parameters were defined as an input and/or as a variable in the simulations. We constructed a realistic computational model of a commercial electrohydraulic lithotriptor and optimized our simulation program using the results that were obtained by the manufacturer in an experimental setup. We, then, compared the simulation results with the results from an experimental setup in which oxygen level in water was varied. Finally, we studied the effects of changing the input parameters like ellipsoid size and material, temperature change in the wave propagation media, and shock wave source point misalignment. The simulation results were consistent with the experimental results and expected effects of variation in physical parameters of the system. The results of this study encourage further investigation and provide adequate evidence that the numerical modeling of a shock wave therapy system is feasible and can provide a practical means to test novel ideas in new device design procedures.

  12. Use of external shock-wave lithotripsy and adjuvant ursodiol for treatment of radiolucent gallstones. A national multicenter study.

    PubMed

    Burnett, D; Ertan, A; Jones, R; O'Leary, J P; Mackie, R; Robinson, J E; Salen, G; Stahlgren, L; Van Thiel, D H; Vassy, L

    1989-07-01

    A prospective multicenter trial was performed to evaluate the use of external shockwave lithotripsy (ESL) and adjuvant medical therapy for the treatment of gallstones. A Medstone STS lithotripter was used together with ursodiol. Two hundred twenty-three patients were treated under general anesthesia (75%) or with intravenous analgesia (25%). Initial treatments were on an inpatient basis, but as centers gained experience, outpatient treatments became more common. Stone fragmentation and clearance were greatest in patients with solitary gallstones less than 2 cm in diameter. In this group of patients, stone fragmentation occurred in 97% of patients, and the cumulative stone-free rates at three and six months were 54% and 90%, respectively. These results indicate that fragmentation of gallstones can be achieved by a dry shock-wave lithotripter and that stone clearance is induced more rapidly by external shock-wave lithotripsy and adjuvant ursodiol therapy than by ursodiol therapy alone.

  13. Tissue damage in kidney, adrenal glands and diaphragm following extracorporeal shock wave lithotripsy.

    PubMed

    Gecit, Ilhan; Kavak, Servet; Oguz, Elif Kaval; Pirincci, Necip; Günes, Mustafa; Kara, Mikail; Ceylan, Kadir; Kaba, Mehmet; Tanık, Serhat

    2014-10-01

    This study was designed to investigate whether exposure to short-term extracorporeal shock wave lithotripsy (ESWL) produces histologic changes or induces apoptosis in the kidney, adrenal glands or diaphragm muscle in rats. The effect of shock waves on the kidney of male Wistar rats (n = 12) was investigated in an experimental setting using a special ESWL device. Animals were killed at 72 h after the last ESWL, and the tissues were stained with an in situ Cell Death Detection Kit, Fluorescein. Microscopic examination was performed by fluorescent microscopy. Apoptotic cell deaths in the renal tissue were not observed in the control group under fluorescent microscopy. In the ESWL group, local apoptotic changes were observed in the kidney in the area where the shock wave was focused. The apoptotic cell deaths observed in the adrenal gland of the control group were similar to those observed in the ESWL groups, and apoptosis was occasionally observed around the capsular structure. Apoptotic cell deaths in the diaphragm muscle were infrequently observed in the control group. Apoptosis in the ESWL group was limited to the mesothelial cells. This study demonstrated that serious kidney, adrenal gland and diaphragm muscles damage occurred following ESWL, which necessitated the removal of the organ in the rat model. It is recognized that the ESWL complications related to the kidney, adrenal gland and diaphragm muscles are rare and may be managed conservatively.

  14. Treatment of cystine stones: combined approach using open pyelolithotomy, percutaneous pyelolithotripsy, extracorporeal shock wave lithotripsy and chemolysis.

    PubMed

    Aabech, J; Andersen, J T

    1993-01-01

    Treatment of cystine stones in the urinary tract can be difficult because of a high frequency of recurrence, resistance to Extracorporeal Shock Wave Lithotripsy (ESWL), difficulty in localization and access to peripheral stones during Percutaneous Nephrolithotripsy (PCNL), and the insufficient effect of oral chemolysis. We present two cases of urinary cystine calculi treated with a combination of pyelolithotomy, PCNL, ESWL and percutaneous irrigation chemolysis, using N-acetylcysteine and Tromethamine-E. PMID:8290924

  15. Suppressing bubble shielding effect in shock wave lithotripsy by low intensity pulsed ultrasound.

    PubMed

    Wang, Jen-Chieh; Zhou, Yufeng

    2015-01-01

    Extracorporeal shock wave lithotripsy (ESWL) has been used as an effective modality to fragment kidney calculi. Because of the bubble shielding effect in the pre-focal region, the acoustic energy delivered to the focus is reduced. Low pulse repetition frequency (PRF) will be applied to dissolve these bubbles for better stone comminution efficiency. In this study, low intensity pulsed ultrasound (LIPUS) beam was aligned perpendicular to the axis of a shock wave (SW) lithotripter at its focus. The light transmission was used to evaluate the compressive wave and cavitation induced by SWs without or with a combination of LIPUS for continuous sonication. It is found that bubble shielding effect becomes dominated with the SW exposure and has a greater significant effect on cavitation than compressive wave. Using the combined wave scheme, the improvement began at the 5th pulse and gradually increased. Suppression effect on bubble shielding is independent on the trigger delay, but increases with the acoustic intensity and pulse duration of LIPUS. The peak negative and integral area of light transmission signal, which present the compressive wave and cavitation respectively, using our strategy at PRF of 1 Hz are comparable to those using SW alone at PRF of 0.1 Hz. In addition, high-speed photography confirmed the bubble activities in both free field and close to a stone surface. Bubble motion in response to the acoustic radiation force by LIPUS was found to be the major mechanism of suppressing bubble shielding effect. There is a 2.6-fold increase in stone fragmentation efficiency after 1000 SWs at PRF of 1 Hz in combination with LIPUS. In summary, combination of SWs and LIPUS is an effective way of suppressing bubble shielding effect and, subsequently, improving cavitation at the focus for a better outcome.

  16. Shockwave lithotripsy: anecdotes and insights.

    PubMed

    Lingeman, James E; Kim, Samuel C; Kuo, Ramsay L; McAteer, James A; Evan, Andrew P

    2003-11-01

    Shockwave lithotripters have evolved considerably since the introduction of the Dornier HM3 machine 20 years ago. Although shockwave lithotripsy (SWL) remains the preferred treatment for the majority of symptomatic upper urinary-tract calculi, newer lithotripters are not as effective and may have a higher risk of side effects. Lack of progress in lithotripter evolution is attributable to inadequate understanding of how and why shockwaves produce effects on stone and tissue. Current knowledge suggests that stones fragment by the mechanisms of compression fracture, spallation, squeezing, and acoustic cavitation, while tissue damage from shockwaves is secondary to cavitation and non-cavitational forces such as sheer stress. It appears likely that most tissue damage from shockwaves is caused by cavitation. As the understanding of SWL matures, new lithotripter designs may emerge that truly represent an improvement on the original Dornier HM3 machine.

  17. [Treatment of patients with staghorn calculi by means of extracorporeal shock wave lithotripsy (ESWL)].

    PubMed

    Kato, H; Kinoshita, N; Onishi, T; Kurimoto, K; Tochigi, H; Kawamura, J

    1993-11-01

    Between August, 1987 and December, 1991, 84 patients with 87 staghorn calculi were treated mainly with extracorporeal shockwave lithotripsy (ESWL) using a Dornier HM-3 improved lithotriptor. Patients were 38 men (38 renal units, mean age 54.9 years) and 46 women (49 renal units, mean age 54.3 years). Staghorn calculi were divided into 2 types; 54 units of complete type (mean stone area 9.2 cm2) and 34 units of incomplete type (mean stone area 5.5 cm2). Patients with complete type were treated with 3.6 sessions and 7,779 shock waves on average and 31.6 days for hospitalization was required, while patients with incomplete type were treated with 2.4 sessions and 5,288 shock waves on average and 15.7 days for hospitalization was required. After treatment, the excellent rate was 47.2% for the complete type and 44.1% for the incomplete type. After the monotherapy of ESWL the excellent rate was 46.9% and after the combined therapy with percutaneous nephrolithotripsy (PNL) and/or percutaneous nephrostomy (PCN) it was 43.5%. We considered that the ESWL monotherapy for staghorn calculi was not feasible in patients with a large stone volume, with severe hydrocalices, with cystine stones and with so-called "complex staghorn calculi".

  18. Use of in situ extracorporeal shock wave lithotripsy in upper ureteric stone.

    PubMed

    Islam, M S; Rahman, S; Islam, M A; Ahmed, I; Maola, G; Uddin, M M

    2010-04-01

    This study was done to determine the effectiveness of in situ extracorporeal shock wave lithotripsy (ESWL) in upper ureteric calculi in terms of stone clearance, peroperative & postoperative complications and also to determine some criteria for selection of patients for this procedure. From July, 2003 to July 2004, a total of 67 patients, with excreting kidneys and having stone size less than 2 cm were treated by in situ ESWL using Lithostar plus Lithotriptor. The patient group comprised of 52 men and 15 women, age ranged from 14 years to 65 years. Of the total 67 patients selected for study 44 patients were included in group I, having stone size ?1.5 and visible distal flow of contrast on IVU & 23 patients were included in Group II with stone size>1.5 cm to 2 cm and contrast seen only upto stone. Four (04) patients from Group I and three (03) patients from group II were dropped out during the follow up period so that data of 40 patients in group I and 20 patients in group II were analyzed finally. Number of shock wave was given in 1 to 3 sessions. Finally 95% of group I and 85% of group II achieved complete clearance of calculi at the end of 3 sessions. In situ ESWL is a good option for the treatment of upper ureteric calculi.

  19. Intraductal shock-wave lithotripsy in complicated common bile duct stones.

    PubMed

    Riemann, J F; Kohler, B; Weber, J; Schlauch, D

    1992-02-01

    Intracorporeal shockwave lithotripsy was performed in 36 patients with problematic common bile duct stones. All of the patients had undergone unsuccessful mechanical lithotripsy prior to this procedure. In 29 patients (80.6%), the stones were fragmented under cholangioscopic control and subsequently extracted with a Dormia basket. In seven patients, the procedure failed due to stone impaction or failure to intubate the common bile duct with a nasobiliary tube. No complications were observed. Cholangioscopically guided intracorporeal shockwave lithotripsy is a highly effective and safe procedure for the conservative treatment of complicated common bile duct stones.

  20. Renal morphology and function immediately after extracorporeal shock-wave lithotripsy

    SciTech Connect

    Kaude, J.V.; Williams, C.M.; Millner, M.R.; Scott, K.N.; Finlayson, B.

    1985-08-01

    The acute effects of extracorporeal shock-wave lithotripsy (ESWL) on morphology and function of the kidney were evaluated by excretory urography, quantitative radionuclide renography (QRR), and magnetic resonance imaging (MRI) in 33 consecutive patients. Excretory urograms demonstrated an enlarged kidney in seven (18%) of 41 treatments and partial or complete obstruction of the ureter by stone fragments after 15 (37%) of 41 treatments. Total effective renal plasma flow (ERPF) was not changed after ESWL, but the percentage ERPF of the treated kidney was decreased by more than 5% in 10 (30%) of 33 cases. QRR images showed partial parenchymal obstruction in 10 (25%) of 41 teated kidneys and total parenchymal obstruction in 9 (22%). MRI disclosed one or more abnormalities in 24 (63%) of 38 treated kidneys. Treated kidneys were normal by all three imaging methods in 26% and abnormal by one or more tests in 74% of cases. The morphologic and functional changes are attributed to renal contusion resulting in edema and extravasation of urine and blood into the interstitial, subcapsular, and perirenal spaces.

  1. Treatment Protocols to Reduce Injury and Improve Stone Breakage in SWL

    NASA Astrophysics Data System (ADS)

    McAteer, James A.; Evan, Andrew P.; Connors, Bret A.; Pishchalnikov, Yuri A.; Williams, James C.; Lingeman, James E.

    2008-09-01

    Here we provide a capsule summary of key observations showing that adverse effects can be reduced and stone breakage outcomes can be improved by the choice of the treatment protocol used in SWL. The take home message is—technique in lithotripsy can be used to significant advantage. SW-rate is key, and so is the sequence of SW delivery. Patient studies have shown that stone breakage is significantly improved at 60SW/min compared to a rate of 120SW/min, and laboratory experiments with pigs show that acute SWL injury to the kidney can be reduced dramatically by further slowing the SW firing rate to 30SW/min. The sequence of SW administration has a profound effect on the kidney, and renal injury is significantly reduced when the treatment protocol incorporates a priming dose of SW's followed by a brief pause before treatment is resumed. Continued developments in lithotripsy technology are welcome and will hopefully lead to improved SWL systems. Current experience suggests, however, that technology is not a substitute for expert technique, and attention to the fundamentals of SW delivery is essential to achieve the best possible outcomes regardless of the lithotripter at hand.

  2. How painful are shockwave lithotripsy and endoscopic procedures performed at outpatient urology clinics?

    PubMed

    Jeong, Byong Chang; Park, Hyoung Keun; Kwak, Cheol; Oh, Seong-June; Kim, Hyeon Hoe

    2005-08-01

    Our aim was to investigate the subjective pain felt by patients during shockwave lithotripsy (SWL) and endoscopic procedures such as cystoscopy, retrograde ureteral stenting, retrograde pyelography (RGP), and ureteroscopic lithotripsy performed in an outpatient clinic, and to identify how severe pain during such procedures is. We estimated subjective pain in 984 patients after SWL (186), cystoscopy (489), retrograde ureteral stenting (127), RGP (97), and ureteroscopic lithotripsy (85) performed by a single expert in an outpatient clinic using a prospective questionnaire with a ten point visual analog scale between January 2001 and December 2003. There was no premedication in any procedure except ureteroscopic lithotripsy for which an intramuscular injection of analgesics (pethidine HCl 50 mg) was used. The pain scale score in SWL was 6.62+/-2.27, the highest among the procedures (P<0.05). Pain scores for endoscopies were 4.48+/-2.07 in retrograde ureteral stenting, 3.81+/-2.06 in ureteroscopic lithotripsy, 3.72+/-1.75 in RGP, and 3.08+/-1.95 in cystoscopy. In this study, we observed that patients feel most pain in SWL without anesthesia, and that pain during ureteroscopic lithotripsy under local anesthesia is not high, compared with other endoscopic procedures.

  3. Extracorporeal shockwave lithotripsy or percutaneous nephrolithotomy for lower pole nephrolithiasis?

    PubMed

    Cass, A S

    1996-02-01

    A controversy has arisen as to whether the initial form of therapy for lower pole nephrolithiasis should be extracorporeal shockwave lithotripsy (SWL) or percutaneous nephrolithotomy (PCNL). We reviewed our results with 968 single lower pole stones treated by SWL and reviewed publications comparing SWL and PCNL for lower pole nephrolithiasis. In our cases, the stone-free rate was 71.2%, the rate of repeat treatment and post-treatment secondary procedures was 6.4%, the complication rate was 0.5%, and the hospital stay was less than 24 hours in 99.3% of patients. In published series of PCNL for lower pole nephrolithiasis, the stone free rate was 70.5% to 100%, repeat treatment rates were 4% to 62.5%, the complication rates were 13% to 38%, and the hospital stay was 3.1 to 6.1 days. The rates of recurrent stone disease with PCNL were 11% to 22%, similar to the rates after SWL. The percentage of renal urolithiasis patients with lower pole calculi since we started our unit in late 1986 has remained essentially constant at 38%. Although the stone-free rate with PCNL is higher than with SWL, the lower complication rate, lower repeat treatment/secondary procedure rate, the shorter hospital stay, and the similar recurrent stone rate with SWL make SWL more clinically effective as the primary therapy for lower pole calculi less than 2 cm in diameter.

  4. Comparison of general anesthesia and intravenous sedation-analgesia for SWL.

    PubMed

    Zommick, J; Leveillee, R; Zabbo, A; Colasanto, L; Barrette, D

    1996-12-01

    We compared general anesthesia and intravenous sedation-analgesia for SWL on a Dornier HM3 lithotripter with respect to treatment and anesthesia time, X-ray exposure, shockwaves administered, and efficacy. The case records of 49 patients receiving general anesthesia and 118 patients who underwent intravenous sedation-analgesia were examined. Follow-up plain abdominal radiographs were evaluated for residual stones. Treatments accomplished under intravenous sedation-analgesia required less anesthesia time and less SWL time. The amount of fluoroscopy time was increased. The success rate in treating patients with these two types of anesthesia was not significantly different. Intravenous sedation-analgesia is safe and effective for shockwave lithotripsy in the HM3 lithotripter. This technique facilitates more rapid outpatient treatment and has excellent patient tolerance.

  5. [Role of extracorporeal shock wave lithotripsy in the treatment of common bile duct and intrahepatic calculi].

    PubMed

    Dagenais, M; Lapointe, R; Déry, R; Gianfelice, D; Roy, A; Gagnon, J

    1995-01-01

    The management of intrahepatic and common bile duct stones has been modified by the advent of endoscopic sphincterotomy and percutaneous extraction through a T-tube tract or transhepatic access. Occasionally, nonoperative extraction is incomplete. The use of extracorporeal lithotripsy is reviewed in this setting. From May 1990 to February 1994, 18 patients (age 68.4 +/- 4.6 years) were treated by extracorporeal shockwave lithotripsy combined with endoscopic sphincterotomy and retrograde extraction or percutaneous approach. 72% of patients had previously undergone a cholecystectomy and 44% exploration of the common duct. Patients were submitted to 1.56 +/- 0.17 session of lithotripsy (5.546 +/- 701 shockwaves). Hospital stay was 19.5 +/- 3.3 days. After the lithotripsy, 1.17 +/- 0.19 endoscopic or percutaneous procedures per patient were necessary to clear the biliary tract. Seventy-eight percent of patients became stone-free. The five failures were treated by endobiliary prosthesis (n = 4) or cholecystectomy and bile duct exploration (n = 1). Lithotripsy in association with the usual therapeutic modalities contributes to clearing the bile duct from stones and avoids surgery in the majority of patients. A multidisciplinary approach is necessary in order to obtain those results.

  6. [Experience of extracorporeal shock-wave lithotripsy for the urolithiasis in horseshoe kidney].

    PubMed

    Ohyama, A; Asai, Y; Ameno, Y; Sakakura, T; Sugita, O; Kamizuru, M; Sakamoto, W; Nakatani, T; Kishimoto, T; Maekawa, M

    1991-12-01

    At Osaka City University, 1,987 patients with urolithiasis have been treated by extra-corporeal shockwave lithotripsy (ESWL) during a four-year period. We treated 5 patients with horseshoe kidney and the obtained results were analyzed retrospectively. Three of these patients, who had a solitary stone could successfully be treated by ESWL as monotherapy. One who had multiple stones required transurethral lithotripsy after ESWL due to stone-street. The remaining 1 patient who had undergone heminephrectomy developed perirenal hematoma after ESWL, which spontaneously disappeared without any specific treatment. We discuss the special care related to the use of ESWL in the horseshoe kidney.

  7. [Conservative treatment of severe renal trauma after extracorporeal shockwave lithotripsy].

    PubMed

    Marchini, Giovanni Scala; Lopes, Roberto Iglesias; Bruschini, Homero; Torricelli, Fábio; Lopes, Roberto Nicomedes

    2011-01-01

    Subcapsular and perinephric hematomas are relatively common after shock-wave lithotripsy, but high-grade kidney injuries are extremely rare. We present the first case of a high-grade kidney injury after shock-wave lithotripsy managed conservatively. A 57-year-old white female patient with left 1.5cm superior ureteral calculi was submitted to shock-wave lithotripsy.

  8. Extracorporeal Shock Wave Lithotripsy for Management of Residual Stones after Ureterolithotripsy versus Mini-Percutaneous Nephrolithotomy: A Retrospective Study

    PubMed Central

    Huang, Zhichao; Zhao, Xiaokun; Zhang, Lei; Zhong, Zhaohui; Xu, Ran; Zhang, Lianping

    2013-01-01

    Purpose To compare the efficacy of extracorporeal shock wave lithotripsy in managing residual stones after ureterolithotripsy and mini-percutaneous nephrolithotomy. Materials and Methods A retrospective study was carried out of 71 patients with proximal urinary tract stones (greater than 10 mm) who underwent ureterolithotripsy or mini-percutaneous nephrolithotomy at a single institution from 2009 to 2011. The 71 patients were divided into two groups: group I (n = 37) comprised patients who underwent ureterolithotripsy, and group II (n = 34) comprised patients who underwent mini-percutaneous nephrolithotomy. Clinical characteristics, stone-free rates, stone demographics, and complications were evaluated. Results The overall stone-free rate was 90.1%. The stone-free rates in groups I and II were 97.3% and 82.4%, respectively. There was a statistically significant difference in the stone-free rates between groups I and II (P = 0.035). Neither serious intraoperative nor postoperative complications were observed. No significant difference in complications was observed between the two groups (P = 0.472). Conclusions The results of our study suggest that extracorporeal shock wave lithotripsy is an effective and safe auxiliary procedure for managing residual stones after primary endoscopic surgery. This procedure is associated with a satisfactory stone-free rate and a low complication rate, particularly for residual stones after ureteroscopic procedures. PMID:23785516

  9. [The application of extracorporeal shock-wave lithotripsy in the treatment of choledocholithiasis].

    PubMed

    Nichitaĭlo, M E; Ogorodnik, P V; Goĭda, S M; Diachenko, V V; Goĭda, M S; Sobchinskiĭ, S A; Voĭtseshin, V V; Gul'ko, O N

    2001-10-01

    The method of extracorporal shockwave biliary lithotripsy was introduced in the clinic since 1993 yr in patients with residual choledocholithiasis. The method was applied in 25 patients. Cholecystectomy with external drainage of common biliary duct was performed in all patients beforehand. Positive result was noted in 16 observations. All patients are alive.

  10. Part I. Mechanisms of injury associated with extracorporeal shock wave lithotripsy; Part II. Exsolution of volatiles

    NASA Astrophysics Data System (ADS)

    Howard, Danny Dwayne

    Part I - Shock waves are focused in extracorporeal shock wave lithotripsy (ESWL) machines to strengths sufficient to fracture kidney stones. Substantial side effects-most of them acute-have resulted from this procedure, including injury to soft tissue. The focusing of shock waves through various layers of tissue is a complex process which stimulates many bio-mechano-chemical responses.This thesis presents results of an in vitro study of the initial mechanical stimulus. Planar nitrocellulose membranes of order 10 um thick were used as models of thin tissue structures. Two modes of failure were recorded: Failure due to cavitation collapsing on or near the membranes, and failure induced by altering the structure of shock waves. Tests were done in water at and around F2 to characterize the extent of cavitation damage, and was found to be confined within the focal region, 1.2 cm along the axis of focus.Scattering media were used to simulate the effects of acoustic nonuniformity of tissue and to alter the structure of focusing shock waves. 40 um diameter (average) hollow glass spheres were added to ethylene glycol, glycerine and castor oil to vary the properties of the scattering media. Multiple layer samples of various types of phantom tissue were tested in degassed castor oil to gauge the validity of the scattering media. The scattering media and tissue samples increased the rise time decreased strain rate in a similar fashion. Membranes were damaged by the decreased strain rate and accumulated effects of the altered structure: After about 20 or so shocks immersed in the scattering media and after about 100 shocks behind the tissue samples. The mode of failure was tearing with multiple tears in some cases from about .1 cm to about 3 cm depending of the number of shocks and membrane thickness.Part II - This work examines the exsolution of volatiles-carbon dioxide from water-in a cylindrical test cell under different pressure conditions. Water was supersaturated with

  11. High frequency jet ventilation through a supraglottic airway device: a case series of patients undergoing extra-corporeal shock wave lithotripsy.

    PubMed

    Canty, D J; Dhara, S S

    2009-12-01

    High frequency jet ventilation has been shown to be beneficial during extra-corporeal shock wave lithotripsy as it reduces urinary calculus movement which increases lithotripsy efficiency with better utilisation of shockwave energy and less patient exposure to tissue trauma. In all reports, sub-glottic high frequency jet ventilation was delivered through a tracheal tube or a jet catheter requiring paralysis and direct laryngoscopy. In this study, a simple method using supraglottic jet ventilation through a laryngeal mask attached to a circle absorber anaesthetic breathing system is described. The technique avoids the need for dense neuromuscular blockade for laryngoscopy and the potential complications associated with sub-glottic instrumentation and sub-glottic jet ventilation. The technique was successfully employed in a series of patients undergoing lithotripsy under general anaesthesia as an outpatient procedure.

  12. Comparison of Extracorporeal Shock Wave Lithotripsy for Urolithiasis Between Children and Adults: A Single Centre Study

    PubMed Central

    Assad, Salman; Rahat Aleman Bhatti, Joshua; Hasan, Aisha; Shabbir, Muhammad Usman; Akhter, Saeed

    2016-01-01

    Objective To retrospectively evaluate the effectiveness of extracorporeal shock wave lithotripsy (ESWL) for urolithiasis and compare the results between children and adults. Materials and methods From January 2011 to January 2015 (four years), ESWL was performed in 104 children and 300 adults for urolithiasis. MODULITH® SLX-F2 lithotripter (Storz Medical AG, Tägerwilen, Switzerland) equipment was used for ESWL. The stone-free rates, the number of ESWL sessions required, complication rates and ancillary procedures used were evaluated in a comparative manner. Results The mean age ± standard deviation (SD) of children was 7.84±4.22 years and of adults was a 40.22±1.57 years. Mean ± SD of the stone size was 1.28±61 cm in the adults while 1.08 ± 0.59 cm in the children. In adults, the complications included steinstrasse in six (1.98%) patients, fever in 15 (4.95%), hematuria in 19 (6.28%) and sepsis in six (1.98%) patients. In children, steinstrasse was observed in two (1.9%), mild fever in two (1.9%), hematuria in six (5.7%) and sepsis was seen in four (3.8%) patients. The overall complication rate in the adults and in the children, it was found to be 46/300 (15%) and in the children, it was seen to be 14/104 (13%). No statistical difference was found in post-ESWL complications between children and adults (P>0.05). Ancillary procedures including double J (DJ) stent were used in 13 (12.5%) children and 87 (29%) adults. There was a better stone clearance rate in children i.e. 79% as compared to 68% in adults (X2: P=0.036). Conclusion Children can achieve high stone-free rates after ESWL with a lower need for repeat ancillary procedures as compared to adults. However, there is a difference in the post-ESWL complications between these groups. PMID:27800291

  13. Shock wave-bubble interaction near soft and rigid boundaries during lithotripsy: numerical analysis by the improved ghost fluid method.

    PubMed

    Kobayashi, Kazumichi; Kodama, Tetsuya; Takahira, Hiroyuki

    2011-10-01

    In the case of extracorporeal shock wave lithotripsy (ESWL), a shock wave-bubble interaction inevitably occurs near the focusing point of stones, resulting in stone fragmentation and subsequent tissue damage. Because shock wave-bubble interactions are high-speed phenomena occurring in tissue consisting of various media with different acoustic impedance values, numerical analysis is an effective method for elucidating the mechanism of these interactions. However, the mechanism has not been examined in detail because, at present, numerical simulations capable of incorporating the acoustic impedance of various tissues do not exist. Here, we show that the improved ghost fluid method (IGFM) can treat shock wave-bubble interactions in various media. Nonspherical bubble collapse near a rigid or soft tissue boundary (stone, liver, gelatin and fat) was analyzed. The reflection wave of an incident shock wave at a tissue boundary was the primary cause for the acceleration or deceleration of bubble collapse. The impulse that was obtained from the temporal evolution of pressure created by the bubble collapse increased the downward velocity of the boundary and caused subsequent boundary deformation. Results of this study showed that the IGFM is a useful method for analyzing the shock wave-bubble interaction near various tissues with different acoustic impedance. PMID:21918295

  14. Shock wave-bubble interaction near soft and rigid boundaries during lithotripsy: numerical analysis by the improved ghost fluid method.

    PubMed

    Kobayashi, Kazumichi; Kodama, Tetsuya; Takahira, Hiroyuki

    2011-10-01

    In the case of extracorporeal shock wave lithotripsy (ESWL), a shock wave-bubble interaction inevitably occurs near the focusing point of stones, resulting in stone fragmentation and subsequent tissue damage. Because shock wave-bubble interactions are high-speed phenomena occurring in tissue consisting of various media with different acoustic impedance values, numerical analysis is an effective method for elucidating the mechanism of these interactions. However, the mechanism has not been examined in detail because, at present, numerical simulations capable of incorporating the acoustic impedance of various tissues do not exist. Here, we show that the improved ghost fluid method (IGFM) can treat shock wave-bubble interactions in various media. Nonspherical bubble collapse near a rigid or soft tissue boundary (stone, liver, gelatin and fat) was analyzed. The reflection wave of an incident shock wave at a tissue boundary was the primary cause for the acceleration or deceleration of bubble collapse. The impulse that was obtained from the temporal evolution of pressure created by the bubble collapse increased the downward velocity of the boundary and caused subsequent boundary deformation. Results of this study showed that the IGFM is a useful method for analyzing the shock wave-bubble interaction near various tissues with different acoustic impedance.

  15. [Extracorporeal shock wave lithotripsy of a deep calculus of the ureter].

    PubMed

    Miller, K; Bubeck, J R; Hautmann, R

    1987-01-01

    Until recently, extracorporeal shockwave lithotripsy (ESWL) was limited to ureteral calculi above the pelvic brim. A new positioning technique has now made it possible to use ESWL for stones in the lower ureter too. The overall success rate with 72 patients treated in our department from January through August 1986 was 91%. ESWL, as a noninvasive method, is preferable to invasive procedures for the treatment of distal ureteral calculi. This may lead to narrowing of the range of indications for ureteroscopy.

  16. Treatment of staghorn calculi by percutaneous nephrolithotomy and SWL: the Hotel Dieu de France experience.

    PubMed

    Merhej, S; Jabbour, M; Samaha, E; Chalouhi, E; Moukarzel, M; Khour, R; Chaiban, R

    1998-02-01

    To evaluate the combined approach of percutaneous nephrolithotomy (PCNL) and extracorporeal shockwave lithotripsy (SWL) in the treatment of staghorn calculi, we carried out a retrospective review of 101 patients. The stone surface area ranged from 654 to 3042 mm2 (1535 mm2 on average). During PCNL, a single access tract was used in 22 patients, a double tract in 65 patients, and a triple tract in 14 patients. A double-J stent was placed percutaneously in 62 patients. Extracorporeal lithotripsy was scheduled at the patient's convenience on an outpatient basis approximately 2 weeks after PCNL. The mean hospital stay was 4.4 days. The combined approach showed a stone-free rate of 67% on the initial evaluation, an insignificant residual fragment rate of 26%, and a residual stone rate of 7%. With a follow-up of 52 months on average, the global stone growth rate was 17%, being 4.4% only among the stone-free group and 27% among the group with insignificant residual fragments. The global transfusion rate was 10%. Percutaneous stone debulking combined with SWL on an outpatient basis is an efficient, minimally invasive treatment for staghorn renal calculi. Reducing the number of access tracts, using the flexible nephroscope liberally, and placing a double-J stent frequently after PCNL increases the stone-free rate while reducing the morbidity and hospital stay.

  17. Shockwave lithotripsy and pacemakers: experience with 20 cases.

    PubMed

    Albers, D D; Lybrand, F E; Axton, J C; Wendelken, J R

    1995-08-01

    Lithotripsy treatment of urinary tract calculi initially excluded patients with cardiac pacemakers. Continued research and clinical study of patient outcomes has promoted a change in that initial concept. The Oklahoma Lithotripsy Center has successfully treated 20 patients with various types of pacemakers. No significant cardiovascular events occurred during treatment. Patients should be evaluated before the procedure by a cardiologist, and dual-chamber pacemakers should be reprogrammed to the single-chamber mode. Patients who cannot tolerate this should not undergo SWL. Rate-responsive pacemakers should be programmed to the non-rate-responsive (VVI) mode. The pacemaker should be at least 5 cm from the blast path. With these precautions and careful monitoring, SWL can be performed safely in most patients with pacemakers.

  18. EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY AND ENDOSCOPIC URETERAL STENT PLACEMENT IN AN ASIAN SMALL-CLAWED OTTER (AONYX CINEREA) WITH NEPHROLITHIASIS.

    PubMed

    Wojick, Kimberlee B; Berent, Allyson C; Weisse, Chick W; Gamble, Kathryn C

    2015-06-01

    Urolithiasis is a significant disease concern in Asian small-clawed otters (Aonyx cinerea), with over 60% of captive animals affected. Bilateral ureteral stent placement, using endoscopic and fluoroscopic guidance, and extracorporeal shock wave lithotripsy (ESWL) were performed as salvage procedures in a 13-yr-old intact female Asian small-clawed otter following a 7-yr history of nephrolithiasis and progressive renal insufficiency. Following the procedure, radiographs revealed a slight shifting of urolith position, although a decrease in urolith mass was not observed. As a result of declining quality of life related to severe osteoarthritis, the otter was euthanized 5 wk after the procedure. While this treatment approach was unsuccessful in this case, the technique was clinically feasible, so ESWL and ureteral stent placement may remain a consideration for other individuals of this species presented earlier in the course of this disease. PMID:26056891

  19. Extracorporeal shockwave lithotripsy in pediatrics.

    PubMed

    D'Addessi, Alessandro; Bongiovanni, Luca; Sasso, Francesco; Gulino, Gaetano; Falabella, Roberto; Bassi, Pierfrancesco

    2008-01-01

    Since its introduction in 1980, extracorporeal shockwave lithotripsy (SWL) has become the first therapeutic option in most cases of upper-tract urolithiasis, and the technique has been used for pediatric renal stones since the first report of success in 1986. Lithotripter effectiveness depends on the power expressed at the focal point. Closely correlated with the power is the pain produced by the shockwaves. By reducing the dimensions of the focus, it becomes possible to treat the patient without anesthesia or analgesia but at the cost of a higher re-treatment rate. Older children often tolerate SWL under intravenous sedation, and minimal anesthesia is applicable for most patients treated with second- and third-generation lithotripters. Ureteral stenting before SWL has been controversial. Current data suggest that preoperative stent placement should be reserved for a few specific cases. Stone-free rates in pediatric SWL exceed 70% at 3 months, with the rate reaching 100% in many series. Even the low-birth-weight infant can be treated with a stone-free as high as 100%. How can one explain the good results? Possible explanations include the lesser length of the child's ureter, which partially compensates for the narrower lumen. Moreover, the pediatric ureter is more elastic and distensible, which facilitates passage of stone fragments and prevents impaction. Another factor is shockwave reproduction in the body: there is a 10% to 20% damping of shockwave energy as it travels through 6 cm of body tissue, so the small body volume of the child allows the shockwaves to be transmitted with little loss of energy. There are several concerns regarding the possible detrimental effect of shockwaves on growing kidneys. Various renal injures have been documented with all type of lithotripters. On the other hand, several studies have not shown adverse effects. In general, SWL is considered to be the method of choice for managing the majority of urinary stones in children of all

  20. Electrohydraulic lithotripsy of upper ureteral calculi with semirigid ureteroscope.

    PubMed

    Yang, S S; Hong, J S

    1996-02-01

    Forty-three patients with single ureteral calculi located above the pelvic brim were treated by electrohydraulic lithotripsy (EHL) using a semirigid mini-ureteroscope. Of the 43 calculi, 36 (84%) were fragmented in one procedure. Six calculi (14%) were pushed back to the renal pelvis and treated successfully by complementary extracorporeal shockwave lithotripsy (SWL). The total success rate of ureteroscopic manipulation thus was 98%. The operation time (mean 26.4 minutes) and postoperative hospital stay (mean 2.53 days) were relatively short. Complications were limited to four (9%) minor perforations of the ureter managed by internal stenting. Among these patients with complications, there were no significant ureteral strictures noted on excretory urography or ureteroscopic examination 1 to 3 months after ureterolithotripsy. The costs of ureteroscopy with EHL are lower than that of SWL or ureteroscopic lasertripsy. The total fees for ureteroscopy with EHL are about two thirds those for SWL in Taiwan. Despite the longer learning curve required for ureteroscopy, ureteroscopy associated with EHL is a cost-effective alternative for the treatment of upper ureteral calculi, especially when SWL is not readily available.

  1. [Clinical application of Modulith SL20 on extracorporeal shock wave lithotripsy for upper urinary tract calculi].

    PubMed

    Tanda, H; Kato, S; Ohnishi, S; Nakajima, H; Ujiie, T; Maruta, H

    1991-12-01

    Thirty-nine patients, 27 males and 12 females with renal and ureteral stones, were treated using the Modulith SL 20 between October 1990 and January 1991. Thirty-three of the 39 cases had a single session of extracorporeal shockwave lithotripsy (ESWL) and the other six cases had two sessions. The pulverization rate of ESWL by this device was 84.6%. According to the X-rays taken 21 days after ESWL, of the 37 cases, 14 (37.8%) were stone-free, 18 (48.7%) had residual sandy stones less than 4 mm in diameter, five (13.5%) had residual stone fragments larger than 4.1 mm in diameter, and two cases were not clear. Using the criterion of cases which can be expected to have spontaneous passage, in other words, residual stones less than 4 mm in diameter, lithotripsy with the Modulith SL 20 was regarded as "effective" in 32 of the 37 cases (86.5%). As side effects of this treatment, hematuria was observed for several days after ESWL in all patients, but not other serious complications were observed. Among the 37 cases in which the grade could be evaluated the evaluation for 24 (64.9%) was "useful" and that for 13 (35.1%) "useful to some extent". Therefore, ESWL was performed very successfully.

  2. Ulnar nerve neuropraxia after extracorporeal shock wave lithotripsy: a case report.

    PubMed

    Konczak, Clark R

    2005-03-01

    A case is presented that illustrates and discusses the clinical presentation, diagnosis and chiropractic management of a 50-year-old male presenting with a case of ulnar neuropraxia following extracorporal shockwave lithotripsy. Onset is believed to be due to the patient's arm position in full abduction and external rotation during the lithotripsy procedure. Motor abnormalities related to the ulnar nerve were noted in the absence of distinct sensory findings. Chiropractic treatment focused on relief of the patient's pain during the course of the condition. Treatment may have helped in the rapid and complete resolution of his symptoms in this case. Poor patient positioning on hard surfaces, for extended periods may place pressure on superficial nerves resulting in nerve injury. In this case, the outcome was excellent, with complete resolution of symptoms less than one week later. The prognosis for this type of neuropraxia is usually good with conservative management. The patient history and chronological clinical course strongly suggest a causal association between the patient's position during the procedure and the development of the ulnar neuropraxia.

  3. Outcome assessment of double-J stents during extracorporeal shockwave lithotripsy of small solitary renal calculi.

    PubMed

    Low, R K; Stoller, M L; Irby, P; Keeler, L; Elhilali, M

    1996-08-01

    The utility of indwelling double-J ureteral stents during extracorporeal shockwave lithotripsy (SWL) of renal calculi is ill defined. We evaluated 179 patients treated with SWL for small (< 20 mm in diameter) solitary renal calculi with (N = 27) or without (N = 152) indwelling ureteral stents. There was no significant difference in the stone-free rates at 1 month (both 52%) and 3 months (61% nonstented group v 67% stented group; P = 0.45) or in the retreatment rates (13.3% nonstented group v 14.8% stented group; P = 0.60). The incidence and severity of pain/renal colic were similar for the two treatment groups. There was minimal morbidity associated with SWL in either group. Placement of double-J stents for the purpose of improving stone-free rates, alleviating pain, or preventing ureteral obstruction in conjunction with SWL of solitary renal calculi < 20 mm in diameter is unnecessary.

  4. Extracorporeal shockwave lithotripsy in anomalous kidneys.

    PubMed

    Baltaci, S; Sarica, K; Ozdiler, E; Dinçel, C; Küpeli, S; Gögüş, O

    1994-06-01

    Traditionally, stones in anomalous kidneys have been removed by open or percutaneous surgery. Extracorporeal shockwave lithotripsy (SWL) with the Dornier MPL 9000 lithotripter was performed in seven patients with horseshoe kidneys, four with pelvic ectopic kidneys, and six with malrotated kidneys. Twelve patients (71%) needed repeated treatments. A total of 11 patients (65%) in all the groups were stone free, and four patients had asymptomatic residual fragments no more than 5 mm in diameter. In the remaining two patients, no sign of stone disintegration was observed, and they underwent open surgery. Extracorporeal lithotripsy is the treatment of choice for stones in horseshoe or malrotated kidneys but is not useful for stones in most pelvic kidneys.

  5. Shock-induced bubble jetting into a viscous fluid with application to tissue injury in shock-wave lithotripsy

    PubMed Central

    Freund, J. B.; Shukla, R. K.; Evan, A. P.

    2009-01-01

    Shock waves in liquids are known to cause spherical gas bubbles to rapidly collapse and form strong re-entrant jets in the direction of the propagating shock. The interaction of these jets with an adjacent viscous liquid is investigated using finite-volume simulation methods. This configuration serves as a model for tissue injury during shock-wave lithotripsy, a medical procedure to remove kidney stones. In this case, the viscous fluid provides a crude model for the tissue. It is found that for viscosities comparable to what might be expected in tissue, the jet that forms upon collapse of a small bubble fails to penetrate deeply into the viscous fluid “tissue.” A simple model reproduces the penetration distance versus viscosity observed in the simulations and leads to a phenomenological model for the spreading of injury with multiple shocks. For a reasonable selection of a single efficiency parameter, this model is able to reproduce in vivo observations of an apparent 1000-shock threshold before wide-spread tissue injury occurs in targeted kidneys and the approximate extent of this injury after a typical clinical dose of 2000 shock waves. PMID:19894850

  6. Combined short and long-delay tandem shock waves to improve shock wave lithotripsy according to the Gilmore-Akulichev theory.

    PubMed

    de Icaza-Herrera, Miguel; Fernández, Francisco; Loske, Achim M

    2015-04-01

    Extracorporeal shock wave lithotripsy is a common non-invasive treatment for urinary stones whose fragmentation is achieved mainly by acoustic cavitation and mechanical stress. A few years ago, in vitro and in vivo experimentation demonstrated that such fragmentation can be improved, without increasing tissue damage, by sending a second shock wave hundreds of microseconds after the previous wave. Later, numerical simulations revealed that if the second pulse had a longer full width at half maximum than a standard shock wave, cavitation could be enhanced significantly. On the other side, a theoretical study showed that stress inside the stone can be increased if two lithotripter shock waves hit the stone with a delay of only 20 μs. We used the Gilmore-Akulichev formulation to show that, in principle, both effects can be combined, that is, stress and cavitation could be increased using a pressure pulse with long full width at half maximum, which reaches the stone within hundreds of microseconds after two 20 μs-delayed initial shock waves. Implementing the suggested pressure profile into clinical devices could be feasible, especially with piezoelectric shock wave sources. PMID:25553714

  7. Combined short and long-delay tandem shock waves to improve shock wave lithotripsy according to the Gilmore-Akulichev theory.

    PubMed

    de Icaza-Herrera, Miguel; Fernández, Francisco; Loske, Achim M

    2015-04-01

    Extracorporeal shock wave lithotripsy is a common non-invasive treatment for urinary stones whose fragmentation is achieved mainly by acoustic cavitation and mechanical stress. A few years ago, in vitro and in vivo experimentation demonstrated that such fragmentation can be improved, without increasing tissue damage, by sending a second shock wave hundreds of microseconds after the previous wave. Later, numerical simulations revealed that if the second pulse had a longer full width at half maximum than a standard shock wave, cavitation could be enhanced significantly. On the other side, a theoretical study showed that stress inside the stone can be increased if two lithotripter shock waves hit the stone with a delay of only 20 μs. We used the Gilmore-Akulichev formulation to show that, in principle, both effects can be combined, that is, stress and cavitation could be increased using a pressure pulse with long full width at half maximum, which reaches the stone within hundreds of microseconds after two 20 μs-delayed initial shock waves. Implementing the suggested pressure profile into clinical devices could be feasible, especially with piezoelectric shock wave sources.

  8. When should one perform shockwave lithotripsy for lower caliceal stones?

    PubMed

    Ilker, Y; Tarcan, T; Akdas, A

    1995-12-01

    Extracorporal shockwave lithotripsy of lower caliceal stones is often unrewarding because of the difficulty of passing stone fragments. We report our results in SWL of lower pole stones in 219 patients and compare them with the results of SWL of middle (82 patients) and upper pole (85 patients) stones. The stone-free rate of SWL monotherapy was found to be 59%, 77%, and 64% in lower, middle, and upper caliceal stones, respectively. In lower pole stones, SWL was unsuccessful in 41% of the patients, of whom 9% had minimal residual asymptomatic stones (less than 4 mm in greatest diameter). In comparison with the results of percutaneous nephrolithotomy (PCN) of lower pole urolithiasis in the literature, SWL was unsuccessful in large stones, with stone-free rates of 13% and 0 when the stone size was 3 to 4.9 cm2 and > 5 cm2, respectively. A stone-free rate of 82% when the stone burden was < 1 cm2 is similar to the PCN results of other centers, suggesting that SWL may be the first choice of treatment in lower pole stones of this size. We achieved a stone-free rate of 59% when the stone size was between 1 and 3 cm2, which is lower than the stone-free rates of PCN in the literature. In spite of its lower stone-free rates, SWL, with its lower morbidity, may still be considered an acceptable treatment modality in this range of moderate stone burden, especially when there is a patient desire for conservative treatment.

  9. Electrohydraulic extracorporeal non-water bath shock-wave lithotripsy of gallstones: two years' experience.

    PubMed

    Frick, T W; Hoffmann, R; Schlumpf, R; Largiadèr, F

    1991-01-01

    A prospective study was performed to evaluate the effectiveness of extracorporeal shockwave lithotripsy (ESWL) using a non-water bath lithotripter in combination with oral chemolitholysis on gallstone clearance. Patients were treated without general anesthesia or parenteral analgesia. We treated 74 patients selected according to the widely accepted criteria. Only 2 patients could not be sufficiently treated because of pain. After a 2 year period, 24 (32%) patients showed complete stone clearance, 35 (47%) patients had residual fragments, 5 (7%) patients underwent cholecystectomy, 2 (3%) patients were lost to follow up, and 8 (11%) patients discontinued the treatment before fragment clearance. According to the life-table estimate, 77% of our patients with successful ESWL and uncomplicated oral chemolitholysis are stonefree after 1 year. We consider the major advantage of this nonsurgical treatment of gallstone disease is that general anesthesia or parenteral analgesia has become unnecessary.

  10. Experiences with extracorporeal shock wave lithotripsy in patients with a solitary kidney.

    PubMed

    Sarica, K; Köhle, R; Kunit, G; Frick, J

    1992-01-01

    Between March 1985 and January 1990, 43 patients with stones in solitary kidneys were treated by extracorporeal shockwave lithotripsy (ESWL) in our department. The most common cause of unilateral kidney absence was previously surgical removal of the kidney. The primary treatment modality was ESWL in all patients; the need for auxiliary procedures was higher than in general stone patients. Of the 43 patients 42 were available for control checkups after therapy, and these examinations revealed a stone-free rate of 85.7%. Of the patients 14.3% had asymptomatic lower calix fragments. All our patients showed a successful result 6 months after ESWL therapy. No loss of kidney was observed. Our results indicate that ESWL as an effective and safe method is also the therapy of choice for stone patients with solitary kidneys.

  11. Simulation of shock-induced bubble collapse with application to vascular injury in shockwave lithotripsy

    NASA Astrophysics Data System (ADS)

    Coralic, Vedran

    Shockwave lithotripsy is a noninvasive medical procedure wherein shockwaves are repeatedly focused at the location of kidney stones in order to pulverize them. Stone comminution is thought to be the product of two mechanisms: the propagation of stress waves within the stone and cavitation erosion. However, the latter mechanism has also been implicated in vascular injury. In the present work, shock-induced bubble collapse is studied in order to understand the role that it might play in inducing vascular injury. A high-order accurate, shock- and interface-capturing numerical scheme is developed to simulate the three-dimensional collapse of the bubble in both the free-field and inside a vessel phantom. The primary contributions of the numerical study are the characterization of the shock-bubble and shock-bubble-vessel interactions across a large parameter space that includes clinical shockwave lithotripsy pressure amplitudes, problem geometry and tissue viscoelasticity, and the subsequent correlation of these interactions to vascular injury. Specifically, measurements of the vessel wall pressures and displacements, as well as the finite strains in the fluid surrounding the bubble, are utilized with available experiments in tissue to evaluate damage potential. Estimates are made of the smallest injurious bubbles in the microvasculature during both the collapse and jetting phases of the bubble's life cycle. The present results suggest that bubbles larger than one micrometer in diameter could rupture blood vessels under clinical SWL conditions.

  12. Efficacy of Combined Endoscopic Lithotomy and Extracorporeal Shock Wave Lithotripsy, and Additional Electrohydraulic Lithotripsy Using the SpyGlass Direct Visualization System or X-Ray Guided EHL as Needed, for Pancreatic Lithiasis

    PubMed Central

    Ito, Ken; Igarashi, Yoshinori; Okano, Naoki; Mimura, Takahiko; Kishimoto, Yui; Hara, Seiichi; Takuma, Kensuke

    2014-01-01

    Introduction. To evaluate the efficacy of combined endoscopic lithotomy and extracorporeal shock wave lithotripsy (ESWL), and additional electrohydraulic lithotripsy (EHL) as needed, for the treatment of pancreatic duct stones, we retrospectively evaluated 98 patients with chronic pancreatitis and pancreatic lithiasis. Methods. For the management of main pancreatic duct (MPD) stones in 98 patients, we performed combined endoscopic treatment (ET)/ESWL therapy as the first treatment option. When combined ET/ESWL was unsuccessful, EHL with the SpyGlass Direct Visualization system or X-ray guided EHL was performed. Outpatient ESWL was reserved as one of the final treatment options. Results. Fragmentation was successful in 80 (81.6%) patients as follows: combined ET/ESWL: 67 cases; SpyGlass EHL: 4 cases; X-ray guided EHL: 3 cases; and outpatient ESWL: 6 cases. Successful outcome was obtained by combined ET/ESWL in 67 of the 98 patients (74.5%), by EHL in 7 of 14 patients (7.1%), and by outpatient ESWL in 6 of 6 patients (6.1%). Negotiating the guidewire through a severe MPD stricture was significantly associated with a higher rate of stone fragmentation (P = 0.0003). Conclusions. In cases where combined ET/ESWL was not successful for stone clearance, EHL using the SpyGlass system or X-ray guided EHL was effective in cases where the guidewire could be negotiated through the MPD stricture and it increased the fragmentation rate. PMID:24999474

  13. Gallstone lithotripsy: the Rotterdam experience.

    PubMed

    Plaisier, P W; van der Hul, R L; den Toom, R; Nijs, H G; Terpstra, O T; Bruining, H A

    1994-06-01

    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.

  14. Effect of extracorporeal shockwave lithotripsy on plasma and urine endothelin concentrations.

    PubMed

    Esen, A A; Gezer, S; Gemalmaz, A; Kirkali, G; Kirkali, Z

    1996-08-01

    Since the first reports of extracorporeal shockwave lithotripsy (SWL), there have been increasing numbers of articles in the literature documenting renal blood flow impairment and blood pressure elevation as complications. However, little is known about the pathophysiology and prevention of these complications. In this prospective study, the influence of high-energy shockwaves on plasma and urine endothelin concentrations was investigated in 20 patients with renal stones. The patients were randomly assigned to receive a calcium channel blocker, 10 mg of nitrendipine (Bypress; Bayer) (N = 10) 2 hours before SWL or no medication (control group; N = 10). Blood samples were taken just before and 1 minute after application of 3000 shocks. Urine samples were collected by ureteral catheters. The plasma endothelin-1 concentrations were significantly elevated after SWL in the control group (P = 0.003). On the other hand, nitrendipine significantly reduced plasma endothelin concentrations after SWL (P = 0.003). No significant change was observed in urine samples and blood pressure measurements. These results suggest that endothelin release after SWL may be a cause for lithotripsy-induced hemodynamic changes. Medical prevention with calcium channel blockers warrants further investigation.

  15. Immersion anesthesia for extracorporeal shock wave lithotripsy. Review of two hundred twenty treatments.

    PubMed

    London, R A; Kudlak, T; Riehle, R A

    1986-08-01

    Two hundred twenty extracorporeal shockwave lithotripsy (ESWL) treatments at the New York Hospital-Cornell Medical Center between September, 1984, and April, 1985, were reviewed with respect to anesthetic management. One hundred seventy-four treatments (79%) were performed under a regional anesthetic technique (RA), either with an indwelling epidural catheter (155 treatments), or with a single spinal injection (19 treatments). Forty-six treatments (21%) were performed under general anesthesia (GA). Ninety per cent of the patients were classified as ASA I or II. Hypotension during treatment, defined as blood pressure falls greater than 20 per cent of baseline mean arterial pressure, was recorded with 19.5 per cent of the regional anesthetic treatments (18.7% of the epidurals and 26.3% of the spinals) and 13.0 per cent of the general anesthetic treatments. Blood pressure falls were larger in the regional group than in the general group. The average recovery room stay was longer for the bupivacaine (0.25-0.5%) epidurals and the tetracaine (0.4%) spinals (252 min and 212.1 min, respectively) than for the lidocaine (1.5-2.0%) epidurals and the general anesthetics (101.7 min and 102.1 min, respectively). General anesthesia, with controlled ventilation, was advantageous in minimizing renal excursion and stone movement during treatment. Yet, in appropriately selected and sedated patients, regional anesthesia with continuous lidocaine epidural techniques was found to provide acceptable anesthesia for patients undergoing ESWL.

  16. Extracorporeal shock-wave lithotripsy with MPL9000 for the treatment of urinary stones in pediatric patients.

    PubMed

    Zanetti, G; Montanari, E; Guarneri, A; Seveso, M; Trinchieri, A; Rovera, F; Austoni, E; Pisani, E

    1993-12-01

    Extracorporeal shock-wave lithotripsy (ESWL) is now applied as the treatment of choice in most cases of urinary stones. Its acceptance in pediatry, however has been only gradual despite numerous positive studies. We report on fourteen young patients (mean age: 9.7 years) who were all treated by ESWL with the MPL9000 lithotriptor for renal stones. Each patient received an average of 1440 shocks with generator energy set at 14.4 Kv. Six of these patients required either analgosedation or anesthesia. No observable complications of treatment occurred. At one-month follow up, the kidneys of twelve patients were found to be stone-free, while two still presented fragments that could pass spontaneously. At three-month follow-up, thirteen patients were stone-free and a single patient retained some fragments. From this data we infer that ESWL with the MPL9000 lithotriptor may be used safety and efficiently to treat urolithiasis in younger patients. PMID:8312950

  17. Suppression of large intraluminal bubble expansion in shock wave lithotripsy without compromising stone comminution: Methodology and in vitro experiments

    NASA Astrophysics Data System (ADS)

    Zhong, Pei; Zhou, Yufeng

    2001-12-01

    rupture in shock wave lithotripsy.

  18. Role of sonography-guided lithotripsy in renal stone with angiomyolipoma.

    PubMed

    Parmar, Sameer; Desai, Samir

    2013-04-01

    Treatment of angiomyolipoma (AML) of kidney with stone has been challenging for urologists. We present our experience of treating the renal stone in the presence of AML with shockwave lithotripsy (SWL). Position of the patient with respect to the direction of the shockwaves and accurate knowledge of the dimension of the focal zone are critical aspects of SWL. Keeping the AML safely away from the focal zone at all times during the procedure is only possible by usage of real-time ultrasonography in lieu of fluoroscopy.

  19. Arguments for choosing extracorporeal shockwave lithotripsy for removal of urinary tract stones.

    PubMed

    Tiselius, Hans-Göran; Chaussy, Christian G

    2015-10-01

    At a time when there is an almost unlimited enthusiasm and preference among urologists for endoscopic stone removal, we have found it essential to meet some of the frequently presented arguments on why extracorporeal shockwave lithotripsy (SWL) should not be used. We have based our considerations in this brief article on our 30-35 years' experience with the non-invasive or least invasive technique that SWL represents. Stone disintegration, requirement of repeated treatment sessions, the concern of residual fragments, complications and economic aspects are some points that are discussed.

  20. Extracorporeal shock wave lithotripsy for pancreatic and large common bile duct stones.

    PubMed

    Tandan, Manu; Reddy, D Nageshwar

    2011-10-21

    Extraction of large pancreatic and common bile duct (CBD) calculi has always challenged the therapeutic endoscopist. Extracorporeal shockwave lithotripsy (ESWL) is an excellent tool for patients with large pancreatic and CBD calculi that are not amenable to routine endotherapy. Pancreatic calculi in the head and body are targeted by ESWL, with an aim to fragment them to < 3 mm diameter so that they can be extracted by subsequent endoscopic retrograde cholangiopancreatography (ERCP). In our experience, complete clearance of the pancreatic duct was achieved in 76% and partial clearance in 17% of 1006 patients. Short-term pain relief with reduction in the number of analgesics ingested was seen in 84% of these patients. For large CBD calculi, a nasobiliary tube is placed to help target the calculi, as well as bathe the calculi in saline - a simple maneuver which helps to facilitate fragmentation. The aim is to fragment calculi to < 5 mm size and clear the same during ERCP. Complete clearance of the CBD was achieved in 84.4% of and partial clearance in 12.3% of 283 patients. More than 90% of the patients with pancreatic and biliary calculi needed three or fewer sessions of ESWL with 5000 shocks being delivered at each session. The use of epidural anesthesia helped in reducing patient movement. This, together with the better focus achieved with newer third-generation lithotripters, prevents collateral tissue damage and minimizes the complications. Complications in our experience with nearly 1300 patients were minimal, and no extension of hospital stay was required. Similar rates of clearance of pancreatic and biliary calculi with minimal adverse effects have been reported from the centers where ESWL is performed regularly. In view of its high efficiency, non-invasive nature and low complication rates, ESWL can be offered as the first-line therapy for selected patients with large pancreatic and CBD calculi.

  1. The protective effects of the traditional Chinese herbs against renal damage induced by extracorporeal shock wave lithotripsy: a clinical study.

    PubMed

    Sheng, Binwu; He, Dalin; Zhao, Jun; Chen, Xingfa; Nan, Xunyi

    2011-04-01

    Extracorporeal shock wave lithotripsy (ESWL)-induced renal damage can occur as a result of multiple mechanisms. We have reported previously that Astragalus membranaceus, Salvia miltiorrhiza, a decoction of six drugs containing rhizoma Rehmanniae preparata and supplements of a few traditional Chinese medicinal herbs for invigorating the kidney and excreting calculus, have a protective effect on renal injury induced by high-energy shock waves (HESW) in rabbits. In this clinical study we further investigate the protective effects of these traditional Chinese herbs against renal damage induced by ESWL. Sixty consenting patients with renal calculus who underwent ESWL treatment were included and randomly assigned to the medication group or control group. Post-ESWL plasma nitric oxide (NO), endothelin-1 (ET-1), malondialdehyde (MDA), and serum tumor necrosis factor α (TNF-α) increased significantly in the controls (P < 0.05), while in the medication group, slightly but not significantly elevated levels of plasma ET-1, NO, and serum TNF-α were found. The difference between the groups was statistically significant (P < 0.05). The levels of superoxide dismutase (SOD) decreased gradually in the controls, reaching a trough 72 h after ESWL (P < 0.05), while in the treated group it was unchanged, and remained at a level higher versus the controls (P < 0.05). Plasma NO peaked twice by 72 h and at 1 week in the controls (P < 0.05). Urinary enzymes and β(2)-microglobulin increased significantly and peaked by 24 h and immediately after ESWL (P < 0.05). These values were greater in the controls, and the difference was statistically significant (P < 0.05). This study demonstrates that the preparations of traditional Chinese medicines for invigorating the kidney and excreting calculus can reduce renal tubular damage induced by ESWL, and can shorten the recovery time of renal tubules in human subjects. PMID:20607528

  2. Effectiveness of SWL for lower-pole caliceal nephrolithiasis: evaluation of 452 cases.

    PubMed

    Pacík, D; Hanák, T; Kumstát, P; Turjanica, M; Jelínek, P; Kladenský, J

    1997-10-01

    The authors report on the treatment of lower-pole caliceal nephrolithiasis with extracorporeal shockwave lithotripsy (SWL) using the Czech-made Medilit M-5 lithotripter. In 310 patients, they have performed 452 treatments and evaluated the results 3 months after the last session using plain radiographs and ultrasound examination. The effectiveness of treatment and the success rate of SWL decreased with increasing size of stones: with stones >20 mm, it declined to 30%. This poor success rate was attributable not only to the size of the concrement, but also to its location in a lower calix, which is unfavorable for the passage of fragments. For big lower-pole caliceal stones (>20 mm in the longest diameter), the authors recommend percutaneous nephrolithotomy as the primary management method, the effectiveness of which does not depend on the size of the stone. The success rate achieved in treating the lower-pole caliceal lithiasis using the Medilit M-5 machine was 61.3%, similar to that achieved with other lithotripters.

  3. Early detection of infected ureteral obstruction after SWL employing C-reactive protein.

    PubMed

    Wolff, J M; Boeckmann, W; Mattelaer, P; Krämer, U; Jakse, G

    1996-12-01

    Infection of the obstructed upper urinary tract is a severe complication of stone disease. Early detection and therapy is crucial to prevent septicemia. The authors investigated prospectively whether C-reactive protein (CRP) might act as a marker for the early detection of infected upper urinary tract obstruction. The serum concentration of CRP was compared with the classic markers of inflammation--white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and temperature--in the follow-up of 85 patients undergoing 173 extracorporeal shockwave lithotripsy (SWL) treatments. Post-SWL, 69% of the patients showed dilation of the upper tract on ultrasonography and 16.5% became symptomatic and required intervention. In this group, the mean CRP value was increased 18-fold, whereas the WBC count, ESR, and temperature were not markedly raised. In contrast, patients with no need for additional treatment showed no more than a 2-fold increase in CRP. C-Reactive protein seems to be a useful indicator for the early detection of infected upper urinary tract obstruction.

  4. Overview of shock waves in medicine

    NASA Astrophysics Data System (ADS)

    Cleveland, Robin O.

    2003-10-01

    A brief overview of three applications of shock waves is presented. Shock wave lithotripsy (SWL) has been in clinical use for more than 20 years. In the United States it is used to treat more than 80% of kidney stone cases and has wide acceptance with patients because it is a noninvasive procedure. Despite SWLs enormous success there is no agreement on how shock waves comminute stones. There is also a general acceptance that shock waves lead to trauma to the soft tissue of the kidney. Yet there has been little forward progress in developing lithotripters which provide comminution with less side-effects, indeed the original machine is still considered the gold standard. The last decade has seen the advent of new shock wave devices for treating principally musculoskeletal indications, such as plantar fasciitis, tennis elbow, and bone fractures that do not heal. This is referred to as shock wave therapy (SWT). The mechanisms by which SWT works are even less well understood than SWL and the consequences of bioeffects have also not been studied in detail. Shock waves have also been shown to be effective at enhancing drug delivery into cells and assisting with gene transfection. [Work partially supported by NIH.

  5. Effects of extracorporeal shockwave lithotripsy on urinary concentration of epidermal growth factor.

    PubMed

    Baltaci, S; Ozer, G; Soygür, T; Yaman, O; Sarica, K; Müftüoğlu, Y Z; Göğüş, O

    1996-12-01

    In a prospective study, we tried to determine whether extracorporeal shockwave lithotripsy (SWL) has any effect on urinary epidermal growth factor (EGF) concentrations and to investigate whether EGF can be used as a marker for detecting shockwave-induced impairment of distal tubular cells. A total of 12 patients with renal pelvic or caliceal stones < or = 2 cm undergoing anesthesia-free SWL without ancillary measures and a control group of 10 patients without any urologic symptoms were included in this study. The urinary concentrations of EGF were measured by radioimmunoassay before and 4 hours, 24 hours, and 7 days after SWL. Relative urinary EGF concentrations were expressed as the ratio of EGF to creatinine (ng/mL creatinine). The mean urinary EGF concentration (mean +/- standard error) in control subjects and patients with renal pelvic or caliceal stones before SWL was 23.90 +/- 3.15 ng/mL creatinine and 22.18 +/- 6.85 ng/mL creatinine, respectively (p > 0.05). In patients with stones, we found a decrease in urinary EGF concentration 4 hours, 24 hours, and 7 days after SWL. Indeed, 7 days after SWL, the EGF concentration was on average half of the original value, a biologically significant, although not statistically significant, decrease.

  6. Anesthetic management of patients receiving calculus therapy with a third-generation extracorporeal lithotripsy machine.

    PubMed

    Hosking, M P; Morris, S A; Klein, F A; Dobmeyer-Dittrich, C

    1997-10-01

    We reviewed the anesthetic requirements for satisfactory use of a third-generation electromagnetic-source design for extracorporeal shockwave lithotripsy (SWL). Medical records were reviewed for a period of 9 months on all patients receiving anesthesia care for SWL with and without other urologic procedures. The Modulith SL20 was used on 56 ASA Class I-III patients having 87 SWL treatments. Demographic and anesthetic variables were recorded. Complications documented included dysrhythmias, nausea necessitating treatment, and conversion from sedation to regional or general anesthesia. The majority of procedures (83%) were performed on an outpatient basis. Patients were classified as ASA physical status I (27%), II (63%), or III (10%). Monitored anesthesia care with intravenous sedation was utilized in 93% of cases. Of these cases, 78 involved a combination of intravenous propofol, fentanyl, and midazolam; the remaining 3 involved propofol, alfentanil, and/or midazolam. The mean treatment duration was 36 minutes. Patients were discharged within 1 hour after procedure completion in 77 cases (89%). Nausea necessitating treatment was rare (3%). The mean dose of propofol administered with SWL as the only procedure was 272 +/- 112 mg. When SWL was combined with other urologic procedures, the mean dose of propofol was 334 +/- 121 mg. Continuous intravenous propofol infusion provides excellent procedural conditions for SWL on the Modulith SL120, a third-generation lithotripter.

  7. [Extracorporeal shockwave lithotripsy of pancreatic calculi].

    PubMed

    Sauerbruch, T

    1990-05-01

    Using extracorporeal shock wave lithotripsy (ESWL) pancreatic stones may be disintegrated. Acute adverse effects directly attributably to shock wave lithotripsy are rare. More than half of the patients will exhibit complete clearance of the pancreatic duct system after ESWL, endoscopic sphincterotomy and extraction of fragments. Most of the patients in whom the ducts could be cleared from the stones also showed improvement of chronic pancreatic pain. These findings, however, have to be substantiated by larger clinical studies with longer follow-up periods.

  8. A Case of Septic Shock caused by Achromobacter xylosoxidans in an Immunocompetent Female Patient after Extracorporeal Shock Wave Lithotripsy for a Ureteral Stone

    PubMed Central

    Lee, So Yon; Park, In Young; Park, So Yeon; Lee, Jin Seo; Kang, Goeun; Kim, Jae Seok

    2016-01-01

    Achromobacter xylosoxidans can cause various types of infections, but its infection in humans is rare. A. xylosoxidans has been reported as a rare etiological agent of infections including primary bacteremia, catheter-related bloodstream infection, endocarditis, otitis, and pneumonia, particularly in immunocompromised hosts. We encountered a case of septic shock caused by A. xylosoxidans in a 52-year-old, immunocompetent woman with no underlying disease, who received extracorporeal shock wave lithotripsy to remove a left upper ureteral stone. She was treated with antibiotics to which the organism was susceptible but died as a result of septic shock. PMID:27104016

  9. Primary extracorporeal shockwave lithotripsy in management of large bladder calculi.

    PubMed

    Husain, I; el-Faqih, S R; Shamsuddin, A B; Atassi, R

    1994-06-01

    Large bladder calculi are often outside the range of treatment with conventional endoscopic lithotrites because of either anatomic factors or the mechanical limits of available instruments. Alternative methods of cystolithotripsy: ultrasonic, electrohydraulic, or laser, can prove time-consuming or even hazardous, so that open surgery is often the most expeditious option. We report our experience using Dornier HM3 extracorporeal shockwave lithotripsy (SWL) for initial bladder stone reduction preparatory to transurethral litholapaxy and definitive treatment of any underlying obstructive pathology. Primary cystolitholapaxy was judged impractical in these 24 patients (21 adults and 3 children) presenting 31 large bladder stones (mean size 35.6 mm). In all patients, primary transpelvic SWL was followed immediately by endoscopic evacuation of stone debris or cystolitholapaxy. In addition, 10 of the 24 patients (42%) underwent a definitive endoscopic operation for treatment of an underlying obstructive lesion at either the same or a follow-on session. Morbidity was minimal, and the mean hospital stay after the initial SWL treatment was 3.5 days. In our experience, Dornier SWL has proved invaluable in enabling cystolitholapaxy of very large bladder calculi that would otherwise require protracted and difficult endoscopic manipulation or open surgery.

  10. [The value of shockwave lithotripsy].

    PubMed

    Beglinger, C

    1994-03-26

    The standard treatment for symptomatic cholecystolithiasis remains surgery, the present method of choice being laparoscopic cholecystectomy. Noninvasive treatment options are available, but should be restricted to selected cases. Extracorporal shock wave lithotripsy (ESWL) is an alternative to noninvasive treatment, provided the patients are carefully selected. The main disadvantages include prolonged administration of gall salts and the problem of stone recurrence.

  11. [Research on Energy Distribution During Osteoarthritis Treatment Using Shock Wave Lithotripsy].

    PubMed

    Zhang, Shinian; Wang, Xiaofeng; Zhang, Dong

    2015-04-01

    Extracorporeal shock wave treatment is capable of providing a non-surgical and effective treatment modality for patients suffering from osteoarthritis. The major objective of current works is to investigate how the shock wave (SW) field would change if a bony structure exists in the path of the acoustic wave. Firstly, a model of finite element method (FEM) was developed based on Comsol software in the present study. Then, high-speed photography experiments were performed to record cavitation bubbles with the presence of mimic bone. On the basis of comparing experimental with simulated results, the effectiveness of FEM model could be verified. Finally, the energy distribution during extracorporeal shock wave treatment was predicted. The results showed that the shock wave field was deflected with the presence of bony structure and varying deflection angles could be observed as the bone shifted up in the z-direction relative to shock wave geometric focus. Combining MRI/CT scans to FEM modeling is helpful for better standardizing the treatment dosage and optimizing treatment protocols in the clinic. PMID:26211244

  12. [Research on Energy Distribution During Osteoarthritis Treatment Using Shock Wave Lithotripsy].

    PubMed

    Zhang, Shinian; Wang, Xiaofeng; Zhang, Dong

    2015-04-01

    Extracorporeal shock wave treatment is capable of providing a non-surgical and effective treatment modality for patients suffering from osteoarthritis. The major objective of current works is to investigate how the shock wave (SW) field would change if a bony structure exists in the path of the acoustic wave. Firstly, a model of finite element method (FEM) was developed based on Comsol software in the present study. Then, high-speed photography experiments were performed to record cavitation bubbles with the presence of mimic bone. On the basis of comparing experimental with simulated results, the effectiveness of FEM model could be verified. Finally, the energy distribution during extracorporeal shock wave treatment was predicted. The results showed that the shock wave field was deflected with the presence of bony structure and varying deflection angles could be observed as the bone shifted up in the z-direction relative to shock wave geometric focus. Combining MRI/CT scans to FEM modeling is helpful for better standardizing the treatment dosage and optimizing treatment protocols in the clinic.

  13. Modeling and experimental analysis of acoustic cavitation bubbles for Burst Wave Lithotripsy

    PubMed Central

    Maeda, Kazuki; Colonius, Tim; Kreider, Wayne; Maxwell, Adam; Cunitz, Bryan; Bailey, Michael

    2016-01-01

    A combined modeling and experimental study of acoustic cavitation bubbles that are initiated by focused ultrasound waves is reported. Focused ultrasound waves of frequency 335 kHz and peak negative pressure 8 MPa are generated in a water tank by a piezoelectric transducer to initiate cavitation. The resulting pressure field is obtained by direct numerical simulation (DNS) and used to simulate single bubble oscillation. The characteristics of cavitation bubbles observed by high-speed photography qualitatively agree withs the simulation result. Finally, bubble clouds are captured using acoustic B-mode imaging that works in synchronization with high-speed photography. PMID:27087826

  14. Tamsulosin and doxazosin as adjunctive therapy following shock-wave lithotripsy of renal calculi: randomized controlled trial.

    PubMed

    Zaytoun, Osama M; Yakoubi, Rachid; Zahran, Abdel Rahman M; Fouda, Khaled; Marzouk, Essam; Gaafar, Salah; Fareed, Khaled

    2012-08-01

    Alpha-blockers have been established as medical expulsive therapy for urolithiasis. We aimed to assess the effect of tamsulosin and doxazosin as adjunctive therapy following SWL for renal calculi. We prospectively included 150 patients who underwent up to four SWL sessions for renal stones from June 2008 to 2009. Patients were randomized into three groups of 50 patients each, group A (phloroglucinol 240 mg daily), group B (tamsulosin 0.4 mg once daily plus phloroglucinol), and group C (doxazosin 4 mg plus phloroglucinol). The treatment continued up to maximum 12 weeks. Patients were evaluated for stone expulsion, colic attacks, amount of analgesics and side-effects of alpha-blockers. There were no significant differences between the groups regarding stone expulsion rates (84; 92 and 90%, respectively). The mean expulsion time of tamsulosin was significantly shorter than both control group (p = 0.002) and doxazosin (p = 0.026). Both number of colic episodes and analgesic dosage were significantly lower with tamsulosin as compared to control and doxazosin. Steinstrasse was encountered in 10 (6.7%) patients with no significant difference between the groups. 16 patients on tamsulosin and 21 on doxazosin experienced adverse effects related to postural hypotension. Moreover, 2 (4%) patients in the tamsulosin group reported ejaculatory complaints. In conclusion, adjunction of tamsulosin or doxazosin after SWL for renal calculi decreases the time for stone expulsion, amount of the analgesics and number colic episodes. There was no benefit regarding the overall stone expulsion rate. The side-effects of these agents are common and should be weighted against the benefits of their usage.

  15. Extracorporeal shockwave lithotripsy for urinary calculi in autosomal dominant polycystic kidney disease.

    PubMed

    Delakas, D; Daskalopoulos, G; Cranidis, A

    1997-06-01

    Autosomal dominant polycystic kidney disease (ADPKD) is an inherited systemic disorder. Renal stones have a high rate of occurrence among patients with ADPKD and are a significant cause of morbidity in this disorder. Thirteen patients with ADPKD and symptomatic or obstructive renal stones presented to our hospital for evaluation and treatment with extracorporeal shockwave lithotripsy (SWL). A total of 16 renal units were treated. The auxiliary procedures included placement of a double-J stent in nine kidneys when the stone was larger than 8 mm in diameter. Eleven patients (85%) were stone free 3 months after lithotripsy; a second treatment was necessary in two patients. We conclude that SWL can be used as a primary management tool for renal stones in patients with ADPKD.

  16. Pacemakers, implantable cardioverter/defibrillators, and extracorporeal shockwave lithotripsy: evidence-based guidelines for the modern era.

    PubMed

    Platonov, Michael A; Gillis, Anne M; Kavanagh, Katherine M

    2008-02-01

    Early work examining interactions between extracorporeal shockwave lithotripsy (SWL) and implantable pacemakers or implantable cardioverter/defibrillators suggested that shockwave oversensing may result in inappropriate suppression of pacing, delivery of antitachycardia pacing therapy, delivery of inappropriate shock therapy, or outright damage to such devices. In the absence of national guidelines, those provided by manufacturers are nonuniform and practice patterns vary between centers. Improvements in SWL energy delivery as well as in device shielding and discrimination technologies have demonstrated improved safety data in recent years. We review these advances in both technologies as well as the most recent data to construct practice guidelines for the modern era.

  17. Acute cyst rupture, hemorrhage and septic shock after a shockwave lithotripsy in a patient with autosomal dominant polycystic kidney disease.

    PubMed

    Kim, Hyeong Gon; Bae, Sang Rak; Lho, Yong Soo; Park, Hyoung Keun; Paick, Sung Hyun

    2013-06-01

    The incidence of urinary calculi in autosomal dominant polycystic kidney disease (ADPKD) ranges from 10 to 36 %. Shockwave lithotripsy (SWL) for urinary calculi in ADPKD was reported to be a safe and effective treatment option. However, there is a potential risk of cyst rupture and traumatic hemorrhage because of shockwaves. A 39-year-old female with polycystic kidneys and upper ureter stone was treated with SWL and developed life-threatening complications of cyst rupture, traumatic hemorrhage and septic shock. She was initially treated with supportive care in the intensive care unit, but in the end nephrectomy was performed.

  18. Renal nerves mediate changes in contralateral renal blood flow after extracorporeal shockwave lithotripsy.

    PubMed

    Connors, Bret A; Evan, Andrew P; Willis, Lynn R; Simon, Jay R; Fineberg, Naomi S; Lifshitz, David A; Shalhav, Arieh L; Paterson, Ryan F; Kuo, Ramsay L; Lingeman, James E

    2003-01-01

    Renal blood flow falls in both kidneys following delivery of a clinical dose of shockwaves (SW) (2000 SW, 24 kV, Dornier HM3) to only one kidney. The role of renal nerves in this response was examined in a porcine model of renal denervation. Six-week-old pigs underwent unilateral renal denervation. Nerves along the renal artery of one kidney were identified, sectioned and painted with 10% phenol. Two weeks later the pigs were anesthetized and baseline renal function was determined using inulin and PAH clearances. Animals then had either sham-shockwave lithotripsy (SWL) (group 1), SWL to the innervated kidney (group 2) or SWL to the denervated kidney (group 3). Bilateral renal function was again measured 1 and 4 h after SWL. Both kidneys were then removed for analysis of norepinephrine content to validate the denervation. Renal plasma (RPF) flow was significantly reduced in shocked innervated kidneys (group 2) and shocked denervated kidneys (group 3). RPF was not reduced in the unshocked denervated kidneys of group 2. These observations suggest that renal nerves play a pivotal role in modulating the vascular response of the contralateral unshocked kidney to SWL, but only a partial role, if any, in modulating that response in the shocked kidney.

  19. Impact of ureteric stent on outcome of extracorporeal shockwave lithotripsy: A propensity score analysis

    PubMed Central

    Gołąb, Adam; Słojewski, Marcin

    2016-01-01

    Introduction Extracorporeal shockwave lithotripsy (SWL) is one of the most frequently performed procedures in patients with urolithiasis. For ureter-localized stones, SWL is often preceded by a double J stent insertion. However, fear of serious complications, including sepsis associated with stents, is often expressed. The following study assessed the impact of stent insertions on the results of SWL in patients with ureteric stones. Material and methods The study group consisted of 411 ureteric stone patients who were treated with SWL from January 2010 to December 2014. In 60 cases, treatment was preceded by ureteric stent insertion. A propensity scoring system was used to pair non-stented patients with the stented group. Success rates were assessed and compared using the chi-squared test. Multivariate logistic regression analysis was used to evaluate the influence of particular variables on the stone-free rate. Results The overall success rate was 82.2%. After matching, the success rate of the stented group was not significantly different from the control group (85.0% vs. 83.3% respectively, p = 0.80). The mean number of sessions was higher in the stented group (1.88 per patient). Stones located in the lower part of the ureter have the greatest chance of being successfully treated. Conclusions The double J stent has no influence on the outcome of SWL treatment. In view of the greater likelihood of having additional sessions, this approach should be reserved for selected cases. PMID:27551556

  20. A comparative study to analyze the efficacy and safety of flexible ureteroscopy combined with holmium laser lithotripsy for residual calculi after percutaneous nephrolithotripsy.

    PubMed

    Xu, Gang; Wen, Jiaming; Li, Zhongyi; Zhang, Zhewei; Gong, Xiuqing; Chen, Jimin; Du, Chuanjun

    2015-01-01

    A certain proportion of patients with initial Percutaneous nephrolithotripsy (PCNL) management require ancillary procedures to increase the stone-free rate. In this study, we aim to analyze the efficacy and safety of flexible ureteroscopy combined with holmium laser lithotripsy (F-UL) for treatment of residual calculi after PCNL by comparison with extracorporeal shockwave lithotripsy (SWL). Total of 96 patients with residual renal calculi (4 mm to 20 mm) after PCNL was enrolled from May 2010 to March 2013. They were randomly divided into two groups: US Group: patients were treated with F-UL; SWL Group: patients were treated with SWL. Follow-up was made one month and three months after treatment. The mean residual stone size after PCNL was 12.4 ± 4.3 mm in US group compared with 11.9 ± 4.5 in SWL group. The stone-free rate was 84.7% one month after surgical procedure in US group, this rate increased to 91.3% in the third months, while the stone-free rate in SWL group is 64.6% one month after treatment and 72.9% in the third month. For residual stone in lower calyx, the stone-free rate three month after treatment was 90.4% in US group compared to 65.2% in SWL group (P < 0.05). The overall complication rate was low in both groups, no severe complication was found. Both F-UL and SWL are safe and effective methods for residual calculi after PCNL, without severe complications. F-UL provided significantly higher stone-free rate compared with SWL, especially for low-pole calculi.

  1. Calculus fragmentation in laser lithotripsy.

    PubMed

    Welch, A J; Kang, H W; Lee, H; Teichman, J M H

    2004-03-01

    The intracorporeal treatment of urinary calculi with lasers is presented, which describes laser-calculus interactions associated with lithotripsy. Reliable fragmentation of calculi with diverse compositions and minimal collateral tissue damage are primarily contingent upon laser parameters (wavelength, pulse duration, and pulse energy) and physical properties of calculi (optical, mechanical, and chemical). The pulse duration governs the dominant mechanism in calculi fragmentation, which is either photothermal or photoacoustical/photomechanical. Lasers with long pulse durations (i.e. > tens of micros) induce a temperature rise in the laser-affected zone with minimal acoustic waves; material is removed by means of vaporization, melting, mechanical stress, and/or chemical decomposition. Short-pulsed laser ablation (i.e. < 10 micros), on the other hand, produces shock waves, and the resultant mechanical energy fragments calculi. Work continues throughout the world to evaluate the feasibility of advanced lasers in lithotripsy and to optimize laser parameters and light delivery systems pertinent to efficient fragmentation of calculi.

  2. Changing paradigms in the treatment of uroliths by lithotripsy.

    PubMed

    Lulich, Jody P; Adams, Larry G; Grant, David; Albasan', Hasan; Osborne, Carl A

    2009-01-01

    Surgery remains a common procedure for removal of uroliths from the lower urinary tract of dogs. Incorporation of intracorporeal laser lithotripsy and extracorporeal shock wave lithotripsy has provided impetus for a paradigm shift in the way veterinarians manage urinary stones, however. These minimally invasive techniques provide a successful alternative to surgical urolith extraction.

  3. Cost-effectiveness of extracorporeal shock wave lithotripsy in a poor resource setting: The Okada, Nigeria experience

    PubMed Central

    Eze, Kenneth C.; Irekpita, E.; Salami, T. A.

    2016-01-01

    Background: The first extracorporeal shock wave lithotripsy (ESWL) used in Nigeria was at Igbinedion Hospital and Medical Research Centre (IHMRC), Okada in 1992 and it functioned for 6 consecutive years. The objectives of this study were to analyze the cost-effectiveness of the procedure and highlight the associated factors that led to its failure. Methods: A retrospective study of medical records and publications associated with the use of ESWL at IHMRC, Okada, for the period of 1992 to 1998. The study was conducted between January 2003 and November 2008. Unclassified authentic information relating to the use of ESWL and treatment of upper urinary tract stones was obtained from the IHMRC Okada and some government hospitals on hospital bills. Relevant documents in public domains related to the national and international wages and emoluments of medical workers and socioeconomic development of Nigeria within the time the ESWL functioned were studied. Result: A total of 32 patients were treated with 51 treatment sessions which is an average of nine patients per year and an average of two treatment sessions per patient were involved. The reasons for the low patronage were the extremely low stone formation rate of Nigerians, poverty, and out-of-pocket payment system. In addition, each treatment session of ESWL at Okada cost an average of $681.8 compared to $227.3 for open nephrolithotomy in a nearby high profile teaching hospital. The IHMRC, Okada, paid an average annual salary of ₦180,000 ($8,181.8) for each medical consultant compared to ₦120,000 ($5,454.5) paid by federal teaching hospitals in Nigeria within the period. Expatriate consultant doctors from Europe and USA who initially manned the lithotriptor at IHMRC, Okada, were paid much higher salaries. Average annual income of $5,909 for each of the 6 years amounting to a total of $34,771.7 for the six years was realized which could not maintain staff salaries in the hospital leading to staff emigration

  4. Combined percutaneous balloon dilation and extracorporeal shock wave lithotripsy for treatment of biliary stricture and common bile duct stones.

    PubMed

    Schoonjans, R; De Man, M; Aerts, P; Van der Spek, P; Van Steenberge, R; Lepoutre, L

    1994-09-01

    We report a case of cholangitis, liver abscess, and common bile duct stones in a patient with a benign stricture at a choledochojejunal anastomosis, 3 yr after a complicated duodenohemipancreatectomy. Because surgical reintervention seemed inappropriate, a percutaneous transhepatic balloon dilation was performed after temporary internal-external biliary drainage. Extracorporeal shockwave lithotripsy (ESWL) was successfully applied to fragment all common bile duct stones, with subsequent spontaneous evacuation of all stone fragments through the dilated bilioenteric anastomosis. Only one similar case report has been published before (1), though with a different sequence of therapeutic modalities. Moreover, according to our literature review, this is the first report of ESWL of common bile duct stones by means of the Dornier Compact Lithotriptor (Dornier, Germany) with electromagnetic shockwave source.

  5. [Ambulatory treatment without anesthesia of urinary lithiasis by extracorporeal shock-wave lithotripsy: 7,000 cases].

    PubMed

    Torrecilla, C; Contreras, J; Tesedo, X; López-Costea, M; Pérez-Céspedes, M; Serrallach, N

    1993-01-01

    Exposition of results and complications in 7,162 consecutive sessions with Shockwave Extracorporeal Lithotripsy (SWEL) applied to 3,950 lithiasis located at all levels of the urinary tract. These procedures have been performed without sedation or anaesthesia. Diuresis was not forced during or after treatment with serotherapy, mannitol, or diuretics. Treatment was conducted in an outpatients clinic in all cases. The treatment/lithiasis ratio in this initial series was 1.7. Following therapy, 7.09% of patients treated attended the emergency unit due to colic pain/fever. 3.60% of patients treated required hospitalization due to major complications: subcapsular-retroperitoneal haematoma, 9 cases; ureteral obstruction, 120 cases; septicemia, 22 cases; renal function annulment, 11 cases and death, 2 cases.

  6. Comparing extracorporeal shock wave lithotripsy and ureteroscopy for treatment of proximal ureteric calculi: a cost-effectiveness study.

    PubMed

    Izamin, I; Aniza, I; Rizal, A M; Aljunid, S M

    2009-03-01

    Extracorporeal shockwave lithotripsy (ESWL) and ureteroscopy (URS) are two main methods of treating proximal ureteric stones. Success rates and cost-effectiveness of the two methods were compared. A total of 67 patients who underwent treatment between January 2007 and July 2007 at a state general hospital were included in the study. The success rate for ESWL group was 81.8% and for URS group was 84.6%. ESWL technique produced a significant higher overall cost per patient than URS (RM930.02 versus RM621.95 respectively). There was no significant difference in quality of patient's life. Cost-effectiveness ratio was lower for URS. The analysis suggested that URS was more cost-effective than ESWL.

  7. Focused Ultrasound and Lithotripsy.

    PubMed

    Ikeda, Teiichiro; Yoshizawa, Shin; Koizumi, Norihiro; Mitsuishi, Mamoru; Matsumoto, Yoichiro

    2016-01-01

    Shock wave lithotripsy has generally been a first choice for kidney stone removal. The shock wave lithotripter uses an order of microsecond pulse durations and up to a 100 MPa pressure spike triggered at approximately 0.5-2 Hz to fragment kidney stones through mechanical mechanisms. One important mechanism is cavitation. We proposed an alternative type of lithotripsy method that maximizes cavitation activity to disintegrate kidney stones using high-intensity focused ultrasound (HIFU). Here we outline the method according to the previously published literature (Matsumoto et al., Dynamics of bubble cloud in focused ultrasound. Proceedings of the second international symposium on therapeutic ultrasound, pp 290-299, 2002; Ikeda et al., Ultrasound Med Biol 32:1383-1397, 2006; Yoshizawa et al., Med Biol Eng Comput 47:851-860, 2009; Koizumi et al., A control framework for the non-invasive ultrasound the ragnostic system. Proceedings of 2009 IEEE/RSJ International Conference on Intelligent Robotics and Systems (IROS), pp 4511-4516, 2009; Koizumi et al., IEEE Trans Robot 25:522-538, 2009). Cavitation activity is highly unpredictable; thus, a precise control system is needed. The proposed method comprises three steps of control in kidney stone treatment. The first step is control of localized high pressure fluctuation on the stone. The second step is monitoring of cavitation activity and giving feedback on the optimized ultrasound conditions. The third step is stone tracking and precise ultrasound focusing on the stone. For the high pressure control we designed a two-frequency wave (cavitation control (C-C) waveform); a high frequency ultrasound pulse (1-4 MHz) to create a cavitation cloud, and a low frequency trailing pulse (0.5 MHz) following the high frequency pulse to force the cloud into collapse. High speed photography showed cavitation collapse on a kidney stone and shock wave emission from the cloud. We also conducted in-vitro erosion tests of model and natural

  8. Focused Ultrasound and Lithotripsy.

    PubMed

    Ikeda, Teiichiro; Yoshizawa, Shin; Koizumi, Norihiro; Mitsuishi, Mamoru; Matsumoto, Yoichiro

    2016-01-01

    Shock wave lithotripsy has generally been a first choice for kidney stone removal. The shock wave lithotripter uses an order of microsecond pulse durations and up to a 100 MPa pressure spike triggered at approximately 0.5-2 Hz to fragment kidney stones through mechanical mechanisms. One important mechanism is cavitation. We proposed an alternative type of lithotripsy method that maximizes cavitation activity to disintegrate kidney stones using high-intensity focused ultrasound (HIFU). Here we outline the method according to the previously published literature (Matsumoto et al., Dynamics of bubble cloud in focused ultrasound. Proceedings of the second international symposium on therapeutic ultrasound, pp 290-299, 2002; Ikeda et al., Ultrasound Med Biol 32:1383-1397, 2006; Yoshizawa et al., Med Biol Eng Comput 47:851-860, 2009; Koizumi et al., A control framework for the non-invasive ultrasound the ragnostic system. Proceedings of 2009 IEEE/RSJ International Conference on Intelligent Robotics and Systems (IROS), pp 4511-4516, 2009; Koizumi et al., IEEE Trans Robot 25:522-538, 2009). Cavitation activity is highly unpredictable; thus, a precise control system is needed. The proposed method comprises three steps of control in kidney stone treatment. The first step is control of localized high pressure fluctuation on the stone. The second step is monitoring of cavitation activity and giving feedback on the optimized ultrasound conditions. The third step is stone tracking and precise ultrasound focusing on the stone. For the high pressure control we designed a two-frequency wave (cavitation control (C-C) waveform); a high frequency ultrasound pulse (1-4 MHz) to create a cavitation cloud, and a low frequency trailing pulse (0.5 MHz) following the high frequency pulse to force the cloud into collapse. High speed photography showed cavitation collapse on a kidney stone and shock wave emission from the cloud. We also conducted in-vitro erosion tests of model and natural

  9. Two-year experience with ureteral stones: extracorporeal shockwave lithotripsy v ureteroscopic manipulation.

    PubMed

    Park, H; Park, M; Park, T

    1998-12-01

    Extracorporeal shockwave lithotripsy (SWL) and ureteroscopic manipulation became the standard treatments for ureteral stones in recent years. There still exists significant debate as to the most appropriate treatment modality for ureteral stones. During a period of 2 years, from January 1994 to December 1995, 651 patients with ureteral stones were treated, and 589 patients were retrospectively reviewed, excluding 62 patients with incomplete follow-up. Four hundred forty-two patients were treated with SWL using the MPL 9000 with ultrasonic guidance and 115 patients with ureteroscopic manipulations using 7.9F to 11.5F rigid and semirigid ureteroscopes. In SWL treatments, the overall stone-free rate was 74.7% with one session. The stone-free rate was significantly affected by the size of stones, being 83.6% when the stone was <1.0 cm and 42.1% when the stone was >1.0 cm. The stone-free rate after a second SWL session was 84.4% and was 90.3% after a third session. The stone-free rates according to the site of the stone were 72.4 (proximal), 70.0 (mid), and 80.2% (distal) after a single session. In ureteroscopic manipulation, an overall stone-free rate of 87.8% was obtained regardless of the size of the stones. The success rates according to the location of stones were 75.0 (proximal), 94.6 (mid), and 86.4% (distal). Open ureterolithotomy was performed in 32 patients, with a 100% success rate. In our study, the size of the stones was the most important factor influencing the success rate of SWL treatment. We consider ureteroscopic manipulation as the first-line treatment modality when the stone is >1.0 cm, especially if it is in the distal ureter. Proper selection of patients for in situ SWL or ureteroscopy would improve the results of initial treatment.

  10. [Extracorporeal shockwave lithotripsy and hemophilia: apropos of a case].

    PubMed

    Brunet, P; Rigot, J M; Coupez, B; Mazeman, E

    1995-02-01

    We report pelvis calculi fragmentation through the use of extracorporeal shock wave lithotripsy in a patient with mild hemophilia B. The EDAP LT 01 lithotriptor was used without incident. We review other reported cases in the literature.

  11. [Extracorporeal shockwave lithotripsy (SWL) of common bile duct calculi without previous endoscopic papillotomy].

    PubMed

    Jakobeit, C; Greiner, L; Schumacher, R; Johanns, W; Janssen, J; Sulliga, M; Schnabel, R; Welp, L B; Pumplün, B

    1996-07-01

    In 17 patients (8 men, 9 women; mean age 61.5 years) with problematic bile-duct stones (papilla endoscopically inaccessible, residual bile-duct stones after recent laparoscopic cholecystectomy or age below 25 years) the chances of successful treatment by ESWL without sphincterotomy were examined. In 15 patients with solitary stones measuring up to 14 mm "pulverization-ESWL" produced complete freedom from stones after spontaneous migration of fragments through the intact papilla. Only two patients with two ductal stones measuring up to 15 mm still had residual fragments in the bile duct after treatment. The ideal stone for ESWL without sphincterotomy is thus the solitary bile-duct stone measuring up to 14 mm. Before performing a high-risk sphincterotomy, before re-operation and in young patients one should therefore always examine whether ESWL without sphincterotomy is indicated.

  12. [Extracorporeal shockwave lithotripsy: treatment of choice in ureteral calculi].

    PubMed

    Rigatti, P; Montorsi, F; Guazzoni, G; Maffezzini, M

    1989-05-15

    Extracorporeal shock wave lithotripsy represents the therapy of choice for reno-ureteral stone disease being resolutive in more than 85% of cases. This procedure can be successfully applied to ureteral stones providing appropriate preoperative cystoscopic manipulations and a correct positioning of the patient on the stretcher of the lithotripter. We hereby report our experience in 119 patients with ureteral lithiasis submitted to extracorporeal shock wave lithotripsy with a 98% success rate.

  13. Effectiveness of extracorporeal shockwave lithotripsy in the management of stone-bearing horseshoe kidneys.

    PubMed

    Kirkali, Z; Esen, A A; Mungan, M U

    1996-02-01

    Although extracorporeal shockwave lithotripsy (SWL) has dramatically changed the management of urinary tract stone disease, the anatomic abnormalities of horseshoe kidneys cause some difficulties in the use of SWL in this disorder. In this study, 18 patients with stone-bearing horseshoe kidneys were investigated retrospectively in order to determine the effectiveness of SWL. Patients received an average of 11,437 + or - 3062 shocks at an average of 18.8 kV with the Siemens Lithostar. Ten patients were treated in the supine position; stones could be localized in the prone position in eight. Catheterization with a double-J stent was the only adjunctive procedure; it was used in four patients prior to SWL. Adequate stone fragmentation (smaller than 5 mm) was achieved in 14 of the 18 patients (78%). Although 5 of them (28%) became stone free within 6 months after the treatment, residual fragments persisted in 9 patients (50%) during the mean follow-up of 55 months. Stones of 4 patients (22%) were not fragmented adequately. We concluded that although adequate fragmentation can be achieved in stone-bearing horseshoe kidneys, the anatomic abnormalities prevent fragment passage in a substantial number of patients.

  14. Effects of extracorporeal shockwave lithotripsy on renal growth and function: an animal model.

    PubMed

    Claro, J de A; Denardi, F; Ferreira, U; Rodrigues Netto, N; Saldanha, L B; Figueiredo, J F

    1994-06-01

    The long-term effects of extracorporeal shockwave lithotripsy (SWL) on children are unclear. At 40 days of age, with an average weight of 166 g, 34 Wistar white rats were divided into three groups: 9 rats (control group) received no shockwaves, 10 rats (Group 1) received 1000 shockwaves at 16.0 kV, and 15 animals (Group 2) received 1000 shockwaves at 17.2 kV. Six months later, at maturity, body weight; lithium and creatinine; fractional sodium, potassium, and lithium excretion; and the clearances of lithium and creatinine were measured, and the kidneys were studied grossly and histologically. We found no significant changes in overall animal or renal growth between the post-SWL groups and the control group. However, there were significant changes in renal function, mainly in Group 2; the animals of this group presented a significant increase in blood lithium and potassium, besides a significant decrease in the fractional potassium excretion compared with the control group. Furthermore, the animals in Group 2 showed permanent histologic renal changes, including red cells in Bowman's capsule and glomerular congestion. The disorders caused by SWL are compatible with hyporeninemic hypoaldosteronism, an inappropriate low plasma renin activity and aldosterone deficiency. We conclude that SWL does not affect either overall animal or renal growth but may cause permanent histologic damage and significant changes in renal function.

  15. Minor residual fragments after extracorporeal shockwave lithotripsy: spontaneous clearance or risk factor for recurrent stone formation?

    PubMed

    Buchholz, N P; Meier-Padel, S; Rutishauser, G

    1997-08-01

    The aim of this study was to follow the fate of residual stone fragments (RF) < 5 mm after extracorporeal shockwave lithotripsy (SWL) over a sufficiently long period to determine how many are spontaneously cleared and after what time interval. A further aim was to clarify their role in clinical outcome and stone recurrence and regrowth. The clinical and radiologic data of 266 patients were analyzed. The patients were followed up for a mean of 387 days. After SWL, 55 patients (21%) had residual fragments < 5 mm in diameter. There were no significant differences between the stone-free patients and those with RF with regard to age, sex, relevant medical history, or SWL treatment. After a mean follow-up of 2.5 years, 12.7% of the residual fragments had not passed spontaneously, but all of them were clinically silent and located exclusively in the lower calices and the proximal ureter. Only 2% of the patients with RF showed stone regrowth, and no stone recurrences were observed within the follow-up period. In conclusion, although a minor pathophysiological role of RF < or = 5 mm cannot be discounted in recurrence and regrowth of kidney stones after SWL, more invasive attempts to clear all minor fragments do not seem warranted.

  16. Update on contact lithotripsy.

    PubMed

    Michel, M S; Köhrmann, K U; Alken, P

    2000-11-01

    Despite the development of extracorporeal shockwave lithotripsy, endoscopic stone removal, with or without intracorporeal lithotripsy, is still an effective minimally invasive alternative for special indications. There is no defined all-purpose lithotripsy procedure for contact lithotripsy. The choice of the lithotripsy procedure for endoscopic stone disintegration depends on a number of different factors, the main one being stone localization. Small calibre, flexible probes (electrohydraulic, pneumatic, laser) are especially appropriate for ureterorenoscopy, but the speed of stone disintegration is a limiting factor. In contrast, large calibre rigid probes (ultrasound) are clearly more effective, but are unsuitable in size for flexible ureterorenoscopy. This indicates that the type and size of the endoscope decisively influences the choice of devices for endoscopic stone disintegration. Additional inhibiting factors are the flexibility or the rigidity of the instrument and the diameter of the working channel. It must be noted that total costs are not only calculated on the purchase of the equipment, but must also cover disposable materials.

  17. [Extracorporeal shockwave lithotripsy and lymph node calcification].

    PubMed

    Higashihara, E; Fujime, M; Niijima, T

    1987-05-01

    A female patient with calculi in the left kidney and calcified lymph nodes in the vicinity of the left renal pelvis was treated successfully with extracorporeal shock wave lithotripsy. The simultaneous action of the shock waves on the calcified lymph nodes did not cause any alteration of the lymph node structure. Thus a shock-wave treatment can be carried out even in the presence of a calcified lymph node without complications.

  18. [Sonography and biliary extracorporeal shockwave lithotripsy (ESWL)].

    PubMed

    Jakobeit, C; Greiner, L; Rebensburg, S; Spelter, M; Schumacher, R; Frenzel, F; Pumplün, B

    1992-12-01

    Ultrasound is an indispensable tool for preliminary diagnosis ("filter function"), during treatment ("monitoring function") and in the follow-up examinations ("follow-up function") after shock-wave lithotripsy of gallstones. It permits rapid and reliable assessment of the therapeutic outcome and early identification of complications, which present-day experience has shown to be rare.

  19. [Sonography and biliary extracorporeal shockwave lithotripsy].

    PubMed

    Jakobeit, C; Greiner, L

    1992-12-01

    Ultrasound is an indispensable tool for preliminary diagnosis ('filter function'), during treatment ('monitoring function') and in the followup examinations ('follow-up function') after shock wave lithotripsy of gallstones. It permits rapid and reliable assessment of the therapeutic outcome and early identification of complications, which experience to date has shown to be rare.

  20. [Extracorporeal shockwave nephro-uretero-lithotripsy].

    PubMed

    Lopatkin, N A; Martov, A G; Beshliev, L A

    1992-01-01

    Extracorporeal shock-wave lithotripsy (ESWL) has been widely introduced in the treatment of nephro-uretero-lithiasis during the last decade as it provides a noninvasive removal of the stones from the upper urinary tracts. The paper covers the history, techniques, indications, contraindications, anesthesia, complications and results of the method. Positive and negative characteristics of ESWL equipment (lithotriptors) are considered. The experience with 5000 lithotripsies led the authors to the conclusion that ESWL does not solve all the problems in the treatment of nephro-uretero-lithiasis and should be introduced only in large clinics practicing actively x-ray endoscopy and equipped with modern endoscopic and ultrasonic urologic units.

  1. Cost effectiveness of adjuvant bile salt treatment in extracorporeal shock wave lithotripsy for the treatment of gall bladder stones.

    PubMed

    Nicholl, J P; Ross, B; Milner, P C; Brazier, J E; Westlake, L; Kohler, B; Frost, E; Williams, B T; Johnson, A G

    1994-09-01

    The relative cost effectiveness of adjuvant urso and chenodeoxycholic acid treatment in extracorporeal shockwave lithotripsy (ESWL) has been assessed as part of a pragmatic randomised controlled trial of ESWL as a treatment of gall bladder stones. Of the first patients with gall stone volume < 4 cm3 randomised to ESWL in the main trial, 24 were randomised to have ESWL alone and 26 to have adjuvant bile acid treatment, one of whom died before the end of the 12 month follow up period. At 12 months after treatment, differences in gall stone clearance between ESWL alone (3/24 (13%) clear, 5 (21%) referred for surgery) and ESWL and bile acids (6/25 (24%) clear, 2 (8%) referred for surgery) were not significant (p = 0.36, log rank test). Patients in both groups had substantial and significant health gains (according to biliary pain frequency and severity, Nottingham Health Profile scores, visual analogue scale symptom scores, and complications) but there were no significant differences between the groups. Improvements in both groups usually occurred within a few weeks of treatment and were unrelated to gall stone clearance. Costs were greater in the bile salt group (95% confidence intervals for estimated cost difference: 90 pounds to 630 pounds). If the purpose of treatment is symptom relief rather than gall stone clearance then adjuvant bile salt treatment seems to be unnecessary.

  2. [30-months extracorporeal electrohydraulic shock-wave lithotripsy of gallstones using the MPL-9000 at the Zurich University Hospital].

    PubMed

    Frick, T; Hoffmann, R; Largiadèr, F; Ammann, R; Häcki, W; Fuchs, W

    1991-07-20

    The effect of extracoporeal shockwave lithotripsy (ESWL) in combination with oral chemolitholysis on gallstone clearance was tested in a prospective study. We used a non-waterbath lithotripter, and the patients were treated without general anesthesia or intravenous analgesia. They solely received oral or subcutaneous premedication. Within the 30 months study-period 78 patients were selected according to the "Munich-criteriae". At the end of the study period 33 patients were free of stones, 20 patients had residual fragments, and 25 patients stopped the therapy prior to complete stone clearance because of compliance (n = 11), or methodological (n = 14) problems. This includes 3 patients in whom the ESWL had to be discontinued because of pain. No severe complications were seen with the exception of one attack of acute pancreatitis, from which the patient recovered. The rate of stone clearance was analyzed using the life-table calculation according to KAPLAN-MEIER to weigh the follow-up time of each patient. At 12 months it revealed a stonefree rate of 70% in patients who did not discontinue the treatment because of methodological problems. The advantage of ESWL is the possibility to treat gallstones without general anesthesia or intravenous analgesia. However, the patient-population must be highly selected, and there is the risk of recurrence.

  3. Factors influencing the failure of extracorporeal shock wave lithotripsy with Piezolith 3000 in the management of solitary ureteral stone.

    PubMed

    Hwang, Insang; Jung, Seung-Il; Kim, Kwang Ho; Hwang, Eu Chang; Yu, Ho Song; Kim, Sun-Ouck; Kang, Taek Won; Kwon, Dong Deuk; Park, Kwangsung

    2014-06-01

    Studies of predictive factors of extracorporeal shockwave lithotripsy (ESWL) failure in patients with ureteral stones have not yielded results sufficient to prevent ESWL failure. The present study investigated patients with ureteral stone and analyzed the predictive factors of ESWL failure. Ninety patients with ureteral stone treated from January 2006 to June 2012 using ESWL for ureteral stone were enrolled. Patient's demographic data including age, gender, body mass index (BMI), symptoms and calculous characteristics including location, size, episode and the grade of hydronephrosis were recorded. Statistical results were performed using univariate and multivariate analyses for the predictive factors of ESWL failure. In univariate analysis, calculous location, size, and grade of hydronephrosis between two groups displayed significant differences (p < 0.05). The predictive factors of ESWL failure were BMI >25 kg/m(2) [Odds ratio (OR) = 3.5, 95% confidence interval (CI) 1.1-11.0], calculous size ≥ 1 cm (OR = 10.5, 95% CI 3.0-36.2), calculous location (mid-ureter; OR = 8.49, 95% CI 1.5-45.7) and severe grade of hydronephrosis (OR = 12.3, 95% CI 1.9-79.5). In conclusions, ESWL failure can be predicted in cases of obesity, calculous size exceeding 1 cm, mid-ureteral stone and severe hydronephrosis. When we consider calculous management in patients with these risk factors, initial surgical approach is recommended instead of ESWL.

  4. Pneumatic lithotripsy applied through deflected working channel of miniureteroscope: results in 143 patients.

    PubMed

    Knispel, H H; Klän, R; Heicappell, R; Miller, K

    1998-12-01

    Although extracorporeal shockwave lithotripsy (SWL) is a successful treatment for ureteral calculi, introduction of miniureteroscopes has advanced endoscopic management. We combined the use of a semirigid ureteroscope with a pneumatic lithotripter (Swiss Lithoclast) for the treatment of ureteral calculi. From January 1992 to August 1994, 143 patients (87 male, 56 female; mean age 48.7 years; age range 22-74 years) with urolithiasis underwent endoscopic lithotripsy with the Swiss Lithoclast under general anesthesia. The 0.8 = mm probe was inserted through the deflected working channel (3.4F) of the Micro-6L ureteroscope (tip diameter 6.9F). The calculi were in the distal (N = 96; 67.1%), mid (N = 34; 23.8%), and proximal part (N = 13; 9.1%) of the ureter. The mean stone size was 6.8 mm (range 5-26 mm). Of the 137 patients whose stones we could access adequately, 70 (51.1%) were stone free immediately after the procedure, and another 31 (22.6%) had residual fragments <3 mm that passed spontaneously. The remaining 36 patients underwent another 50 procedures; 30 SWL sessions in 26 patients (19%), 17 further endoscopic lithotripsies in 14 (10.2%), and open surgery in 3. Application of the Swiss Lithoclast through semirigid miniureteroscopes is highly effective for endoscopic lithotripsy, regardless of stone composition. Deflection of the probe up to 30 degrees did not impair the disintegration rate. Because of the high migration rate of mid and proximal ureteral stones, the Swiss Lithoclast is not recommended in these cases as a primary procedure. Low capital cost and simple and safe handling are the device's major advantages over laser lithotripsy.

  5. Flexible Ureterorenoscopy Versus Extracorporeal Shock Wave Lithotripsy for the Treatment of Renal Pelvis Stones of 10–20 mm in Obese Patients

    PubMed Central

    Javanmard, Babak; Razaghi, Mohammad Reza; Ansari Jafari, Anahita; Mazloomfard, Mohammad Mohsen

    2015-01-01

    Introduction: To compare outcomes of retrograde intrarenal surgery (RIRS) with extracorporeal shock wave lithotripsy (ESWL) as treatment of choice. Methods: A total number of 46 patients with renal pelvic stones 10-20 mm and body mass index (BMI) >30 randomized in two groups underwent RIRS and ESWL from 2011 to 2014 and followed for 3 months. Results: The patients mean ± SD age was 36.1 ± 13.1 years in ESWL and 33.2 ± 11.4 years in RIRS groups (P = .1) with comparable BMI in both groups (36.2 vs 38.1). In ESWL and RIRS groups, the operation time was 72.2 ± 21 vs 66.5 ± 19 minutes (P = .061), respectively. Stone free rate (SFR) at 3 months was 68% in ESWL group vs 90.4% in RIRS group (P = .019). The complication rate was 20% in ESWL group vs 14.2% in RIRS group (P = .211) but all of them were minor and managed conservatively. Conclusion: According to our study, RIRS procedure in comparison with ESWL is a safe and successful option of treatment for renal pelvis stone of 10-20 mm in obese people. PMID:26705461

  6. Fertility measures in women after extracorporeal shockwave lithotripsy of distal ureteral stones.

    PubMed

    Erturk, E; Ptak, A M; Monaghan, J

    1997-10-01

    Long-term effects of extracorporeal shockwave lithotripsy (SWL) on female fertility remain a concern. Thirty-nine women of childbearing age who were treated for distal ureteral stones were surveyed. The mean age of these women was 33 years, and the average stone size was 6.9 mm. The mean calculated radiation exposure to the ovaries and the uterus was 7.53 and 10.9 mSv, respectively. Ten women (26%) attempted to become pregnant. No fertility problems were noted in these women, and 11 healthy babies were delivered. These preliminary findings provide further information regarding the safety of SWL in the treatment of distal ureteral stones in women of reproductive age.

  7. Limitations of extracorporeal shockwave lithotripsy for lower caliceal stones: anatomic insight.

    PubMed

    Sampaio, F J; Aragao, A H

    1994-08-01

    In addition to gravity-dependent position, we suppose that other particular anatomic features may be important in the retention of stone debris in lower calices after extracorporeal shockwave lithotripsy (SWL). We analyzed the inferior-pole collecting system anatomy in 146 three-dimensional polyester resin corrosion endocasts of the pelviocaliceal system. In 74% of the cases, there was an angle of greater than 90 degrees formed between the lower infundibulum and the renal pelvis, and in 26%, the angle was 90 degrees or less. In 60%, there was a lower infundibulum 4 mm or larger in diameter. The inferior pole was drained by multiple calices disposed in two rows in 57% of the cases and by one midline caliceal infundibulum in 43%. We believe that the physician must appreciate these anatomic features when considering SWL to treat calculi located in lower calices.

  8. Outcome of extracorporeal shockwave lithotripsy monotherapy for large renal calculi: effect of stone and collecting system surface areas and cost-effectiveness of treatment.

    PubMed

    Murray, M J; Chandhoke, P S; Berman, C J; Sankey, N E

    1995-02-01

    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.

  9. [Extracorporeal shockwave lithotripsy in childhood].

    PubMed

    Schultz-Lampel, D; Lampel, A; Lazica, M; Thüroff, J W

    1997-05-01

    In general, the criteria for treatment of urolithiasis in children are the same as those for adults. Today, extracorporeal shock wave lithotripsy (ESWL) is the method of choice for treatment of most pediatric urinary stones. Stone-free rates between 57% and 97% at short-term follow-up and 57%-92% at long-term follow-up have proven the efficacy of ESWL treatment in children. So far, there is no evidence of negative side effects of ESWL treatment in children in the long-term, confirming the safety of ESWL treatment seen in the short-term results. In particular, neither induction of hypertension nor deterioration of renal function have been detected in children when limitation of shock wave energy and shock wave numbers have been carefully observed.

  10. Quantitative Assessment of Shockwave Lithotripsy Accuracy and the Effect of Respiratory Motion*

    PubMed Central

    Bailey, Michael R.; Shah, Anup R.; Hsi, Ryan S.; Paun, Marla; Harper, Jonathan D.

    2012-01-01

    Abstract Background and Purpose Effective stone comminution during shockwave lithotripsy (SWL) is dependent on precise three-dimensional targeting of the shockwave. Respiratory motion, imprecise targeting or shockwave alignment, and stone movement may compromise treatment efficacy. The purpose of this study was to evaluate the accuracy of shockwave targeting during SWL treatment and the effect of motion from respiration. Patients and Methods Ten patients underwent SWL for the treatment of 13 renal stones. Stones were targeted fluoroscopically using a Healthtronics Lithotron (five cases) or Dornier Compact Delta II (five cases) shockwave lithotripter. Shocks were delivered at a rate of 1 to 2 Hz with ramping shockwave energy settings of 14 to 26 kV or level 1 to 5. After the low energy pretreatment and protective pause, a commercial diagnostic ultrasound (US) imaging system was used to record images of the stone during active SWL treatment. Shockwave accuracy, defined as the proportion of shockwaves that resulted in stone motion with shockwave delivery, and respiratory stone motion were determined by two independent observers who reviewed the ultrasonographic videos. Results Mean age was 51±15 years with 60% men, and mean stone size was 10.5±3.7 mm (range 5–18 mm). A mean of 2675±303 shocks was delivered. Shockwave-induced stone motion was observed with every stone. Accurate targeting of the stone occurred in 60%±15% of shockwaves. Conclusions US imaging during SWL revealed that 40% of shockwaves miss the stone and contribute solely to tissue injury, primarily from movement with respiration. These data support the need for a device to deliver shockwaves only when the stone is in target. US imaging provides real-time assessment of stone targeting and accuracy of shockwave delivery. PMID:22471349

  11. [Extracorporeal lithotripsy of stones in the single kidney].

    PubMed

    Dzeranov, N K; Moskalenko, S A; Obukhova, T V

    1997-01-01

    The authors used shockwave lithotripsy (SWL) in 130 patients with solitary kidney to crush renal calculi. Valid policy in preoperative drainage may result in a significant reduction of the occurrence of postoperative obstructive complications. It was only 11.5%. A valid choice of sparing regimen of crushing kidney and prepelvic ureter calculi help prevent hematomas, a severe complication of early postoperative period. No cases of this complication were seen in the study. A significant renal function failure in early postoperative period was not recorded. A 2.5--5-year follow-up in 21 patients has found that in 61.9% of patients renal function recovered or remained stable, in 38.1% of patients renal function declined. This was due to deterioration of the underlying disease (chronic pyelonephritis, frequent recurrences of lithogenesis).

  12. [Shockwave lithotripsy in sialolithiasis patients].

    PubMed

    Abdusalamov, M R; Afanas'ev, V V; Gamataev, I I

    2014-01-01

    Shockwave lithotripsy was performed by various appliances in sialolithiasis patients. The best results were obtained by means of miniature appliances. Lithotripsy proved to be useful safe alternative for sialolithiasis treatment.

  13. An Evaluation of Electroacupuncture at the Weizhong Acupoint (BL-40) as a Means of Relieving Pain Induced by Extracorporeal Shock Wave Lithotripsy.

    PubMed

    Chen, Wei-Ta; Chang, Fang-Chia; Chen, Yi-Hung; Lin, Jaung-Geng

    2014-01-01

    Background. Extracorporeal shock wave lithotripsy (ESWL) is the preferred option for urolithiasis treatment. However, intensities of pain may be induced and the sedative anesthetic or analgesics were usually needed. The aim of this study was to develop an improved acupuncture-assisted anesthesia approach in pain relief. Methods. We conducted a single-blind, randomized controlled study in China Medical University Hospital. Patients treated by ESWL due to upper urolithiasis were randomly divided into control group, sham-EA group, and 100 Hz EA group. The high frequency electroacupuncture (EA) was applied at the Weizhong acupoint (100 Hz EA group) for 20 minutes prior to the ESWL. In the sham-EA group, the same procedures were performed as those of 100 Hz EA group but no electric current was given to stimulate the acupoints. In the control group, no action was taken before operation. The information including the numbers and dosage of analgesic requirements, pain score, vital signs, and the satisfaction of procedure was collected. Results. A total of 74 subjects were recruited and we found that the interval to the first request analgesic, the number/total dosage of additional analgesic, recovery time from anesthesia, and the satisfaction were all better in both the 100 Hz EA and the sham-EA group. The 100 Hz EA also showed better relief of painful sensations by delaying the onset of pain. Conclusions. The 100 Hz EA and the sham-EA can effectively relieve pain due to ESWL as well as reducing the dosage of opium analgesic used. PMID:25152761

  14. Extracorporeal shock wave lithotripsy versus retrograde intrarenal surgery for treatment for renal stones 1-2 cm: a meta-analysis.

    PubMed

    Zheng, Changjian; Yang, Hongmei; Luo, Jun; Xiong, Bo; Wang, Hongzhi; Jiang, Qing

    2015-11-01

    This study is to evaluate the efficacy and safety of extracorporeal shock wave lithotripsy (ESWL) versus retrograde intrarenal surgery (RIRS) for the treatment for renal calculi 1-2 cm. PubMed, Embase, the Cochrane Central Register of Controlled Trials, and the Chinese Biomedical Literature Database were researched and hand-searched for relevant congress abstracts and journals about RIRS and ESWL for the treatment for 1- to 2-cm renal stones. The retrieval time ended in September 2014. The related trials met the inclusion criteria were included in the meta-analysis. Two reviewers independently assessed the quality of all included studies, and meta-analysis was performed with RevMan 5.2. Seven literatures were retrieved, including 983 patients. The meta-analysis results showed that, compared to RIRS group, the patients in ESWL group had the following features:(1) the stone-free rate [relative risk (RR) 0.86; 95% confidence interval (CI) 0.77-0.95, P = 0.005] was significantly different between two groups; (2) The retreatment rate of RIRS group was lower (RR 8.12; 95% CI 4.77-13.83, P < 0.00); (3) The complications were not significantly different between two groups (Grade I RR 1.06; 95% CI 0.67-1.69, P = 0.80; Grade II RR 0.75; 95% CI 0.29-1.91, P = 0.54; Grade III RR 0.86; 95% CI 0.26-2.86, P = 0.80). Compared to ESWL, our results showed that RIRS provided significantly higher stone-free rate and lower retreatment rate and without increase in the incidence of complications. However, further randomized trials are needed to confirm these findings. PMID:26211003

  15. Optimal Skin-to-Stone Distance Is a Positive Predictor for Successful Outcomes in Upper Ureter Calculi following Extracorporeal Shock Wave Lithotripsy: A Bayesian Model Averaging Approach

    PubMed Central

    Cho, Kang Su; Jung, Hae Do; Ham, Won Sik; Chung, Doo Yong; Kang, Yong Jin; Jang, Won Sik; Kwon, Jong Kyou; Choi, Young Deuk; Lee, Joo Yong

    2015-01-01

    Objectives To investigate whether skin-to-stone distance (SSD), which remains controversial in patients with ureter stones, can be a predicting factor for one session success following extracorporeal shock wave lithotripsy (ESWL) in patients with upper ureter stones. Patients and Methods We retrospectively reviewed the medical records of 1,519 patients who underwent their first ESWL between January 2005 and December 2013. Among these patients, 492 had upper ureter stones that measured 4–20 mm and were eligible for our analyses. Maximal stone length, mean stone density (HU), and SSD were determined on pretreatment non-contrast computed tomography (NCCT). For subgroup analyses, patients were divided into four groups. Group 1 consisted of patients with SSD<25th percentile, group 2 consisted of patients with SSD in the 25th to 50th percentile, group 3 patients had SSD in the 50th to 75th percentile, and group 4 patients had SSD≥75th percentile. Results In analyses of group 2 patients versus others, there were no statistical differences in mean age, stone length and density. However, the one session success rate in group 2 was higher than other groups (77.9% vs. 67.0%; P = 0.032). The multivariate logistic regression model revealed that shorter stone length, lower stone density, and the group 2 SSD were positive predictors for successful outcomes in ESWL. Using the Bayesian model-averaging approach, longer stone length, lower stone density, and group 2 SSD can be also positive predictors for successful outcomes following ESWL. Conclusions Our data indicate that a group 2 SSD of approximately 10 cm is a positive predictor for success following ESWL. PMID:26659086

  16. Shockwave lithotripsy and endourological stone treatment in children.

    PubMed

    Lahme, Sven

    2006-04-01

    Urolithiasis in children is a rare disease in developed countries. Due to the particular anatomical conditions of the infant body, indications and results of the well-known treatment modalities, such as shockwave lithotripsy (SWL), ureteroscopy and PCNL, have to be determined. Experience in active stone treatment in children is very rare and only a limited number of papers are available. SWL can be performed only if focus size and treatment facilities are adapted to the size of the child. Miniaturization of ureteroscopes allows primary access to the infant upper urinary tract. Results, complications and morbidity of the treatment are similar to the results in adults. The main prerequisite for the primary endoscopic approach is the experience of the surgeon. PCNL should be performed as Mini-Perc. Percutaneous procedures show equal results and morbidity compared to the treatment of adults, in experienced hands. As two-thirds of infant stone patients have an underlying metabolic disorder, close cooperation of adult and pediatric urologists, nephrologists and radiologists is necessary in order to achieve good results in the treatment of infant stones.

  17. [Complications of extracorporeal shockwave lithotripsy].

    PubMed

    Fuchs, G J; David, R D; Fuchs, A M

    1989-01-01

    The authors reviewed treatments performed worldwide using extracorporeal shock wave lithotripsy since its introduction in West Germany in 1980 to determine the efficacy of this treatment modality and its potential risks. The prevention of complications related to patients or shock wave energy are discussed, as well as the cardiovascular complications related to immersion, prevention of lesions to nearby organs, treatment of ESWL-induced bleeding, treatment of post-ESWL ureteral obstruction, prevention and treatment of infection, and long-term biological effects. Currently, less than 5% of patients are excluded from treatment with ESWL due to technical reasons or increased risk of periprocedural complications. Patients with cardiac pacemakers have been treated safely. Calcifications of the ipsilateral renal artery or aorta are considered only relative contraindications. However, certain technical limitations exist; i.e., the Dornier HM-3 cannot support patients weighing more than 135 kg., and patient height is also a limiting factor. There is an impressively low incidence of complications related to the energy of the shock wave. The severity and extent of damage are dose- and pressure-dependent. The potential for induction of cardiac arrhythmias secondary to the shock wave exists; however, effective prevention is achieved by coupling the shock wave discharge to the electrocardiogram. Complications of immersion are also extremely rare and can be avoided by careful preoperative evaluation. Damage to nearby organs such as pulmonary, gastric, duodenal or colonic contusions, constitute a very infrequent complication. Elevations of liver enzymes have also been noted post-lithotripsy. However, all these changes were transient and had no significant clinical consequences. Management of post-ESWL ureteral obstruction is by endourological procedures.(ABSTRACT TRUNCATED AT 250 WORDS)

  18. Improving the lens design and performance of a contemporary electromagnetic shock wave lithotripter.

    PubMed

    Neisius, Andreas; Smith, Nathan B; Sankin, Georgy; Kuntz, Nicholas John; Madden, John Francis; Fovargue, Daniel E; Mitran, Sorin; Lipkin, Michael Eric; Simmons, Walter Neal; Preminger, Glenn M; Zhong, Pei

    2014-04-01

    The efficiency of shock wave lithotripsy (SWL), a noninvasive first-line therapy for millions of nephrolithiasis patients, has not improved substantially in the past two decades, especially in regard to stone clearance. Here, we report a new acoustic lens design for a contemporary electromagnetic (EM) shock wave lithotripter, based on recently acquired knowledge of the key lithotripter field characteristics that correlate with efficient and safe SWL. The new lens design addresses concomitantly three fundamental drawbacks in EM lithotripters, namely, narrow focal width, nonidealized pulse profile, and significant misalignment in acoustic focus and cavitation activities with the target stone at high output settings. Key design features and performance of the new lens were evaluated using model calculations and experimental measurements against the original lens under comparable acoustic pulse energy (E+) of 40 mJ. The -6-dB focal width of the new lens was enhanced from 7.4 to 11 mm at this energy level, and peak pressure (41 MPa) and maximum cavitation activity were both realigned to be within 5 mm of the lithotripter focus. Stone comminution produced by the new lens was either statistically improved or similar to that of the original lens under various in vitro test conditions and was significantly improved in vivo in a swine model (89% vs. 54%, P = 0.01), and tissue injury was minimal using a clinical treatment protocol. The general principle and associated techniques described in this work can be applied to design improvement of all EM lithotripters.

  19. How do the residual fragments after SWL affect the health-related quality of life? A critical analysis in a size-based manner.

    PubMed

    Sahin, Cahit; Kafkasli, Alper; Cetinel, Cihangir A; Narter, Fehmi; Saglam, Erkin; Sarica, Kemal

    2015-04-01

    This study aimed at evaluating the possible effects of residual fragments (RF) after shockwave lithotripsy (SWL) on the health-related quality of life (QOL) of the patients on a size-related basis. Eighty six patients with RF after SWL were divided into three groups: Group 1 (n:30 with fragments ≤ 2 mm), Group 2 (n:21 2-≤ 4 mm) and Group 3 (n:35 > 4 mm). During a 3-month follow-up, spontaneous passage rates, emergency department visits, mean analgesic required, additional procedures and the QOL were all evaluated. QOL was evaluated using the Short Form-36 survey. Of the 30 patients with fragments ≤ 2 mm all cases passed the fragments spontaneously. Of the 21 cases with fragments 2-≤ 4, however, 76% were stone free. Last, of the 35 cases with fragments >4 mm, 52% passed them spontaneously in 3 months. While no patient with fragments ≤ 2 mm required emergency department visit, 19% of the cases with fragments 2-≤ 4 mm and 51.4 % with fragments >4 mm did require this visit. Mean analgesic need (mg) values were higher in cases with larger fragments. Evaluation of the QOL score data in a subgroup comparison base showed that cases with larger fragments had prominently lower scores during both 1- and 3-month evaluation. RF after SWL could pose an impact on the QOL of the cases in a size-related basis. While fragments ≤ 2 mm had nearly no impact on this aspect larger fragments could significantly affect the QOL.

  20. Mobile lithotripsy services: best bet for most hospitals.

    PubMed

    Dougherty, E; Hagin, D

    1989-03-01

    During its short history, extracorporeal shock wave lithotripsy has revolutionized the treatment of kidney stones and may well have a substantial impact on gallstone treatment. The two technologies are potential money makers for hospitals if properly planned for and conceived. For the majority of hospitals, shared arrangements, whether they involve leases or joint ventures, are the key to a successful lithotripsy program. Rural and midsized communities have the greatest need for renal lithotripsy, and hospitals in these areas should explore mobile programs. Urban hospitals located in areas where there is already adequate access to lithotripters are well advised to work with established programs unless the price of lithotripters drops significantly. The demand for biliary lithotripsy remains uncertain, but one thing is clear: hospitals that don't prepare for it now will be left behind once the technology finds it niche.

  1. [Ureterorenoscopy combined with extracorporeal shockwave lithotripsy].

    PubMed

    González Cabrera, L A; Oro Ortiz, J

    1989-01-01

    In May 1986, extracorporeal shock wave lithotripsy and endourologic procedures became available in the treatment of lithiasis at the "Hermanos Ameijeiras" Hospital. The present study describes our experience and the results achieved during a 12-month period using endourologic procedures. During this period 65 URS procedures were performed to treat post-ESWL ureteral obstruction, and 22 to push the stone up to the kidney for subsequent ESWL treatment.

  2. Fragmentation methods in laser lithotripsy

    NASA Astrophysics Data System (ADS)

    Jiang, Zhi X.; Whitehurst, Colin; King, Terence A.

    1991-07-01

    Following a series of opto-acoustic-mechanical and spectroscopic studies into the basic mechanisms of laser lithotripsy, a plasma-mediated opto-mechanical energy transfer model is presented. Laser energy, first absorbed by the calculi material at the surface and couples into the initiated plasma following ionization of vaporized material, is finally transformed into destructive mechanical energy via a shock wave induced by the impulsive expansion of the resulting plasma. This leads to the fragmentation of the calculi. The laser-plasma energy coupling gives a new definition for the fluence threshold to laser induced breakdown, which agrees with shock wave detection and analysis. A laser pulse shape with initial low intensity and sufficient fluence to vaporize a required amount of target material (lasting a few microsecond(s) ) and terminating in a short, intense pulse of about 1microsecond(s) or less, to couple most of the laser energy into the dense young plasma and so create high pressures, is required to produce optimum effect for laser lithotripsy. An opto-mechanical coupler has been designed which transfers the maximum laser energy into mechanically destructive energy, and successfully fragments various types of urinary and biliary calculi even including those calculi with poor surface absorptance, like pure white cystine. A solid state laser, Ho:YAG (2.1 micrometers wavelength and 150 microsecond(s) pulse width), has also been tested as an alternative to the flashlamp-excited dye laser. The underwater shock wave induced by this laser has been measured and has successfully fragmented calculi with poor absorptance in the visible region.

  3. Do renal cysts affect the success of extracorporeal shockwave lithotripsy? A retrospective comparative study.

    PubMed

    Gücük, Adnan; Oztürk, Ufuk; Uyetürk, Uğur; Kemahlı, Eray; Akın, Güven; Imamoğlu, M Abdurrahim; Metin, Ahmet

    2013-01-01

    The aim of this study was to assess the effect of simple renal cysts on extracorporeal shockwave lithotripsy (SWL) in patients with calyceal renal calculi. Patients with simple renal cysts >35 mm and ipsilateral renal calculi <20 mm that were treated with SWL constituted group 1 (cyst + calculi). The control group included patients aged >40 years that had renal calculi <20 mm and no cysts that were treated with SWL. The 2 groups were compared according to age, gender, body mass index, calculi size, localization, and density, the calculi fragmentation rate, and the percentage of stone-free patients. Mean cyst size in group 1 was 44.04 ± 9.08 mm. Mean age in group 1 was 61.4 ± 10.2 years versus 56.9 ± 8.2 years in the control group; the difference was significant (P = 0.045). There were not any other significant differences between the 2 groups, except for the stone-free rate (P > 0.05), which was 33.3% in group 1 and 68.2% in the control group (P = 0.017). The presence of renal cysts in a patient with calculi requires that an individualized treatment plan be devised, so as to provide the patient with the most effective treatment.

  4. Noncontrast computed tomography can predict the outcome of shockwave lithotripsy via accurate stone measurement and abdominal fat distribution determination.

    PubMed

    Geng, Jiun-Hung; Tu, Hung-Pin; Shih, Paul Ming-Chen; Shen, Jung-Tsung; Jang, Mei-Yu; Wu, Wen-Jen; Li, Ching-Chia; Chou, Yii-Her; Juan, Yung-Shun

    2015-01-01

    Urolithiasis is a common disease of the urinary system. Extracorporeal shockwave lithotripsy (SWL) has become one of the standard treatments for renal and ureteral stones; however, the success rates range widely and failure of stone disintegration may cause additional outlay, alternative procedures, and even complications. We used the data available from noncontrast abdominal computed tomography (NCCT) to evaluate the impact of stone parameters and abdominal fat distribution on calculus-free rates following SWL. We retrospectively reviewed 328 patients who had urinary stones and had undergone SWL from August 2012 to August 2013. All of them received pre-SWL NCCT; 1 month after SWL, radiography was arranged to evaluate the condition of the fragments. These patients were classified into stone-free group and residual stone group. Unenhanced computed tomography variables, including stone attenuation, abdominal fat area, and skin-to-stone distance (SSD) were analyzed. In all, 197 (60%) were classified as stone-free and 132 (40%) as having residual stone. The mean ages were 49.35 ± 13.22 years and 55.32 ± 13.52 years, respectively. On univariate analysis, age, stone size, stone surface area, stone attenuation, SSD, total fat area (TFA), abdominal circumference, serum creatinine, and the severity of hydronephrosis revealed statistical significance between these two groups. From multivariate logistic regression analysis, the independent parameters impacting SWL outcomes were stone size, stone attenuation, TFA, and serum creatinine. [Adjusted odds ratios and (95% confidence intervals): 9.49 (3.72-24.20), 2.25 (1.22-4.14), 2.20 (1.10-4.40), and 2.89 (1.35-6.21) respectively, all p < 0.05]. In the present study, stone size, stone attenuation, TFA and serum creatinine were four independent predictors for stone-free rates after SWL. These findings suggest that pretreatment NCCT may predict the outcomes after SWL. Consequently, we can use these predictors for selecting

  5. Biliary extracorporeal shockwave lithotripsy.

    PubMed

    Rawat, B; Burhenne, H J

    1990-01-01

    Biliary extracorporeal lithotripsy has been considered one of the alternatives to surgery for the treatment of gallstones in the bile ducts and in the gallbladder. Although this technique can fragment almost all gallstones, the clinical effectiveness of this new treatment modality must be measured by successful elimination of all fragments. Some physical principles, stone targeting, patient protocol, complications, and clinical results are presented.

  6. [Extracorporeal shockwave lithotripsy in chronic pancreatitis].

    PubMed

    Soehendra, N; Grimm, H; Meyer, H W; Schreiber, H W

    1989-09-15

    Extracorporeal shock wave lithotripsy was performed on eight patients (six men, two women; mean age 46.3 years, range 36-58) with predominantly stone-induced obstructive pancreatitis. Stones in the pancreatic duct were smashed in one session to such an extent that the fragments were eliminated spontaneously via the ostium which had previously been split endoscopically. Repeat lithotripsy to achieve complete removal was necessary in only two patients. In one there were multiple concrements along the entire length of the main pancreatic duct; the other had a cherry-sized stone near the bifurcation of the accessory pancreatic duct. There were no serious complications. After successful removal of the stones all patients were free of pain which before had required strong analgesics to control. Six patients remained pain-free during a follow-up period of two eight months. Pain again occurred in the other two, but it was less frequent and milder.

  7. Percutaneous nephrolithotomy for renal stones following failed extracorporeal shockwave lithotripsy: different performances and morbidities.

    PubMed

    Zhong, Wen; Gong, Ting; Wang, Liang; Zeng, Guohua; Wu, Wenqi; Zhao, Zhigang; Zhong, Weide; Wan, Shaw P

    2013-04-01

    The purpose of this study is to summarize the results of percutaneous nephrolithotomy (PCNL) for renal stones following failed extracorporeal shockwave lithotripsy (SWL), and to investigate the effect of previous SWL on the performances and morbidities of subsequent PCNL. Sixty-two patients with a history of failed SWL who underwent PCNL on the same kidney (group 1) were compared to 273 patients who had received PCNL as first treatment choice (group 2). Patient demographics, stone characteristics, operative findings, and complications were documented and compared. Groups 1 and 2 had similar patient demographics and stone characteristics. Mean time to establish access was comparable in both groups (10.5 ± 4.2 vs. 9.6 ± 4.5 min, p = 0.894). Time required to remove stones and total operative time were longer in group 1 (71.5 ± 10.3 vs. 62.3 ± 8.6 min, p = 0.011 and 95.8 ± 12.0 vs. 80.6 ± 13.2 min., p = 0.018, respectively). Group 1 had lower clearance rate compared to group 2 (83.9 vs. 93.4 %, p = 0.021), while postoperative complications were similar in both groups. Scattered stone fragments buried within the tissues made the procedure more difficult for stone fragmenting and extracting, which lead to longer operative time and inferior stone free rate. However, the PCNL procedure was safe and effective in patients with failed SWL. The risk of complications was similar and clearance rate was encouraging.

  8. Decreased Radiation Exposure and Increased Efficacy in Extracorporeal Lithotripsy Using a New Ultrasound Stone Locking System

    PubMed Central

    Ravier, Emmanuel; Promeyrat, Xavier; Codas, Ricardo; Fehri, Hakim Fassi; Crouzet, Sebastien; Martin, Xavier

    2015-01-01

    Abstract Purpose: To compare fluoroscopy duration, radiation dose, and efficacy of two ultrasound stone localization systems during extracorporeal shockwave lithotripsy (SWL) treatment. Patients and Methods: Monocentric prospective data were obtained from patients consecutively treated for renal stones using the Sonolith® i-sys (EDAP TMS) lithotripter, with fluoroscopy combined with ultrasound localization using an “outline” Automatic Ultrasound Positioning Support (AUPS) (group A), or the “free-line” Visio-Track (VT) (EDAP-TMS) hand-held three-dimensional ultrasound stone locking system (group B). Efficacy rate was defined as the within-groups proportion stone free or with partial stone fragmentation not needing additional procedures. Statistical analysis used Pearson chi-square tests for categoric variables, nonparametric Mann-Whitney tests for continuous variables, and linear regression for operator learning curve with VT. Continuous variables were reported as median (range) values. Results: Patients in group A (n=73) and group B (n=81) were comparable in baseline characteristics (age, kidney stone size, others) and in SWL application (duration, number of shocks, energy [Joules]). During SWL, the median (range) duration (seconds) of radiation exposure was 159.5 (0–690) in group A and 3.5 (0–478) in group B (P<0.001) and irradiation dose (mGy.cm2), 10598 (0–54843) in group A and 163 (0–13926) in group B (P<0.001). Fluoroscopy time significantly decreased with operator experience using VT. The efficacy rate was 54.5% in group A and 79.5% in group B (P=0.001). Conclusion: VT significantly reduced fluoroscopy use during SWL and the duration and dose of patient exposure to ionizing radiation. Stone treatment efficacy was significantly greater with VT mainly because of a better real-time monitoring of the stone. PMID:26133199

  9. Mobile extracorporeal shockwave lithotripsy.

    PubMed

    Rajagopal, V; Bailey, M J

    1991-01-01

    During the last 18 months, extracorporeal shockwave lithotripsy (ESWL) has been provided at Epsom District Hospital using a mobile unit containing a Dornier HM4 lithotriptor. Patients with upper ureteric and renal stones were selected for treatment, which was performed without anaesthesia or sedation as a day-case procedure; 83 patients were treated, 5 of them with bilateral stones. Seventy patients required 1 treatment session, 17 required 2 and 1 patient required 3. There were no serious complications but 3 patients needed ureteroscopy to remove obstructing stones. The overall success rate was 86%. The cost to treat each NHS patient was 253 pounds. Mobile lithotripsy as a day-case procedure is a safe and cost-effective means of treating urolithiasis and can be performed in a District General Hospital.

  10. [Shockwave lithotripsy in gallbladder and bile duct calculi: indications and results].

    PubMed

    Paumgartner, G

    1990-01-01

    Extracorporeal shock-wave lithotripsy combined with adjuvant litholytic therapy (ursodeoxycholic acid and chenodeoxycholic acid) is a relatively safe and effective noninvasive therapy for selected patients with symptomatic radiolucent gallbladder stones. The best results (80% stone-free patients within 1 year) are obtained with radiolucent solitary stones with a diameter of less than 20 mm. Shock-wave lithotripsy achieves rapid clearance of stones in about 80% of patients with bile duct calculi in whom endoscopic procedures fail.

  11. [Shockwave lithotripsy: energy needed for fragmenting calculi].

    PubMed

    Drach, G W

    1989-01-01

    Based on the experience with the Dornier HM-3 lithotripter, the author analyzes herein the adverse effects caused by extracorporeal shock wave lithotripsy. Although admittedly empirical, an attempt is made to establish the number of shock waves and pressure required to achieve stone fragmentation without causing injury to the kidney. The effects of lung, stomach, colon, and skin or muscle contusions, hematoma, renal scarification, decreases in renal function, elevations in liver enzymes, and pancreatitis are reported, as well as systemic effects such as hemoglobinemia and hemoglobinuria, hearing change, and potential excessive radiation exposure, etc. The estimate of shock wave energy is discussed, highlighting the importance of the number of shock waves over the energy of the shock wave, and attention is focussed on the concept of stone fragility. Although we can nearly define the upper limits of energy related to safety, the author concludes that currently many questions remain unanswered.

  12. [New trends in extracorporeal shockwave lithotripsy].

    PubMed

    Folberth, W

    1992-03-01

    Extracorporeal shock wave lithotripsy has become an established and successful treatment modality for urinary and biliary calculi. However, shock wave technology and corresponding device designs are still at an innovative stage. Three trends are discussed in this paper. In shock wave technology the electromagnetic principle seems to win the race. The demands for successful and tissue-protective stone disintegration require shockwave sources with high dynamic range and optimised focal geometry. Electromagnetic shock wave generators meet all these requirements. For stone localisation an isocentric X-ray targeting system combined with integrated shock wave application is accepted as the "gold standard". In ultrasound localisation in-line targeting is superior to out-of-line targeting.

  13. Impact of shockwave lithotripsy on upper urinary tract calculi.

    PubMed

    Riehle, R A; Näslund, E B; Fair, W; Vaughan, E D

    1986-10-01

    Extracorporeal shock wave lithotripsy (ESWL) currently is performed in selected urologic centers to treat over 80 per cent of patients with symptomatic upper urinary tract calculi. This noninvasive technique utilizing shockwaves to disintegrate stones into sand-sized particles allows the patient to pass the particles with spontaneous urination and replaces most surgery or percutaneous endoscopy for stone removal. However, stone-free success rates must be individualized depending on stone position, stone size, and composition. Lithotripsy of renal stones prior to migration and proximal ureteral stones early in their symptomatic course may alter significantly the incidence of distal ureteral calculi requiring hospitalization, cystoscopy, or ureteroscopy.

  14. [Clinical relevance of extracorporeal shockwave lithotripsy (ESWL) in choledocholithiasis].

    PubMed

    Weiss, W; Türk, C; Brownstone, E; Hruby, W; Klose, W; Kölbl, C; Marberger, M; Tuchmann, A

    1989-09-29

    Primary endoscopic removal of bile duct stones is an established method of treatment. However, the extraction of stones is impossible in about 10% of cases despite successful endoscopic papillotomy and manual lithotripsy. Over a period of two years extracorporeal shock-wave lithotripsy (ESWL) was performed in 32 patients. Piezolith 2200, a second generation lithotripter was used, which requires neither analgesia nor anaesthesia for the patient. Localisation of the stones was carried out by means of a 3.5 MH 2 sector scanner. ESWL treatment was successful in 24 of 32 patients (75%). In 6 patients the bile duct stones were too large or too numerous and in 2 patients sonographic localisation was impossible. Out of a total of 131 patients with stones in the biliary tract only 9 (6.8%) needed surgery. Piezoelectric lithotripsy is a safe and effective adjunct procedure for the treatment of bile duct stones which were not extractable by endoscopy.

  15. [Extracorporeal shockwave biliary lithotripsy. Physical basis and clinical application].

    PubMed

    Méndez-Sánchez, N; Uribe-Esquivel, M; Bosques, F; de la Mora, G; Sánchez, J M; Ponciano, G

    1990-01-01

    Extracorporeal shock waves lithotripsy is a new procedure discovered and applied in the present decade to treat urinary and biliary stones. Shock waves are acoustic waves similar to sonic waves which follow the acoustic laws and therefore the shock waves can be refracted or reflected depending on the medium interface. Due to the high water content, the human body can be crossed by shock waves which eventually may be focused on the target stone. There are several commercially available shock waves generators, i.e. the spark gap emisors which were the first ones, and the piezoceramic and electromagnetic emisors. To focus the shock waves on a biliary stone the machines are provided with fluoroscopic or ultrasound devices or with both in the most advanced machines. Using an electromagnetic emisor (Lithostar plus) our group has treated 78 patients with biliary stones without analgesia or anesthesia. Total stone fragmentation was achieved in 85% of the cases. In patients with cholesterol gallstones who undergo lithotripsy, an adjuvant treatment with oral cholesterol solvent is mandatory. Extracorporeal biliary lithotripsy is free of mortality, and the morbidity is less than 5%.

  16. Small-bowel perforation after shockwave lithotripsy.

    PubMed

    Rodrigues Netto, Nelson; Ikonomidis, Jean A; Longo, José Antonio; Rodrigues Netto, Mauricio

    2003-11-01

    A 51-year-old woman with a history of stone disease sustained two 3 x 2-mm ileal perforations during SWL (6000 shockwaves; 0.33-0.42 mJ/mm2) for a 14 x 8-mm left-sided midureteral stone. Low energy levels should be applied when ureteral stones are treated by SWL with the patient prone.

  17. [Biliary extracorporeal shockwave lithotripsy. Preliminary communication].

    PubMed

    Garnica, E

    1989-01-01

    Shock wave lithotripsy has been successfully used in the treatment of urinary stones. Since 1985, it has also been applied in the management of gallbladder and biliary duct stones. The preliminary experience in Venezuela with the shock wave technology for the treatment of biliary stone disease is presented. The facilities of the Unit for the Treatment of Lithiasis. UNILIT of Venezuela, in Caracas were used. This unit is equipped with a Siemens Lithostar, that operates with an electromagnetic shock wave generator guided by a very accurate computerized biplane fluoroscopic system. Symptomatic gallstones with functioning gallbladder and radiolucid stones smaller than 3 cm, were the most important inclusion criteria. For duct stones, all cases that could not be managed by endoscopy were included. Fifteen cases have been treated from April 1988. Ten with gallstones and 5 with biliary duct stones. Success rate for gallstones, clarifications of gallbladder within a 12 month follow-up, was achieved in 40%. In the cases of biliary duct lithiasis, the aim was to reduce the stone to smaller fragments that could pass spontaneously or be retrieved by endoscopic maneuvers. In all the five cases treated, the stones could be crushed into small fragments and in four, they were easily withdrawn by endoscopic ballooning. Preliminary results and published data suggest that shockwave lithotripsy is a valuable method of treatment for selected cases of gallbladder stones and it is specially useful in the management of biliary duct stones where the endoscopic maneuvers have failed.

  18. Femtosecond laser lithotripsy: feasibility and ablation mechanism

    NASA Astrophysics Data System (ADS)

    Qiu, Jinze; Teichman, Joel M. H.; Wang, Tianyi; Neev, Joseph; Glickman, Randolph D.; Chan, Kin Foong; Milner, Thomas E.

    2010-03-01

    Light emitted from a femtosecond laser is capable of plasma-induced ablation of various materials. We tested the feasibility of utilizing femtosecond-pulsed laser radiation (λ=800 nm, 140 fs, 0.9 mJ/pulse) for ablation of urinary calculi. Ablation craters were observed in human calculi of greater than 90% calcium oxalate monohydrate (COM), cystine (CYST), or magnesium ammonium phosphate hexahydrate (MAPH). Largest crater volumes were achieved on CYST stones, among the most difficult stones to fragment using Holmium:YAG (Ho:YAG) lithotripsy. Diameter of debris was characterized using optical microscopy and found to be less than 20 μm, substantially smaller than that produced by long-pulsed Ho:YAG ablation. Stone retropulsion, monitored by a high-speed camera system with a spatial resolution of 15 μm, was negligible for stones with mass as small as 0.06 g. Peak shock wave pressures were less than 2 bars, measured by a polyvinylidene fluoride (PVDF) needle hydrophone. Ablation dynamics were visualized and characterized with pump-probe imaging and fast flash photography and correlated to shock wave pressures. Because femtosecond-pulsed laser ablates urinary calculi of soft and hard compositions, with micron-sized debris, negligible stone retropulsion, and small shock wave pressures, we conclude that the approach is a promising candidate technique for lithotripsy.

  19. A double-blind assessment of segmental sensory changes with epidural fentanyl versus epidural saline in patients undergoing extracorporeal shock-wave lithotripsy.

    PubMed

    Hore, P J; Silbert, B S; Cook, R J; Beilby, D S

    1990-04-01

    Segmental changes to pin prick and cold stimuli were tested in a double-blind manner in pain-free patients scheduled for extracorporeal shockwave lithotripsy (ESWL). Fifty patients were randomly allocated to receive either epidural fentanyl (100 micrograms in 10 ml normal saline) or 10 ml epidural normal saline. In a further 25 patients an epidural catheter was inserted but no solution injected. In contrast to this latter group, epidural fentanyl and normal saline both produced segmental sensory changes. There were no significant differences between fentanyl and normal saline groups in the number of patients reporting sensory changes to pin prick, rate of onset of these changes, or segmental level. For cold stimuli, more patients in the fentanyl group than in the normal saline group reported a change (16 vs. 8; P = 0.02) but the segmental level was similar. The effect of normal saline as a diluent in epidurally administered opioids may be of clinical importance.

  20. Fetotoxicity and teratogenesis of SWL treatment in the rabbit.

    PubMed

    Frankenschmidt, A; Heisler, M

    1998-02-01

    The potential effects of extracorporeal application of shockwaves on an embryo or fetus were explored in an animal model. In experimental Series A, the fetuses of 30 gravid rabbits were exposed to piezoelectrically induced and sonographically guided shockwaves on Day 25 or 20 of gestation under technical conditions corresponding to extracorporeal lithotripsy in humans. Fetotoxicity was examined by abdominal section 24 hours or 9 days later, and immediate/intermediate damage was assessed (resorptions, viability, gross injuries, and microscopic lesions of the target and neighboring fetuses). In series B, the kidneys of an additional 28 gravid rabbits (including a control group) were exposed to the same shockwave treatment on Day 11 of gestation in order to investigate indirect embryotoxic effects, including teratogenic potency. One day before the expected birth, the maternal kidneys, uteri, and adjacent organs were examined for lesions, and the 156 offspring were assessed for embryolethal, embryonoxious, or teratogenic sequelae. Shockwave targeting of the cranium, thorax, abdomen, or placenta was usually lethal to the fetuses. When the uterine wall or the space between two fetuses was targeted, the fetuses suffered from superficial hematoma, as was found in the surrounding soft tissues within a radius of 1.5 cm. Fetuses outside this region were vital and free of lesions. Shockwave treatment of the maternal kidney resulted in renal petechial hemorrhage or subcapsular hematoma. However, statistically significant embryotoxic or teratogenetic effects could be demonstrated neither from maternal data (resorptions) nor from fetal findings (body measurements, vitality test, inner organs, skeletal deformities). When using a piezoelectric lithotripter with a small focus of high energy, lesions of a fetus are to be expected only when it is located in or close to the focus. It seems that embryotoxic or teratogenic sequelae do not occur when shockwaves are focused outside the

  1. [Extracorporeal shockwave lithotripsy in children].

    PubMed

    Charbit, L; Terdjman, S; Gendreau, M C; Guérin, D; Quental, P; Cukier, J

    1989-01-01

    Upper urinary tract lithiasis is a rare condition in children in comparison to its incidence in the adult population. The distribution of lithiasis in children has been reported to be 56% for idiopathic lithiasis, 20% for metabolic lithiasis, and 25% for lithiasis associated with uropathy. Extracorporeal shock wave lithotripsy (ESWL) has become the treatment of choice for upper urinary tract calculi in the adult patient as well as in children after minor changes and complementary material had permitted the utilization of the Dornier HM-3 lithotripter in these small patients. The reported 3-month success rates range from 47% to 83%, according to the number of patients or kidneys free from calculi. The series reported in the literature have a mean of about 60% completely stone-free kidneys evidenced on the X-ray of the abdomen without preparation at 3 months. Its indications and results are comparable with those of ESWL in the adult. However, the long-term results have as yet not been evaluated and, to date, its hypothetical effects on renal growth or arterial pressure have not yet been elucidated.

  2. Small bowel perforation after extracorporeal shockwave lithotripsy of an ureter stone.

    PubMed

    Klug, R; Kurz, F; Dunzinger, M; Aufschnaiter, M

    2001-01-01

    A 60-year-old man was treated by extracorporeal shock wave lithotripsy (ESWL) for an impacted ureter stone. Two days after the procedure he developed an acute abdomen. On laparotomy, a small bowel perforation in the area of an adhesion to the abdominal wall was found. The adherent intestinal segment was located exactly in the range of the ESWL field, so that excluding further reasons the shockwave lithotripsy must be assumed to be causative.

  3. Optically triggered solid state driver for shock wave therapy

    NASA Astrophysics Data System (ADS)

    Duryea, Alexander P.; Roberts, William W.; Cain, Charles A.; Hall, Timothy L.

    2012-10-01

    Shock wave lithotripsy (SWL) represents one of several first-line therapies for the treatment of stones located in the kidneys and ureters. Additional applications for shock wave therapy are also under exploration, including non-urinary calculi, orthopedics, and neovascularization. Except for the elimination of a large water bath in which the treatment is performed, current procedures remain largely unchanged, with one of the original commercial devices (the Dornier HM3) still considered a gold standard for comparison. To accelerate research in this area, Coleman, et al. published an experimental electrohydraulic shock wave generator capable of simulating the acoustic field generated by the HM3. We propose a further update of this system, replacing the triggered spark gap with an optically triggered solid state switch. The new system has better reliability, a wider operating range, and reduced timing jitter allowing synchronization with additional acoustic sources under exploration for improving efficacy and reducing injury. Originally designed for exciting electrohydraulic spark electrodes, the system can also be adapted for driving piezoelectric and electromagnetic sources.

  4. Experience with 500 extracorporeal shockwave lithotripsy patients using a low-cost unit: the "Econolith".

    PubMed

    Simon, D

    1995-06-01

    The Econolith (Medispec Ltd.) is a modular extracorporeal shockwave (SWL) system that uses the spark gap as its source for lithotripsy. In this study, the immediate and late results and complications in 500 patients (640 treatments) treated with this machine during the last 2 years were summarized. An average fragmentation rate of 86% was achieved after the first treatment. A stone-free situation at 3 months was achieved in 75% of the cases; 18% had small (< 5mm) fragments, and 7% had larger fragments. Auxiliary procedures were required in 8% of the patients. Minor complications such as hematuria, colic, and urinary tract infection were seen in 6% of the patients. The Econolith system is safe and effective. Its mobility and low cost enable any urologist to use this technology even with a low monthly turnover of patients.

  5. [Cost comparison of laparoscopic cholecystectomy and extracorporeal shockwave lithotripsy in the treatment of gallstones].

    PubMed

    Sonnenberg, A; Benninger, J; Ell, C

    1994-11-11

    To aid in the choice between laparoscopic cholecystectomy and extracorporeal shock wave lithotripsy for the treatment of gallstones the costs of the two methods were investigated. A decision tree was constructed so as to set out the initial procedure costs of both techniques and possible subsequent costs due to treatment failure or complications. The computations were based on figures from the University Clinic, Erlangen, in 1993. The direct (medical) costs of laparoscopic cholecystectomy amounted to DM 3556, to which must be added further indirect costs of DM 3152 arising from loss of working capacity and premature death. The direct expenses for lithotripsy including outpatient aftercare were DM 6708 and the indirect expenses DM 1858. The overall costs per patient for lithotripsy are hence DM 1858 higher than those of laparoscopic cholecystectomy. This cost difference remained substantially unaltered even when the success rates of the two techniques were varied over a wide range. When lithotripsy is performed entirely as an outpatient procedure and inpatient costs hence disappear, the expected overall cost drops from DM 8567 to DM 6381. Omission of the lump sum charge for lithotripsy effects a similar drop in overall costs to DM 6379. Laparoscopic cholecystectomy is hence cheaper than lithotripsy. Only if lithotripsy can be performed at very low cost can it compete with laparoscopic cholecystectomy.

  6. Laser lithotripsy: a review of 20 years of research and clinical applications.

    PubMed

    Dretler, S P

    1988-01-01

    Four new technologies have transformed the treatment of urinary calculi: electrohydraulic lithotripsy, ultrasonic lithotripsy, extracorporeal shock wave lithotripsy, and laser lithotripsy. Initial attempts to ablate urinary calculi by continuous wave CO2, ruby, and Nd-YAG lasers failed because of excess thermal injury and inability to pass the laser energy via a flexible fiber. Basic laboratory studies then demonstrated that short pulsed laser energy absorbed by the calculus resulted in fragmentation. The parameters that produced optimal urinary calculus fragmentation were found using the flashlamp pumped tunable dye laser, with the following parameters: wavelength: 504 nm; pulse duration: 1 microsec; fiber: 250 micro silica-coated quartz; repetition: 5-20 Hz. Use of pulsed dye laser caused no tissue damage. The mechanism of fragmentation is light absorption, plasma development, and repetitive acoustic shock wave action with resultant fragmentation. The techniques for application of laser to calculi have been successful, and new, miniature instruments have been developed. Laser lithotripsy is a successful method for fragmenting ureteral calculi. The small caliber of the laser fiber makes this method useful for treating calculi in narrow, tortuous ureters; impacted calculi; distal calculi in ureters that cannot be dilated, via the percutaneous route for stones in calyces or impacted in the upper ureter. Investigations are continuing to optimize fragmentation of harder calculi and to use laser fragmentation within the kidney. Laser lithotripsy may also be used to fragment biliary calculi.

  7. High-energy v low-energy shockwave lithotripsy in treatment of ureteral calculi.

    PubMed

    Mathes, G L; Mathes, L T

    1997-10-01

    The size of the crater formed in a urinary calculus subjected to shockwave lithotripsy (SWL) is directly proportional to the energy delivered to the stone surface. This study compared the effect of high and low energy levels on the outcomes of ureteral SWL. Ureteral calculi (N = 336) were treated with the conventional low-energy Siemens Lithostar and 62 with the higher-energy (1.02 v 0.5 mJ/mm2) modification of the Lithostar, the Siemens Shock Tube C. Stone locations included all regions of the ureter. The average stone treated with the standard Lithostar measured 8.1 mm in diameter and received 5461 shockwaves (treatment time 45 minutes) at 17.2 kV (range 14.5-19.0 kV). The stone-free rate was 72%, with stents being used in 16% of patients and a retreatment rate of 9%. The typical stone treated with Shock Tube C was 10.4 mm in diameter and received 3528 shockwaves (treatment time 30 minutes) at an average energy setting of 4.1 (range 1.5-8.0). The stone-free rate was 75%, with stents being used in 9.8% of cases, and a retreatment rate of only 1.6% (P < 0.003). In this study, Shock Tube C yielded stone-free rates equivalent to those of the conventional machine. However, the number of shockwaves, treatment time, and retreatment rate were significantly lower with the new shock tube. High-energy lithotripsy is more efficient than low-energy treatment of ureteral calculi.

  8. Is percutaneous monotherapy for staghorn calculus still indicated in the era of extracorporeal shockwave lithotripsy?

    PubMed

    Rodrigues Netto, N; Claro, J de A; Ferreira, U

    1994-06-01

    Staghorn stones can be treated by percutaneous nephrolithotomy (PCNL) or by extracorporeal shockwave lithotripsy (SWL); however, the combination of the two techniques appears as the most frequent treatment. In a previous study, the investigators noted that staghorn calculi treated with PCNL monotherapy have a good clearance rate. Herein, we have reviewed 102 staghorn stones that underwent PCNL before (1984-1986) (Group 1; n = 51) and after (1987-1990) (Group 2; n = 45) the introduction of SWL. The stone burden has increased in both size and complexity: there were 27 complete staghorn calculi (60%) in Group 2 compared with 19 (37%) in Group 1. Despite the higher number of kidney punctures, blood urea nitrogen and serum creatinine measurements demonstrated improvement of renal function postoperatively. The stone-free rates were 78% and 89% and the retreatment rates 31% and 18% in Groups 1 and 2, respectively. Complications (29% and 38%) were a function of the technical factors that become more apparent in the more difficult cases. Our data support the concept that the surgeon should have no previous intention to use the lithotripter and, therefore, should try to remove the entire stone percutaneously safely and economically.

  9. Holmium laser lithotripsy of bladder calculi

    NASA Astrophysics Data System (ADS)

    Beaghler, Marc A.; Poon, Michael W.

    1998-07-01

    Although the overall incidence of bladder calculi has been decreasing, it is still a significant disease affecting adults and children. Prior treatment options have included open cystolitholapaxy, blind lithotripsy, extracorporeal shock wave lithotripsy, and visual lithotripsy with ultrasonic or electrohydraulic probes. The holmium laser has been found to be extremely effective in the treatment of upper tract calculi. This technology has also been applied to the treatment of bladder calculi. We report our experience with the holmium laser in the treatment of bladder calculi. Twenty- five patients over a year and a half had their bladder calculi treated with the Holmium laser. This study was retrospective in nature. Patient demographics, stone burden, and intraoperative and post-operative complications were noted. The mean stone burden was 31 mm with a range of 10 to 60 mm. Preoperative diagnosis was made with either an ultrasound, plain film of the abdomen or intravenous pyelogram. Cystoscopy was then performed to confirm the presence and determine the size of the stone. The patients were then taken to the operating room and given a regional or general anesthetic. A rigid cystoscope was placed into the bladder and the bladder stone was then vaporized using the holmium laser. Remaining fragments were washed out. Adjunctive procedures were performed on 10 patients. These included transurethral resection of the prostate, transurethral incision of the prostate, optic internal urethrotomy, and incision of ureteroceles. No major complications occurred and all patients were rendered stone free. We conclude that the Holmium laser is an effective and safe modality for the treatment of bladder calculi. It was able to vaporize all bladder calculi and provides a single modality of treating other associated genitourinary pathology.

  10. [Laser lithotripsy of ureteral calculi].

    PubMed

    Schmeller, N; Ehsan, A; Kriegmair, M; Muschter, R; Liedl, B; Hofstetter, A

    1994-07-01

    A total of 149 patients with 152 ureteral stones were treated with intraureteral lithotripsy by Dye-laser (83.55%), Alexandrite-laser (41.27%), electrohydraulic lithotripsy adapted for use in the ureter (25.16%) or neodymium: YAG laser with optomechanic coupling (3.2%). The Dye-laser has an automatic pulse shut-off mechanism with spectral analysis of the reflected laser beam, so that effective laser pulses can only be released by contact with a stone. Most (127 of 83.5%) of the stones could be completely fragmented, so that no further treatment was necessary. In 16 cases (10.5%) the stone was too hard for fragmentation and had to be removed by alternative techniques. Intraureteral lithotripsy is a save and effective method of treating ureteral stones that cannot be reached or have not been treated successfully by shockwave lithotripsy. No significant differences in outcome were found between the different lasers or electrohydraulic lithotripsy. In selected cases endoscopic treatment may be recommended as treatment of first choice.

  11. [Endoscopic removal of ureteral calculi in the age of extracorporeal shockwave lithotripsy].

    PubMed

    Kaufmann, F; Heidler, H

    1990-03-15

    High success rates of the shock wave lithotripsy in the treatment of ureteral stones are only achieved by repeated sessions and auxiliary measures. Therefore no general therapy of choice can be established. If differentiation is made according to certain criteria the endoscopic removal of ureteral calculi still plays an effective role as a significant complement to the shock wave lithotripsy. With a primary success rate of 93% for the distal ureteral stone and a rate of 1.5% for severe complications the endoscopic removal of large and small ureteral calculi indicated by a high risk situation of a vain attempt of a spontaneous stone loss is presenting a highly effective and successful matter of therapy with low risk. These indications are considered unfavourable assumptions for a primary shock wave lithotripsy. The therapeutical concept, results and complications due to ureteroscopy are presented and compared with the shock wave treatment.

  12. Patient and personnel exposure during extracorporeal lithotripsy.

    PubMed

    Glaze, S; LeBlanc, A D; Bushong, S C; Griffith, D P

    1987-12-01

    Extracorporeal shock wave lithotripsy (ESWL) has provided a nonsurgical approach to treatment of renal stones. The Dornier lithotripter uses dual image intensified x-ray systems to center the stone before treatment. Three imaging modes are offered: a fluoroscopic mode and two video spot filming modes. The average entrance exposure to the stone side of the typical patient at our facility is 2.6 X 10(-3) C kg-1 (10 R) [range: 0.5-7.7 X 10(-3) C kg-1 (2-30 R)] which is comparable and often much less than that reported for percutaneous lithotripsy. Recommendations are made for minimizing patient exposure. Scattered radiation levels in the lithotripter room are presented. We have determined that Pb protective apparel is not required during this procedure provided x-ray operation is temporarily halted should personnel be required to lean directly over the tub to attend to the patient. If the walls of the ESWL room are greater than 1.83 m (6 feet) from the tub, shielding in addition to conventional construction is not required.

  13. Patient and personnel exposure during extracorporeal lithotripsy.

    PubMed

    Glaze, S; LeBlanc, A D; Bushong, S C; Griffith, D P

    1987-12-01

    Extracorporeal shock wave lithotripsy (ESWL) has provided a nonsurgical approach to treatment of renal stones. The Dornier lithotripter uses dual image intensified x-ray systems to center the stone before treatment. Three imaging modes are offered: a fluoroscopic mode and two video spot filming modes. The average entrance exposure to the stone side of the typical patient at our facility is 2.6 X 10(-3) C kg-1 (10 R) [range: 0.5-7.7 X 10(-3) C kg-1 (2-30 R)] which is comparable and often much less than that reported for percutaneous lithotripsy. Recommendations are made for minimizing patient exposure. Scattered radiation levels in the lithotripter room are presented. We have determined that Pb protective apparel is not required during this procedure provided x-ray operation is temporarily halted should personnel be required to lean directly over the tub to attend to the patient. If the walls of the ESWL room are greater than 1.83 m (6 feet) from the tub, shielding in addition to conventional construction is not required. PMID:3679826

  14. [Extracorporeal shockwave lithotripsy today--an assessment of current status].

    PubMed

    Chaussy, C; Wilbert, D M

    1997-05-01

    Extracorporeal shock wave lithotripsy (ESWL) is standard therapy for urolithiasis. With comparable technical principles, various lithotripters have been developed and are in routine use. Renal pelvic stones, calyceal stones, ureteral stones, and other special forms can be treated with varying results. Currently, the so-called clinically insignificant residual fragments and the recurrence of calculi are under discussion. Whereas the side effects of ESWL are well known, studies comparing ESWL with other endourological procedures are still lacking.

  15. Alterations in predicted growth rates of pediatric kidneys treated with extracorporeal shockwave lithotripsy.

    PubMed

    Lifshitz, D A; Lingeman, J E; Zafar, F S; Hollensbe, D W; Nyhuis, A W; Evan, A P

    1998-10-01

    The long-term effects of extracorporeal shockwave lithotripsy (SWL) on the kidneys of children treated for renal calculi are unclear. In order to determine if SWL has any negative effects on renal growth rates, we reviewed long-term (mean 9-year) follow-up data on 29 pediatric patients treated between 1984 and 1988 with an unmodified Dornier HM3 lithotripter. Changes in renal length, serum creatinine, and blood pressure were analyzed. Predicted renal growth was calculated using a formula for age-adjusted renal length. Treated kidneys were stratified into normal and abnormal groups based on a history of renal surgery, evidence of recurrent infection, and obvious anatomic abnormalities. Fifty-six upper urinary tract calculi were treated in 34 renal units. Twenty-two renal units (68%) were rendered stone free, and 65% of the patients continue to be stone free. At follow-up, one patient was classified as having new-onset hypertension, and the mean serum creatinine was 0.93 +/- 0.08 mg/dL. Both at treatment and at follow-up, no significant differences were found in the sizes of the treated and untreated kidneys. However, at treatment, the abnormal group of kidneys seemed to be smaller than expected (mean Z -1.30 +/- 1.10), whereas the group of normal kidneys was very close (mean Z 0.18 +/- 0.54) to the predicted length. At follow-up, the deviations between actual and predicted renal length were significantly more negative. Treated kidneys were an additional 1.26 +/- 0.49 SD units below their expected length (p = 0.02). Untreated kidneys were further below normal as well but possibly to a lesser degree (-0.82 +/- 0.36; p <0.04). Although there was a trend for the abnormal group to have smaller kidneys than the normal group, both groups showed the same trend toward an age-adjusted reduction in renal growth at follow-up. The alterations in renal growth patterns observed in this population are unsettling and could be secondary to either treatment effect (SWL) or, more

  16. [Use of extracorporeal shockwave lithotripsy for kidney calculi].

    PubMed

    Trapeznikova, M F; Dutov, V V

    2004-01-01

    278 patients with coral nephrolithiasis were examined in 1990-2003. Extracorporeal shock-wave lithotripsy was made in 46 (16.5%) patients with 48 coral stones (mean age 48.2 +/- 18.3 years) as a basic treatment. The length of the concrement was 4.9 +/- 1.8 cm, width 3.8 +/- 1.4 cm, a relative area 19.72 +/- 13.01 cm2. All the patients have initially undergone internal drain of the kidney by a catheter (n = 13) or stent (n = 33). Each lithotripsy session included, on the average, 2882 +/- 318 impulses (17-19 kV). The number of high-energy impulses per a session comprised 342 +/- 23. A total number of the sessions reached 3.4 +/- 1.55. Initial destruction of the concrement requires 1.6 +/- 0.6 sessions in 10144 +/- 1081.2 impulses per one patient including 1436 +/- 96.6 high-energy impulses. One procedure comprises 2-3 sessions of lithotripsy with a 5-7 day interval. The results were assessed at discharge after the first session and 6 months later, the degree of stones elimination from the kidney, complications, manipulations to manage the complications. At discharge after 3 lithotripsy sessions recovery was achieved only in 3 out of 46 (6.52%) patients. Six months later the fragments eliminated in 26.1% (12 of 46 patients). Monolithotripsy caused complications in 13 patients. Additional manipulations made up 65.2%. Inefficacy of explorative treatment necessitated conversion to open intervention in 6 (13.1% 0 patients. The use of extracorporeal lithotripsy as a monotherapy in coral nephrolithiasis is now limited.

  17. Semen quality after extracorporeal shockwave lithotripsy for the management of lower ureteric stones: a review of the literature.

    PubMed

    Gulur, Dev Mohan; Philip, Joe

    2011-10-01

    Extracorporeal Shockwave Lithotripsy has long been an important tool in the urologists' armamentarium for the treatment of distal ureteric stones. Several studies have been conducted on the morbidity and adverse effects of ESWL on human tissues but the effect of lithotripsy on semen and testes remains inconclusive. Impact on semen analysis and testes is important because the seminal vesicles and testes are exposed to the shock waves due to their anatomical proximity to the distal ureter. This article has reviewed all the published literature in English language on semen analysis after lithotripsy.

  18. Extracorporeal shockwave lithotripsy of primary intrahepatic stones.

    PubMed

    Kim, M H; Lee, S K; Min, Y I; Lee, M G; Sung, K B; Cho, K S; Lee, S G; Min, P C

    1992-01-01

    Extracorporeal shockwave lithothripsy (ESWL) was performed in intrahepatic stone patients (n = 18) by Dornier MPL 9,000 with ultrasound guidance. The patients had T-tube (n = 9) or percutaneous transhepatic biliary drainage tube (n = 9). Average treatment session was four and shock-wave numbers were in the range of 3,064 to 12,000 (average 6,288 shocks). Intrahepatic stones were removed completely in 16 patients over a 3 month period by ESWL and combined stone extraction maneuver such as cholangioscopic or interventional radiologic method. Extracorporeal shockwave lithothripsy was very helpful in facilitating extraction of stones in unfavorable locations or located above the severe stricture. In summary, extracorporeal shockwave lithotripsy, followed by percutaneous stone extraction, will provide an improvement in the success rate and duration of treatment required for complete removal of primary hepatolithiasis.

  19. [Extracorporeal shockwave lithotripsy on the Sonolith-3000 apparatus].

    PubMed

    Tkachuk, V N; Veroman, V Iu; Komiakov, B K; Bannikov, V V; Sapelkin, A V; Ivanov, A O; Iudkevich, B A; Kalashian, R K

    1991-01-01

    The authors observed 812 patients with nephrolithiasis who underwent 876 sessions of shock-wave lithotripsy on Sonolith-3000 lithotriptor supplied with an ultrasonic system of the stone localization. The size of nephroliths ranged from 0.7 to 4.2 cm. Large-size nephroliths required repeated sessions and pretreatment establishment of the stent. The procedure proceeded without anesthesia. Subsequent renal colic was reported in 126 (15.5%), an exacerbation of pyelonephritis in 45 (5.5%), subcapsular hematoma in 4 (0.5%) of the patients. 790 patients showed clinical response (97.3%), with a complete destruction of the stone in 446 (54.9%) and partial one in 344 (42.4%) cases. 27 subjects were treated in outpatient setting. According to the authors, lithotripsy is contraindicated in urinary tract obstruction below the stone, renal failure, chronic pyelonephritis in the active phase of inflammation, marked impairment of cardiac rhythm.

  20. Lower-pole caliceal stone clearance after shockwave lithotripsy, percutaneous nephrolithotomy, and flexible ureteroscopy: impact of radiographic spatial anatomy.

    PubMed

    Elbahnasy, A M; Clayman, R V; Shalhav, A L; Hoenig, D M; Chandhoke, P; Lingeman, J E; Denstedt, J D; Kahn, R; Assimos, D G; Nakada, S Y

    1998-04-01

    Spatial anatomy of the lower renal pole, as defined by the infundibulopelvic angle (LIP angle), infundibular length (IL), and infundibular width (IW), plays a significant role in the stone-free rate after shockwave lithotripsy. A wide LIP angle, a short IL, and a broad IW, individually or in combination, favor stone clearance, whereas a LIP <70 degrees, an IL >3 cm, or an IW < or =5 mm are individually unfavorable. When all three unfavorable factors or an unfavorable LIP and IL coexist, the post-SWL stone-free rate falls to 50% or less. Using these criteria, more than one fourth of our patients with a lower-pole calculus might have been better served by an initial percutaneous or perhaps ureteroscopic procedure, neither of which is significantly affected by the lower-pole spatial anatomy.

  1. [Percutaneous transhepatic laser lithotripsy of gallstones--results of animal experiments].

    PubMed

    Wenk, H; Thomas, S; Baretton, G; Schildberg, F W

    1989-01-01

    Since laserinduced shock wave lithotripsy of gallstones is possible for treatment of common bile duct stones, the percutaneous transhepatic laserlithotripsy of stones in the gallbladder is examined in an animal study. In 8 animal experiments it could be shown that puncture of the gallbladder, dilatation of the working channel, (laserinduced) shock wave lithotripsy, removal of the fragments and the instruments are possible in one session. Neither when performing simple closure of the wound by suture nor by fibrinsealing severe side-effects could be recognized. After laserlithotripsy ablation of epithelium and hematomas can be observed, which are restituted within one month. The experiments show that in organ-saving shockwave lithotripsy there is no need for waiting for the development of a fistula and the percutaneous approach can be simplified.

  2. Laser lithotripsy for ureteric stones.

    PubMed

    Foo, K T; Wujanto, R; Wong, M Y

    1994-01-01

    The use of laser is a relatively new modality of treatment in urology. With the advent of the pulse-dye laser lithotripter and a finer 7.2 ureteroscope (miniscope), we found that it was more effective for treating ureteric stones than the conventional ultrasound lithotripsy. Between May 1989 and December 1991, 239 patients (162 males, 77 females) with 259 ureteric stones were treated endoscopically by this modality. Their ages ranged from 19 to 81 years (mean 46.3). The stones were mostly of 5 to 10 mm in their transverse diameters. They were situated in the upper ureter in 59, middle ureter in 39, and lower ureter in 161 cases. The miniscope was inserted into the ureter without prior dilatation and under direct vision. Stone fragmentation was performed using the 504-nm pulse-dye laser of 30 to 60 mJ energy. Complete fragmentation of the stone using the Candela laser lithotripter was achieved in 202 patients (85%). The average hospital stay was two days. Of the 37 unsuccessful cases, 11 were due to failed ureteroscopy, ten due to poor visibility from bleeding, 14 due to stone migrating up to the kidneys and two were monohydrate calculi which did not fragment with laser lithotripsy. Open ureterolithotomies were necessary in 14 patients (5.9%). Significant morbidity was perforation of the ureters which occurred in three patients (1.3%). This was due to ureteroscopy rather than the laser lithotripsy itself. With the availability of the new shockwave lithotripter (ESWL) which can treat ureteric stones in even less invasive ways, without anaesthesia and as outpatient, we are now reserving laser lithotripsy for those who failed ESWL. Generally they are the stones which cause severe obstruction to the ureter.

  3. Endoscopic lithotripsy for bile duct stones.

    PubMed

    Lee, J G; Leung, J W

    1993-01-01

    Endoscopic sphincterotomy and common duct stone extraction is successful in 85-90% of patients using conventional balloons and baskets. However, most patients with biliary stones > 2 cm will require mechanical, electrohydraulic, or laser lithotripsy prior to stone extraction. Mechanical lithotripsy is inexpensive, easy to perform, and effective in 80-90% of cases. Most failures result from inability to entrap the stone in the lithotripsy basket. These cases may be successfully treated using either electrohydraulic or laser lithotripsy (intraductal shockwave lithotripsy). In most cases, intraductal shockwave lithotripsy requires direct visual control. Due to difficulty with peroral cholangioscopy, these techniques will not be widely used until a smaller, more maneuverable "mother and baby scope" system is developed. We recommend mechanical lithotripsy as the initial treatment for large biliary stones. Failed cases should be referred to specialized centers for a repeat attempt with intraductal shockwave lithotripsy. With this approach, an experienced endoscopist is successful in removing biliary stones in over 95% of patients. Long term biliary stenting remains a viable option for the high risk patients with large common bile duct stones.

  4. [Opioid analgesia during extracorporeal shockwave lithotripsy of gallstones].

    PubMed

    Schelling, G; Weber, W; Mendl, G; Negri, L; Jänicke, U; Sackmann, M; Peter, K

    1989-11-01

    Gallstone lithotripsy is a new and noninvasive therapeutic option for approximately 20% of patients who harbor cholesterol gallstones. Technologically advanced second-generation lithotripters such as the Dornier MPL 9000 device have greatly simplified biliary lithotripsy with a consecutive reduction in anesthetic requirements. Despite these technical improvements, patients still can experience considerable pain and discomfort during biliary ESWL. Due to its relatively predictable pharmacokinetic profile and its short duration of action, alfentanil appeared to be a suitable drug for pain relief during stone fragmentation. In order to analyze the degree and distribution of pain during gallstone lithotripsy and to evaluate pain control by alfentanil, 44 consecutive patients (ASA I-II) with no previous ESWL therapy were studied. Pain intensity and degree of opioid-induced sedation during shock wave application were evaluated according to 5-point verbal scales that ranged from 0 = no pain to 4 = unbearable pain and 0 = patient awake to 4 = patient asleep. All patients were treated while in the prone position and received oxygen at 6 l/min. After stone focusing, an alfentanil infusion at an initial rate of 2.5 micrograms/kg min was started. Single shock waves were released as test shocks after approximately 2 min. If they were well tolerated, stone fragmentation was begun. If not, more alfentanil was allowed to accumulate until continuous treatment was tolerated. Further in- or decreases of the infusion rate were titrated according to patient response. Registered variables included the required alfentanil loading dose, maintenance and total doses, and the applied shock wave energy approximated by multiplication of shock wave number and voltage squared.(ABSTRACT TRUNCATED AT 250 WORDS)

  5. [Endoscopic lithotripsy with pneumatic shockwave (Swiss Lithoclast) using a mini-ureteroscope].

    PubMed

    Knispel, H H; Klän, R; Dieckmann, K P

    1993-09-01

    We performed endoscopic lithotripsy for 23 urinary stones (21 ureteral and 2 bladder stones) with a pneumatic shockwave unit (Swiss Lithoclast; EMS, Angiomed), for the first time applying the probe through the tangential working channel of a semirigid 6.9-Fr ureteroscope (Circon, ACMI). Disintegration was successful in all stones (5-24 mm). Immediately after treatment, the 2 patients with bladder calculi and 10 of the patients with ureteral stones (47.6%) were stone free, while another 5 had residual fragments < 3 mm. Migration of fragments in 4 patients (19%) led to subsequent extracorporeal shock wave lithotripsy. There were no ureteral perforations in this series. Routine application of double-J stents avoided any serious postoperative complications. Endoscopic lithotripsy with the pneumatic shockwave unit was shown to be highly effective regardless of stone composition. The ltihotripsy probe is easily applied through mini-ureteroscopes.

  6. [Extracorporeal shockwave lithotripsy in the treatment of urolithiasis in children].

    PubMed

    Dzeranov, H K; Pavlov, A Iu; Cherepanova, E V

    2009-01-01

    Extracorporeal shock wave lithotripsy (ESWL) was performed in 1451 children with urolithiasis aged from 7 months to 16 years. A total of 2464 sessions were made. Low-energy impulses in ESWL were effective in 98.8% children with concrements up to 2.0 cm in size and in 98.8% of those with stones larger than 2.0 cm. We believe that main factors of high efficiency of ESWL in children are: more friable structure of stones, small depth of stone location, faster evacuation of the stone fragments. ESWL with low energy impulses is highly effective and is not accompanied with traumatic complications. Renal parenchyma is not affected.

  7. [Extracorporeal shockwave lithotripsy in the treatment of pediatric urolithiasis].

    PubMed

    Zöller, G; Ludewig, M; Kallerhoff, M; Zappel, H

    1991-11-01

    The 2nd generation lithotripter LITHOSTAR plus was used for extracorporeal shock wave lithotripsy of 9 kidney stones, 2 ureteral calculi and 2 bladder stones in 10 children 15 months to 17 years old. Ultrasonic stone localization was used in 2 children, x-ray guided stone localization in 8 children. General anesthesia was necessary in 6 children. A stone free rate of 60% was achieved after 1 treatment. Except for one 14-year old boy no adjuvant procedures like percutaneous nephrostomy or ureteral stents were applied. No major complications were encountered.

  8. Shockwave lithotripsy-new concepts and optimizing treatment parameters.

    PubMed

    Bhojani, Naeem; Lingeman, James E

    2013-02-01

    The treatment of kidney stone disease has changed dramatically over the past 30 years. This change is due in large part to the arrival of extracorporeal shock wave lithotripsy (ESWL). ESWL along with the advances in ureteroscopic and percutaneous techniques has led to the virtual extinction of open surgical treatments for kidney stone disease. Much research has gone into understanding how ESWL can be made more efficient and safe. This article discusses the parameters that can be used to optimize ESWL outcomes as well as the new concepts that are affecting the efficacy and efficiency of ESWL.

  9. Renal milk of calcium: contraindication to extracorporeal shockwave lithotripsy.

    PubMed

    Heidenreich, A; Vorreuther, R; Krug, B; Moul, J W; Engelmann, U H

    1996-01-01

    Renal milk-of-calcium (MOC) cysts are rare findings, with only approximately 60 cases reported in the literature. The diagnosis depends on the demonstration of the typical "half-moon" configuration on horizontal beam radiography; classical ultrasound finding is a gravity-dependent, echogenic shadowy material in a renal cyst. The importance of the MOC syndrome lies in its recognition and differentiation from a renal stone in order to avoid unwarranted surgery or extracorporeal shock-wave lithotripsy (ESWL). We have encountered five patients with renal MOC and present the typical clinical and radiological features in order to facilitate differential diagnosis.

  10. [Antibiotic prophylaxis with enoxacin in extracorporeal shockwave lithotripsy].

    PubMed

    Knipper, A; Böhle, A; Pensel, J; Hofstetter, A G

    1989-01-01

    According to literature, 16 to 35% of operatively removed renal stones harbour bacteria. The efficacy of antibiotic prophylaxis with enoxacin in reducing the rate of bacteriuria after extracorporeal shock wave lithotripsy (ESWL) was investigated in a prospective randomized study. Twenty-five patients received a single 400 mg dose of enoxacin one hour before ESWL, 25 patients did not receive an antibiotic. It was found that a single 400 mg dose of enoxacin one hour before ESWL can reduce the rate of bacteriuria significantly.

  11. [Laser lithotripsy of the upper urinary tract].

    PubMed

    Miller, K

    1995-01-01

    Approximately 10% of all stone patients require an endoscopic stone treatment. With the advent of laserlithotripters a new technology became available, featuring extremely thin (200 microns) and flexible lithotripsy probes. As a consequence, miniscopes have been developed for endoscopic stone manipulation in the ureter. These miniscopes greatly facilitate ureteroscopy and expectantly will reduce complications associated with this procedure. The success rates of laserlithotripsy are in the 90% range, the only serious drawback are the high purchase costs of the laser. Independent from these new possibilities for intracorporeal lithotripsy, extracorporeal shockwave lithotripsy (ESWL) remains the first therapy of choice for ureteral calculi.

  12. Renal function after bilateral extracorporeal shockwave lithotripsy.

    PubMed

    Cass, A S

    1994-12-01

    We studied renal function an average of 44 months after simultaneous bilateral renal SWL in 56 patients. No cases of clinically apparent acute renal failure occurred in the early postoperative period. The glomerular filtration rate (GFR) was calculated using an empiric formula having a significant correlation with measured creatinine clearance, and a change of 20% or greater was considered a clinically significant deterioration in renal function. Of the seven patients with a preoperative serum creatinine concentration of > 1.5 mg/dL, six had an average increase of 35% in postoperative GFR attributable to relief of obstruction, while one had a 30% reduction in GFR. Among 49 patients with a preoperative serum creatinine concentration of 1.5 mg/dL or less, there was an increase in postoperative GFR in 22 patients (45%), no change in 3 (6%), and a decrease in 24 (49%), who had a higher number of multiple renal stones (p < 0.05) and of repeat SWL (p = 0.08). Nine of them (18%) had a clinically significant decrease in GFR of > 20%. A review of the literature showed a long-term reduction of function in the individual human kidney after SWL in some cases of a solitary kidney and in some cases with an untreated contralateral kidney. Because there is no evidence that an untreated contralateral kidney aids the long-term recovery of the function of a treated kidney in all cases, simultaneous or separate bilateral renal SWL would not influence this long-term reduction in renal function, which was felt to occur with multiple renal stones and repeat SWL.

  13. [Extracorporeal shockwave lithotripsy: our experience in 5,000 cases].

    PubMed

    Krayannis, A; Kostakopoulos, A; Deliveliotis, C; Delakas, D; Goulandris, N; Dimopoulos, C

    1989-01-01

    The authors report their experience on 7,500 patients who underwent extracorporeal shock wave lithotripsy (ESWL1). The first 6,800 were treated with the standard Dornier HM-3 lithotripter, while the remaining 700 were treated with the modified HM-3 machine equipped with the new ellipsoid (and the double-shot generator). The authors present the results and conclusions from their experience with 5,000 ESWL treatments which were performed at their Urology Department. An analysis is made on patient age, sex, stone site, duration of sessions, average number of shock waves used, exposure time, number of electrodes per session, retreatments, and results achieved relative to stone size. Furthermore, the authors report on the complications and treatment in special cases; i. e., patients with horseshoe kidneys, solitary kidneys, spinal cord lesions, radiolucent calculi, hemophilia, and staghorn stones. The mean duration of treatment was 37 minutes. The average number of shock waves used was 1,703. The mean radiation exposure time was 1.9 minutes. Two electrodes per session were required in 48% of the patients. Three months following lithotripsy, 72% of the patients were stone-free, 19% had small remaining stone fragments, and 9% had unimportant stone particles.

  14. In situ extracorporeal shockwave lithotripsy for ureteral calculi: investigation of factors influencing stone fragmentation and appropriate number of sessions for changing treatment modality.

    PubMed

    Kim, H H; Lee, J H; Park, M S; Lee, S E; Kim, S W

    1996-12-01

    To determine the factors influencing stone fragmentation and to suggest when to change treatment modality for ureteral calculi refractory to repetitive in situ extracorporeal shockwave lithotripsy (SWL), we analyzed 369 patients treated primarily by the second-generation lithotripter, Siemens Lithostar, from March 1989 to December 1993. Three hundred forty-two (92.7%) of the patients were ultimately free of stones after repetitive in situ SWL. The cumulative stone-free rates of the first, second, and third session were 64%, 81%, and 88%, respectively, and the increment in the cumulative stone-free rate thereafter with further repeated in situ SWL was minimal (p < 0.01). The cumulative stone-free rate at the third session was 89%, 87%, and 86% for proximal, middle, and lower ureteral stones, respectively (p > 0.05). The cumulative stone-free rate at the third session was 100%, 90%, 87%, 70%, 67%, and 50% for stones <5 mm, 6 to 10 mm, 11 to 15 mm, 16 to 20 mm, 21 to 25 mm, and >25 mm, respectively (p < 0.001). According to the radiopacity of the stone, the cumulative stone-free rate at the third session was 96% for stones with minimal opacity, 94% for those with moderate opacity, and 70% for highly opaque stones (p < 0.001). The cumulative stone-free rate at the second session was 100% without ureteral obstruction; 80% with mild, 57% with moderate, and 67% with severe obstruction; and 50% in patients with nonappearance of the kidney (p < 0.05). From these observations, it could be concluded that the factors influencing fragmentation were the size and radiopacity of the calculi and the degree of ureteral obstruction, whereas the location of the calculi did not influence the cumulative stone-free rate of repetitive in situ SWL. It is preferable to restrict in situ SWL to three sessions in patients with ureteral calculi refractory to shockwaves. An early change of treatment modality either to ureteroscopic manipulation or to open surgery would be recommended if there

  15. [Color processing of ultrasonographic images in extracorporeal lithotripsy].

    PubMed

    Lardennois, B; Ziade, A; Walter, K

    1991-02-01

    A number of technical difficulties are encountered in the ultrasonographic detection of renal stones which unfortunately limit its performance. The margin of error of firing in extracorporeal shock-wave lithotripsy (ESWL) must be reduced to a minimum. The role of the ultrasonographic monitoring during lithotripsy is also essential: continuous control of the focussing of the short-wave beamand assessment if the quality of fragmentation. The authors propose to improve ultrasonographic imaging in ESWL by means of intraoperative colour processing of the stone. Each shot must be directed to its target with an economy of vision avoiding excessive fatigue. The principle of the technique consists of digitalization of the ultrasound video images using a Macintosh Mac 2 computer. The Graphis Paint II program is interfaced directly with the Quick Capture card and recovers the images on its work surface in real time. The program is then able to attribute to each of these 256 shades of grey any one of the 16.6 million colours of the Macintosh universe with specific intensity and saturation. During fragmentation, using the principle of a palette, the stone changes colour from green to red indicating complete fragmentation. A Color Space card converts the digital image obtained into a video analogue source which is visualized on the monitor. It can be superimposed and/or juxtaposed with the source image by means of a multi-standard mixing table. Colour processing of ultrasonographic images in extracoporeal shockwave lithotripsy allows better visualization of the stones and better follow-up of fragmentation and allows the shockwave treatment to be stopped earlier. It increases the stone-free performance at 6 months. This configuration will eventually be able to integrate into the ultrasound apparatus itself.

  16. Extracorporeal shockwave lithotripsy for salivary calculi in pediatric patients.

    PubMed

    Ottaviani, F; Marchisio, P; Arisi, E; Capaccio, P

    2001-10-01

    Salivary gland lithiasis is uncommon in pediatric patients. Color Doppler ultrasonography (US) enables an accurate diagnosis of lithiasis to be made without exposure to the radiation of traditional imaging techniques. The development of minimally invasive techniques in the ENT field has made salivary lithotripsy a feasible alternative to traditional invasive surgery. The safety and efficacy of shock wave lithotripsy for salivary calculi were evaluated in pediatric patients. Seven children (5 males; age 4-15 years) with single calculi (mean diameter 4.4 mm) of the submandibular (n = 4) and parotid glands (n = 3) underwent extracorporeal electromagnetic shock wave lithotripsy (EESWL). In four cases the stone was intraductal (two submandibular and two parotideal) and in the remaining three cases it was intraparenchymal (two submandibular and one parotideal). In one case sedative anesthesia was performed. The mean number of therapeutic sessions was five. Patients were followed up clinically and with US for 6-72 months (mean 32 months). Complete disintegration of the calculi was achieved in five cases while in two cases a residual fragment < 2 mm in diameter was observed. None of the patients had recurrence of calculi in the treated gland. Mild self-limited adverse effects (pain, swelling of the gland, self-limiting bleeding from the duct, cutaneous petechiae) were observed in four cases. Our data suggest that EESWL is effective, safe and well tolerated; the minimal invasiveness of the technique suggests that EESWL should be used as the primary approach to salivary calculi in pediatric patients. The continuous US monitoring enables the efficacy of EESWL to be evaluated during both treatment and follow-up, with only slight discomfort for the pediatric patient.

  17. [Clinical experiences with extracorporeal shockwave lithotripsy].

    PubMed

    Ackermann, D; Merz, V; Marth, D; Zehntner, C

    1989-07-01

    Clinical experience with 2738 patients treated by extracorporeal shock wave lithotripsy between March 1985 and December 1988 is reported. All treatments were performed with the Dornier HM-3 lithotriptor. 34% of the patients needed auxiliary measures, consisting primarily of urological manipulation to improve urinary drainage or for better localization and/or focussing of the stones. Severe complications were rare; urosepticemia occurred in 0.3%, 2 patients had to undergo nephrectomy because of abscessing pyelonephritis, and there was one death due to recurrent pulmonary embolism in a patient with polycythemia vera. ESWL was used for stones in the entire upper urinary tract. The stone free rate for pelvic calculi smaller than 2 cm was 79% three months after treatment; a further 16% showed desintegrated material smaller than 5 mm, augmenting the success rate to 95%. The success rate dropped to 74% for very large renal stones of more than 4 cm. A stone free rate of 84-96% was ascertained for ureteral calculi 3 months after ESWL. Absolute contraindications for ESWL are acute pyelonephritis, coagulation disorders and pregnancy. The patients must tolerate anesthesia, as most treatments with this lithotriptor must be carried out under peridural or general anesthesia and only in a few exceptional cases is treatment in sedoanalgesia possible. ESWL is now generally accepted in view of its negligible invasiveness, low morbidity and the high success rate. Modern treatment of urinary calculi is inconceivable without considering ESWL.

  18. [Extracorporeal shockwave lithotripsy of bile duct calculi].

    PubMed

    Greiner, L; Jakobeit, C

    1993-08-01

    Shockwave therapy of bile duct stones is not dependent on difficult preconditions concerning stone-volume and -composition or subsequent lythic therapy. Its main indication is failure of endoscopic sphincterotomy (EST). Shockwave lithotripsy of bile duct stones--which may even be carried out even instead of EST in specific cases--is with a success rate of 80 to 95% as effective as shockwave lithotripsy in urology.

  19. [Current status of extracorporeal shockwave lithotripsy].

    PubMed

    Wilbert, D M; Jocham, D; Eisenberger, F; Chaussy, C

    1994-11-01

    Extracorporeal shockwave lithotripsy has become an established standard procedure for the treatment of nephrolithiasis. Almost 100 lithotripters are installed in large and medium-sized urological departments in Germany. The number of treatments per year averages 660 ESWL sessions per hospital. Multifunctional use and non-urological ESWL therapy ensure maximum utilization of the lithotripter units. In additional hospitals mobile lithotripsy is provided. At present there is a trend toward ambulatory ESWL treatment.

  20. Comparative follow-up of patients with acute and obtuse infundibulum-pelvic angle submitted to extracorporeal shockwave lithotripsy for lower caliceal stones: preliminary report and proposed study design.

    PubMed

    Sampaio, F J; D'Anunciação, A L; Silva, E C

    1997-06-01

    Nowadays, there is a consensus that the poor success rate of extracorporeal shockwave lithotripsy (SWL) is in the treatment of lower caliceal stones. The gravity-dependent position of the lower-pole calices is postulated to be the main factor hindering the spontaneous passage of stone debris that results from SWL. Nevertheless, we proposed that there are some particular features of the inferior-pole collecting system anatomy that could contribute to fragment retention. We studied the influence of the lower infundibulum-pelvic angle on fragment retention, considering 74 patients submitted to SWL for the treatment of lower-pole nephrolithiasis in a Lithostar Plus machine. At a mean follow-up of 9 months, 75% of the patients presenting an angle of greater than 90 degrees between the lower infundibulum where the stone was located and the renal pelvis became stone-free within 3 months. On the other hand, only 23% of the patients presenting an angle smaller than 90 degrees between the lower infundibulum where the stone was located and the renal pelvis became stone-free during the follow-up. Determination of the angle between the renal pelvis and the infundibulum of the inferior pole calix where the stone is located is very important, because the angle will differ in the same kidney, depending on stone location. Although preliminary and based on a small series of patients, our data suggest that an acute pelvic-lower pole infundibular angle hinders the spontaneous discharge of fragments after SWL. Also, use of the proposed technique of pelvic-lower pole infundibular angle measurement will be important for unifying angle evaluation by other investigators.

  1. [Imaging procedures prior to the extracorporeal shockwave lithotripsy of gallstones].

    PubMed

    Schneider, H T; Ell, C; Benninger, J; Theobaldy, S; Friedel, N; Rödl, W; Heyder, N; Hahn, E G

    1991-01-25

    In order to determine whether cholecystography and computed tomography (CT) are capable of better gallstone characterization than conventional radiography alone, 91 patients (76 females, 15 males; mean age 47 +/- 12 years) with symptomatic single gallstones were studied prospectively prior to extracorporeal shock-wave lithotripsy with concomitant oral stone dissolution therapy. In addition, the value of oral cholecystography in demonstrating patency of the cystic duct was compared with ultrasound assessment of gallbladder function. Despite "negative" plain gallbladder radiographs in all patients, oral cholecystography showed significant stone calcification in 8 of the 91 patients and CT showed stone calcifications in 52 of the 91 patients. In 12 patients the maximum stone density was between 50 and 90 Hounsfield units, and in 40 patients it was more than 90 Hounsfield units. CT revealed ring-like calcification in the majority (79%) of these stones. Oral cholecystography showed satisfactory concentration of contrast medium in all patients, while ultrasonography of the gallbladder following a chemically defined test meal demonstrated contractility of more than 50% of initial volume in 69 patients and of less than 30% in 9 patients. Although oral cholecystography is a simple, readily available complication-free method, ultrasound assessment of gallbladder contraction is better for selecting patients for extracorporeal shock-wave lithotripsy. CT allows significantly better characterization of gallstones than oral cholecystography and conventional plain gallbladder radiography.

  2. Acceleration of lithotripsy using cavitation bubbles induced by second-harmonic superimposition

    NASA Astrophysics Data System (ADS)

    Osuga, Masamizu; Yasuda, Jun; Jimbo, Hayato; Yoshizawa, Shin; Umemura, Shin-ichiro

    2016-07-01

    Shock wave lithotripsy potentially produces residual stone fragments too large to pass through ureters and significant injury to the normal tissue surrounding the stone. Previous works have shown that the collapse of cavitation bubbles induced by high-intensity focused ultrasound can produce small stone fragments via cavitation erosion. However, the erosion rate is hypothesized to be reduced by ultrasound attenuation by excessively generated bubble clouds. If so, it is important to generate the bubbles only on the stone surface. The effects of peak-negative-enhanced (PNE) and peak-positive-enhanced (PPE) waves obtained by second-harmonic superimposition were investigated to control cavitation bubbles. With the PNE waves, the bubbles were generated only on the stone surface and the maximum erosion rate was 232 ± 32 mg/min. All the fragments were smaller than 2 mm, which makes them pass through ureters naturally. The proposed method shows the potential to significantly improve the speed of lithotripsy.

  3. Lithotripsy: an update on urologic applications in small animals.

    PubMed

    Lane, India F

    2004-07-01

    Lithotripsy methods for fragmenting uroliths continue to evolve.Increasing access to and experience with newer generation lithotriptors and continued study of laser methodology are likely to increase the application of lithotripsy methods in small animal urology. For small animals in which intervention is recommended for progressive, symptomatic, infected, or obstructive uroliths, nonsurgical extracorporeal or intracorporeal lithotripsy methods maybe considered.

  4. Shockwave lithotripsy in unrecognized pregnancy: interruption or continuation?

    PubMed

    Deliveliotis, C H; Argyropoulos, B; Chrisofos, M; Dimopoulos, C A

    2001-10-01

    A 32-year-old woman underwent SWL of a 4 x 6-mm calculus in the distal third of the right ureter, receiving 2100 shocks at a maximum intensity of 18 kV. Approximately 1 month later, it was discovered that she had been 10 weeks pregnant at the time of SWL. She chose to continue the pregnancy and delivered a normal infant at term. We do not advocate SWL in pregnancy, but further research is mandatory to determine if this procedure can ever be performed safely during pregnancy.

  5. [Lipids in the urine after extracorporeal shockwave lithotripsy].

    PubMed

    Thomas, J; Levillain, P; Thomas, E; Tobelem, G; Economou, C; Thibault, M; Lemonnier, A; Arvis, G

    1986-01-01

    Lipid corpuscles have been found in the urine in about 40 per cent of women (4/10) after extracorporeal shock wave lithotripsy, however this lipuria is very rare in men (1 or 2 per cent of cases) and less pronounced. During three days after treatment, this post-therapeutic lipuria was found to be independent of the age of patients, of the site of the calculi, of their chemical composition or of the number of shock waves administered. This lipuria probably results from the liquefaction of peri-pelvic fat tissue by exothermic reaction. These lipid corpuscles consist mostly of triglycerides and to a lesser extent phospholipids with a very small proportion of cholesterol and fatty acids.

  6. [Extracorporeal shockwave lithotripsy in patients with coagulation disorders].

    PubMed

    Ruiz Marcellán, F J; Mauri Cunill, A; Cabré Fabré, P; Argentino Gancedo Rodríguez, V; Güell Oliva, J A; Ibarz Servio, L; Ramón Dalmau, M

    1992-03-01

    During treatment of renal lithiasis with extracorporeal shock wave lithotripsy (ESWL) hemorrhagic events, especially renal hematoma, may present. A coagulation study is warranted in order to institute hemotherapy for blood factor deficiencies. We reviewed the records of 4,000 patients that had undergone ESWL. Of these, 17 (12 males, 5 females) presented coagulation disorders. The bleeding diatheses were due to platelet deficiency in 6 cases, plasma defects in 5, platelet and plasma disorders in 2, and capillary wall defects in 5 cases. The underlying cause was hepatosplenic disease in 12 cases, iatrogenic in 1, connectivopathy and corticoids in 2, and capillary purpura of unknown cause in 2 cases. Due to this protocol, no patient presented hemorrhage or hematoma from shock wave-induced lesions. These results show that a complete coagulation study must be performed in order to institute the necessary measures in patients with disorders of hemostasis due to the high risk of hematoma repeatedly reported in the literature.

  7. Urinothorax: A path, less travelled: Case report and review of literature

    PubMed Central

    Ranjan, Vikrant; Agrawal, Santosh; Chipde, Saurabh Sudhir; Dosi, Ravi

    2015-01-01

    Urinothorax is a very rare occurrence of urine in the pleural space. Urinothorax can occur as a consequence to percutaneous nephrolithotomy (PCNL), ureterorenoscopic lithotripsy (URSL) or shock wave lithotripsy (SWL). We herewith report a rare case of Urinothorax in a 35 years old male patient and discuss its current knowhow and clinical management. PMID:25810665

  8. Urinothorax: A path, less travelled: Case report and review of literature.

    PubMed

    Ranjan, Vikrant; Agrawal, Santosh; Chipde, Saurabh Sudhir; Dosi, Ravi

    2015-01-01

    Urinothorax is a very rare occurrence of urine in the pleural space. Urinothorax can occur as a consequence to percutaneous nephrolithotomy (PCNL), ureterorenoscopic lithotripsy (URSL) or shock wave lithotripsy (SWL). We herewith report a rare case of Urinothorax in a 35 years old male patient and discuss its current knowhow and clinical management.

  9. Using a three-dimensional computer assisted stone volume estimates to evaluate extracorporeal shockwave lithotripsy treatment of kidney stones.

    PubMed

    Bigum, Lene Hyldgaard; Ulriksen, Peter Sommer; Omar, Omar Salah

    2016-10-01

    This study describes and evaluates the use of non-contrast enhanced computerized tomography (NCCT) before and after extracorporeal shockwave lithotripsy (SWL). Computer measured stone volume was used as an exact measurement for treatment response. 81 patients received SWL of kidney stones at Herlev Hospital between April 2013 and January 2014 and follow-up was possible in 77 (95 %) patients. NCCT was used before and after treatment. Treatment response was expressed as a reduction of the stone volume. Stone characteristics as the stone volumes, HU, SSD and localization were measured by radiologist using a vendor non-specific computer program. Complications, patient characteristics and additional treatment were registered. On average, 5858 shocks were given each patient. The follow-up NCCT was performed 24 days after treatment. It was possible to calculate the stone volume in 88 % of the patients-the remaining 12 % it was not possible due to stone disintegration. The stone free rate was 22 %. The average relative reduction in stone burden was 62 %. Only 8 % of the patients were radiological non-responders. Steinstrasse was observed in 13 (17 %) and 28 (36 %) patients had additional treatment performed. Irradiation dose per NCCT was 2.6 mSv. Stone volume could be calculated in most patients. The relative reduction in stone burden after treatment was 62 %. The stone volume was redundant when evaluating stone free patients, but in cases of partial response it gave an exact quantification, to be used in the further management and follow-up of the patients.

  10. Using a three-dimensional computer assisted stone volume estimates to evaluate extracorporeal shockwave lithotripsy treatment of kidney stones.

    PubMed

    Bigum, Lene Hyldgaard; Ulriksen, Peter Sommer; Omar, Omar Salah

    2016-10-01

    This study describes and evaluates the use of non-contrast enhanced computerized tomography (NCCT) before and after extracorporeal shockwave lithotripsy (SWL). Computer measured stone volume was used as an exact measurement for treatment response. 81 patients received SWL of kidney stones at Herlev Hospital between April 2013 and January 2014 and follow-up was possible in 77 (95 %) patients. NCCT was used before and after treatment. Treatment response was expressed as a reduction of the stone volume. Stone characteristics as the stone volumes, HU, SSD and localization were measured by radiologist using a vendor non-specific computer program. Complications, patient characteristics and additional treatment were registered. On average, 5858 shocks were given each patient. The follow-up NCCT was performed 24 days after treatment. It was possible to calculate the stone volume in 88 % of the patients-the remaining 12 % it was not possible due to stone disintegration. The stone free rate was 22 %. The average relative reduction in stone burden was 62 %. Only 8 % of the patients were radiological non-responders. Steinstrasse was observed in 13 (17 %) and 28 (36 %) patients had additional treatment performed. Irradiation dose per NCCT was 2.6 mSv. Stone volume could be calculated in most patients. The relative reduction in stone burden after treatment was 62 %. The stone volume was redundant when evaluating stone free patients, but in cases of partial response it gave an exact quantification, to be used in the further management and follow-up of the patients. PMID:26914829

  11. [Extracorporeal shockwave lithotripsy--what type of anesthesia?].

    PubMed

    Dimai, W; Grebski, J

    1987-03-21

    Since lithotripsy of renal calculi by shock waves is painful, it requires anesthesia. General or regional anesthesia technics may be used. Of more than 1000 treatments at the University Hospital of Zurich, over 90% were done under epidural anesthesia. It is necessary to extend the anesthesia up to the level of Th 4/5 to block all painful sensations. 1-2% carbonated lidocaine was found to be the most suitable anesthetic, providing fast onset and reasonable duration of anesthesia and thus allowing early mobilisation of the patient after treatment. Approximately 3% of the patients were primarily scheduled for general anesthesia for several reasons. These patients were intubated and ventilated by a conventional anesthesia machine at 40-60 breaths per minute. With the small tidal volumes of 200-300 ml there was only minimal displacement of the concretions by respiratory movements. Monitoring of the endtidal CO2 turned out to be problematic in some cases. Epidural anesthesia with carbonated lidocaine is a highly suitable method for anesthesia in over 90% of lithotripsy treatments.

  12. [Lithotripsy in the conservative treatment of salivary stones].

    PubMed

    Vavrina, J; Müller, W; Schlegel, C

    1997-03-25

    Otolaryngologists and generalists as well are commonly involved in the evaluation and management of salivary gland stones. Most patients present with a history of recurrent swelling and pain in the gland, associated with eating. Up to date conservative therapy was limited to the treatment of the acute sialadenitis, which may develop as a consequence of the obstruction and often recurs until the function of the salivary gland ceases. Surgical treatment depends on the location of the calculus. Distal stones can be removed trans-orally by dilatation or incision of the duct, whereas those near the hilus and intraglandular stones required excision of the gland, including the disadvantage of a scar and the risk of injury to cranial nerves. Extracorporal shock wave lithotripsy is a new noninvasive method, which allows to destroy intra- and extraglandular salivary stones, mostly without the need of local or general anesthesia. Reported disintegration rates vary from 14% to 85%, depending on site and size of the calculus. About 80% of the patients remain symptomless Lithotripsy of salivary stones is a cost-effective, additional treatment modality to surgery and may be employed on an outpatient basis.

  13. [Experience from the first year of treatment of renal calculi with extracorporeal piezoelectric shockwave lithotripsy].

    PubMed

    Jensen, F S; Dørflinger, T; Jensen, K E; Krarup, T; Walter, S

    1991-06-10

    The experience of the first year with piezoelectric extracorporeal lithotripsy is described. One hundred and eighty-eight patients commenced treatment of 194 renoureteric stone units (a total of 328 stones). Twelve per cent required analgesics during therapy. The median number of treatments was two (1-6) and median number of shock waves 4,200 (450-24,606). One hundred and twenty-three stone units had concluded treatment and control schedules at the follow up end date. After six months, 59% of the stone units were stone-free, while 17% had residual fragments up to 2 mm, and additional 15% had residual fragments between 2 and 6 mm. Only few and insignificant complications were observed. Extracorporeal shock wave lithotripsy by the Wolf Piezolith 2300 is a well-tolerated, effective, relative painless and not complicated treatment of renal stones, and an important part of modern treatment of staghorn- and ureteric stones.

  14. [Percutaneous removal of kidney calculi and extracorporeal shockwave lithotripsy in patients with hemorrhagic diatheses].

    PubMed

    Kirschner, P; Ziemer, S; Brien, G; Gromnica-Ihle, E; Schöpke, W; Sydow, K

    1988-07-01

    Hemorrhage is the main complication of percutaneous kidney stone removal. Shock-wave lithotripsy also may causes bleeding complications. It seems that both procedures are contraindicated on patients with coagulation disorders. On the base of two cases the specification of treatment by patients with hemorrhagic diatheses is demonstrated. Modern treatment modalities of urinary stone disease are also applicable to those patients, when attention is paid to some conditions and attentive measures are taken.

  15. Extra corporeal shockwave lithotripsy resulting in skin burns--a report of two cases.

    PubMed

    Rao, Sandhya R; Ballesteros, Natalia; Short, Kerry L; Gathani, Krishna K; Ankem, Murali K

    2014-01-01

    Severe skin injury after extracorporeal shock wave lithotripsy (ESWL) is rare. We describe two patients who suffered full thickness skin burns following ESWL for renal calculi. One patient was treated conservatively and the other underwent debridement with skin grafting. We speculate that failure of the thermostatic mechanism of the lithotripter, leading to overheating of the water-filled cushion, resulted in this very rare adverse event. Proper preoperative patient counseling regarding the risk of serious burn injuries will help to avoid potential litigation.

  16. [Laser-induced shockwave lithotripsy--in vitro trial and animal experiment studies].

    PubMed

    Wenk, H; Benecke, W; Thomas, S; Barreton, G; Lange, V; Möller, K O; Schildberg, F W

    1988-01-01

    Laser induced shock wave lithotripsy is a new procedure to destroy gallstones. Stones of up to 500 mg are destroyed within 5 min. Severe reactions of the soft tissue cannot be observed in animal studies. No perforations, stenoses or thermic lesions after wound healing were observed. The development of an optomechanical transducer replacing the optical lens system at the end of the transmission guide allows its handling in flexible endoscopes. Clinical use is therefore possible from the technical aspect.

  17. [The effect of extracorporeal shockwave lithotripsy on the indices of urinary enzymes in nephrolithiasis patients].

    PubMed

    Neĭmark, A I; Fidirkin, A V; Zhukov, V N

    1997-01-01

    Immediate and long-term effects of extracorporeal shock-wave lithotripsy (ESWL) on urine enzymes were studied in 200 patients with nephrolithiasis (NL). The patients had abnormally high urine excretion of AP, GGT, APA, LDH and NAG, whereas aminotransferases excretion was low. Pathobiochemical and diagnostic implications of these findings are discussed. Immediately after its conduction ESWL entails a mild injury to tubular portion of the nephron. The causes of long-term stay of enzymuria after ESWL in NL patients are discussed.

  18. [Extracorporeal shockwave lithotripsy in sedation-analgesia].

    PubMed

    Berger, M; Brandstetter, A; Chowanetz, E; Gasser, G; Mossig, H; Schmidt, P

    1988-03-01

    The aim of the present study was to examine the effects of combined sedation and analgesia during extracorporeal shockwave lithotripsy using the Dornier lithotriptor HM III. We used a combination of a benzodiazepin derivatives with an opioid. We tested the dosage of drugs needed in relation to the length of treatment, the size of the stone and the overall energy output of the lithotriptor. In addition, continuous records were made of the patient's blood pressure and the oxygen saturation in the blood, with and without oxygen insufflation. Our results show that sedation combined with analgesia is a reasonable and useable alternative to general or regional anaesthesia for extracorporeal lithotripsy.

  19. Subcapsular hematoma after ureteroscopy and laser lithotripsy.

    PubMed

    Paiva, Matheus Miranda; da Silva, Rodrigo Donalisio; Jaworski, Paulo; Kim, Fernando J; Molina, Wilson R

    2016-08-01

    Subcapsular hematoma is an uncommon complication after ureteroscopy and laser lithotripsy. We report on a 38-year-old male with an 8 mm lower pole stone who underwent a left ureteroscopy and laser lithotripsy. The stone was successfully fragmented. Several hours after being discharged home, the patient returned complaining of back pain and hematuria. He was hemodynamically stable. Laboratory exams were normal. A CT study showed a crescent renal subcapsular hematoma surrounding the left kidney. The patient was admitted to the ward for conservative treatment. No additional intervention was necessary. Most subcapsular hematomas tend to resolve spontaneously. PMID:27544565

  20. Ultrasound guided lithotripsy of salivary calculi using an electromagnetic lithotriptor.

    PubMed

    Eggers, G; Chilla, R

    2005-12-01

    Sialolithiasis is a common disease of the major salivary glands. A supplement to the traditional therapies is extracorporeal shock wave lithotripsy of the calculus. This method has been adopted from the therapy of renal or bladder calculi. Patients with a solitary calculus of parotid or submandibular gland were treated with a specially designed lithotriptor. In a retrospective study the results of this therapy were analysed. The success rate was far better for parotid gland calculi than for submandibular calculi. We could not find better results than those published in literature with other devices. In our therapeutic concept, sialolithotripsy is the therapy of first choice for single parotid gland calculi. For submandibular gland calculus this method is advisable in selected cases only.

  1. [Extracorporeal shockwave lithotripsy of gallstones. Retrospective view and perspectives].

    PubMed

    Adamek, H E; Riemann, J F

    1992-07-01

    Extracorporeal shock-wave lithotripsy (ESWL) is a non-invasive technique in gallstone management, which has been in clinical use since many years now. Exact patient selection provides considerable stone-free rates within a year. Side effects and complications are rare. The stone-recurrence rate is about 15% after two years, and thus lower compared to that after oral dissolution therapy alone. Until now, there is no reasonable medical therapy to prevent stone recurrence. Furthermore, ESWL is a suitable therapy for retained common bile duct stones. Although laparoscopic cholecystectomy has become established as a new, minimally invasive surgical method, ESWL will continue to be a successful technique for the treatment of thoroughly selected gallstone patients, who are looking for a non-invasive way to get rid of their biliary pain, but not of their gall bladder.

  2. A mechanistic analysis of stone comminution in lithotripsy

    NASA Astrophysics Data System (ADS)

    Maxwell, Adam D.; Sapozhnikov, Oleg A.; Bailey, Michael R.; Macconaghy, Brian; Crum, Lawrence A.

    2005-04-01

    In vitro experiments and an elastic wave model were employed to isolate and assess the importance of individual mechanisms in stone comminution in lithotripsy. Cylindrical U-30 cement stones were treated in an HM-3-style research lithotripter. Baffles were used to block specific waves responsible for spallation, squeezing, or shear. Surface cracks were added to stones to simulate the effect of cavitation, then tested in water and glycerol (a cavitation suppressive medium). Each case was simulated using the elasticity equations for an isotropic medium. The calculated location of maximum stress compared well with the experimental observations of where cracks naturally formed. Shear waves from the shock wave in the fluid traveling along the stone surface (a kind of dynamic squeezing) led to the largest stresses in the cylindrical stones and the fewest SWs to fracture. Reflection of the longitudinal wave from the back of the stone-spallation-and bubble-jet impact on the proximal and distal faces of the stone produced lower stresses and required more SWs to break stones. Surface cracks accelerated fragmentation when created near the location where the maximum stress was predicted. [Work supported by NIH DK43881, NIH-Fogarty, NSBRI SMS00203, RFBR, and ONRIFO.

  3. Intracorporeal lithotripsy. Update on technology.

    PubMed

    Zheng, W; Denstedt, J D

    2000-05-01

    The number and variety of devices currently available for endoscopic lithotripsy reflect the reality that no single device is ideal in all situations. Although the search for the universal lithotriptor continues, the urologist must consider several factors if faced with the decision of which device to purchase. Perhaps foremost among these factors is the clinical situation with which one commonly deals. For example, although the smaller, flexible probes such as EHL or laser demonstrate considerable utility if used ureteroscopically, the larger stone burden associated with today's percutaneous nephrolithotripsy population often is treated more efficiently with one of the mechanical devices employing a larger, rigid probe, such as ultrasound or the Lithoclast. Similarly, the type and size of endoscopic equipment at one's disposal have a significant impact on which device to purchase or use. There are physical constraints affecting which device may or may not be used, rigid versus flexible endoscope, working channel caliber, and offset versus end-on-port. The skill and experience of the surgeon is also a factor of obvious importance, particularly if one is using a modality with a relatively narrow margin of safety such as EHL. Likewise, the training and experience of nursing personnel is a factor, especially regarding the use of lasers, which require certified personnel who are well versed in laser safety. Finally, in today's environment one must carefully evaluate cost in terms of not only initial capital outlay but also ongoing charges for disposable and maintenance items. Thus, the decision of which device to purchase is complex and requires careful evaluation of all of the previously noted variables. Likewise, if one is fortunate enough to have more than one device available, the decision of which lithotriptor to employ requires a similar decision based on sound surgical judgment. PMID:10778472

  4. Extracorporeal shockwave lithotripsy of pancreatic duct stones.

    PubMed

    Rawat, B; Fache, J S; Burhenne, H J

    1992-01-01

    Encouraging results with extracorporeal shockwave lithotripsy (ESWL) for pancreatic duct stones have been reported from Europe. We present our experience with the first two North American patients, treated with excellent results in one and limited clinical improvement in the other patient at 1 year follow-up. Targeting of pancreatic duct stones was achieved with either fluoroscopy or ultrasound.

  5. Severe perinephric hemorrhage after shockwave lithotripsy.

    PubMed

    Antoniou, N K; Karanastasis, D; Stenos, J L

    1995-06-01

    We report a case of a 69-year-old man who, after a second session of shockwave lithotripsy for multiple stones in the right kidney, showed symptoms of severe hemorrhage and flank pain unresponsive to analgesics, with the gradual development of extensive and serious perinephric hematoma. The bleeding necessitated nephrectomy. Unrecognized chronic pyelonephritis may have been a predisposing factor.

  6. Laser-induced shockwave lithotripsy of gallstones.

    PubMed

    Ell, C; Wondrazek, F; Frank, F; Hochberger, J; Lux, G; Demling, L

    1986-05-01

    With the aid of a Q-switched Nd:YAG laser with energy transmission via a flexible glass fiber, it proves possible under laboratory conditions, to destroy gallstones reliably and reproducibly. Lithotripsy is effected mechanically via a laser-induced local shockwave.

  7. Different modes of fragmenting gallstones in extracorporeal shockwave lithotripsy.

    PubMed

    Nitsche, R; Schweinsberg, V; Klengel, H; Niedmann, P D; Fölsch, U R

    1993-03-01

    Forty radiolucent gallbladder stones from eight patients were fragmented in vitro by extracorporeal shockwave lithotripsy, using the electromagnetic lithotripter Lithostar Plus (Siemens) at five different energy levels. The stones were characterized by size, computed tomography (CT) density, and cholesterol content. The largest residual fragment was measured after every 20 to 100 shock waves. As expected, fewer shock waves were required to achieve fragmentation at higher energy levels. When stones of the same size were compared, there were remarkable differences in the number of shock waves required for fragmentation. These differences must originate in other properties of the stones than size and number. Two different modes of fragmentation were observed: in one group of stones small, flat fragments were chipped off at the beginning of fragmentation ('chipping mode'). These stones initially lost about 25% of their weight as small fragments (< 1 mm) before breaking centrally into some large fragments. In the other group stones initially lost only about 10% of their weight as small fragments (< 1 mm) at the beginning of fragmentation and early broke centrally into some large fragments ('breaking mode'). Stones showing the chipping mode were almost pure cholesterol stones (> 97%) and required significantly less shock waves than stones of the same size showing the breaking mode (cholesterol content, 64-94%). This mode of fragmentation could not be predicted by CT density.

  8. Detection of tissue injury after extracorporeal shockwave lithotripsy of gallstones.

    PubMed

    Brody, J M; Siebert, W F; Cattau, E L; al-Kawas, F; Goldberg, J A; Zeman, R K

    1991-06-01

    We evaluated seven patients undergoing gallstone lithotripsy for evidence of hepatic or renal trauma after each of 10 lithotripsy treatments. Postlithotripsy magnetic resonance imaging (MRI) and sonography showed no evidence of hepatic or renal injury as compared with baseline studies. Four treatments resulted in sonographic evidence of gaseous hepatic microbubbles (analogous to "the bends") due to cavitation effects of the shockwaves. Three of these four treatments produced serum glutamicoxaloacetic transaminase and -pyruvic transaminase elevation. One patient had microscopic hematuria. Minimal tissue damage results from gallstone lithotripsy. MRI and ultrasound, performed after lithotripsy, appear to be less sensitive than transaminasemia in detecting this low-grade injury.

  9. Anaesthesia for extracorporeal shockwave lithotripsy at the Victorian Lithotripsy Service--the first 300 patients.

    PubMed

    Silbert, B S; Kluger, R; Dixon, G C; Berg, J

    1988-08-01

    A prospective survey was undertaken of the anaesthesia for the first 300 patients at the Victorian Lithotripsy Service. The majority (71.7%) were not hospitalised on site, including four quadriplegics and two ASA grade IV patients. Two hundred and eighty-three (94.3%) patients received continuous lumbar epidural anaesthesia, sixteen (5.3%) received general anaesthesia and one received a spinal anaesthetic. Eighty-two patients (27.3%) underwent ancillary procedures at the time of extracorporeal shockwave lithotripsy. The most common intraoperative complications were hypotension (72 patients, 25.4%) and shivering (39 patients, 13.8%). Arrhythmias occurred in nine (3%) patients. There was a 90% patient follow-up rate and the most common postoperative complication was backache (101 patients, 37.4%). The problems of anaesthesia for extracorporeal shockwave lithotripsy are discussed. Epidural anaesthesia offers a number of advantages for this procedure and proved very suitable for the majority of patients.

  10. Extracorporeal shockwave lithotripsy of distal ureteral calculi.

    PubMed

    Miller, K; Bubeck, J R; Hautmann, R

    1986-01-01

    To date, the use of extracorporeal shockwave lithotripsy (ESWL) has been limited to renal calculi and ureteral calculi above the pelvic brim. Modifying the position of the patient on the support of the Dornier lithotripter HM3, we were able to localize and treat distal ureteral calculi. Until April 1986, 43 patients with stones in the lower ureter underwent contact-free lithotripsy. Treatment was successful in 39 patients (90%), 2 of these requiring 2 sessions. In 4 patients treatment failed and stone removal was accomplished using ureteroscopy or open surgery. No complications or adverse side effects were encountered in the whole series. ESWL is now the method of choice for the treatment of distal ureteral calculi in our department.

  11. [Extracorporeal shockwave lithotripsy of bile duct stones].

    PubMed

    Wenzel, H; Greiner, L; Jakobeit, C; Lazica, M; Thüroff, J

    1989-05-12

    Extracorporeal lithotripsy (EL) was undertaken in 50 patients (mean age 73.7 years; range 29-90 years) with extrahepatic and, in five, with intrahepatic gallstones, the usual endoscopic methods having been unsuccessful in removing the stones. Occasionally stone fragments were passed spontaneously, but in most they had to be removed endoscopically, in 48 (96%) with extrahepatic and in three (60%) with intrahepatic stones. Biliary tract or gallbladder infections occurred after the lithotripsy and associated local litholysis in seven of the 48 with extrahepatic (14%) and three of the five (60%) with intrahepatic stones. There was one hospital death. The results indicate that EL has definite advantages over surgical treatment in these patients, who are usually elderly and in whom surgical intervention is more risky.

  12. Supracostal approach for percutaneous ultrasonic lithotripsy.

    PubMed

    Fuchs, E F; Forsyth, M J

    1990-02-01

    The supracostal approach to renal access for ultrasonic lithotripsy continues to be used with good results at The Oregon Health Sciences University when indicated, because it provides better access to much of the kidney collecting system and proximal ureter. The complication rate is acceptably low if the precautions outlined above are followed. Access above the 11th rib is discouraged unless there is no other choice. PMID:2305530

  13. Holmium laser lithotripsy of a complicated biliary calculus.

    PubMed

    Monga, M; Gabal-Shehab, L L; Kamarei, M; D'Agostino, H

    1999-09-01

    More than 500,000 cholecystectomies are performed annually. Extracorporeal shockwave lithotripsy and endoscopic laser lithotripsy have been used for the management of common bile duct calculi, which complicate 10% of cases. We report the first successful clinical application of the Ho:YAG laser to a complex biliary calculus case.

  14. Does the use of doxazosin influence the success of SWL in the treatment of upper ureteral stones? A multicenter, prospective and randomized study.

    PubMed

    Ateş, Ferhat; Eryıldırım, Bilal; Öztürk, Metin Ishak; Turan, Turgay; Gürbüz, Cenk; Ekinci, Mete Oğuz; Yıldırım, Asıf; Göktaş, Cemal; Şenkul, Temuçin; Sarıca, Kemal

    2012-10-01

    The objective of the study is to investigate the effect of doxazosin, administered to the subjects who underwent SWL due to upper ureteral stones, on therapeutic outcomes. The study enrolled the patients with a radio-opaque stone ≥5 mm in upper ureter. Patients were randomized into two groups: the first group underwent SWL following the diagnosis and they were recommended to receive oral hydration. The second group underwent SWL after initiating alpha blocker (doxazosin controlled-release tablet 4 mg/day) and drug therapy was continued until that the patient has been stone free. Parameters of SWL procedure, Steinstrasse, pain score at admission, time to stone passage, the complications developed, the additional procedures that were administered and number of hospital visits done due to pain during the treatment were recorded. A total of 79 patients were enrolled to the study. The subjects evaluated included 35 patients, who received an alpha blocker and 44 patients who did not receive an alpha blocker. For both groups, the level of energy applied per SWL session, the diameter of the stone, the number of hospital visits done due to pain, pain score and the need for analgesia were found to be similar (p > 0.05). The group of doxazosin was more advantageous in terms of stone-free rate, the need for additional procedures and Steinstrasse (p < 0.05). In conclusion, the addition of doxazosin to SWL therapy administered for upper ureteral stones reduces Steinstrasse, and thereby, the need for additional procedures and increases post-treatment stone-free rate. A positive effect of doxazosin on the time to stone passage was not shown.

  15. [Use of high frequency jet ventilation in extracorporeal shockwave lithotripsy].

    PubMed

    Schulte am Esch, J; Kochs, E; Meyer, W H

    1985-06-01

    High frequency jet ventilation (HFJV) was used in 68 patients which were treated with extracorporal shock wave lithotripsy (ESWL) because of stone diseases in the upper urinary tract. The question was whether HFJV in combination with a semiclosed conventional circle system offered a practicable and safe technique to minimize the oscillations which are proportional to the applied tidal volume and to the diaphragmatic movements. With IPPV the mean distance of the stone movement was 32 mm, whereas with the application of HFJV the stones oscillated around their resting position within limits of 2 to 3 mm (ventilation frequency: 200-300/min, driving pressure: 0.6-1.1 bar, tidal volume: 3-8 1/min). The effectiveness of HFJV was monitored by the end-tidal carbon dioxide tension (PeCO2) during intermittently conventional ventilation with "adequate" tidal volumes (TV 15 ml/kg bw). The correlation between PeCO2 and simultaneous measured PaCO2 was r = 0,91. The application of HFJV enhances the efficiency of ESWL. So the treatment of stones of the upper urinary tract can be varied by more subtle dosage of the incoming shock wave energy and by stabilisation of the stones in the underlying ellipsoid of the energy focus.

  16. The problem of coupling in dry-head lithotripsy

    NASA Astrophysics Data System (ADS)

    Pishchalnikov, Yuri A.; McAteer, James A.; Neucks, Joshua S.; Pishchalnikova, Irina V.; Williams, James C.

    2007-04-01

    Recent in vitro studies have shown that air pockets can get trapped at the coupling interface of the treatment head in dry-head lithotripsy, and this can pose a significant barrier to transmission of shock wave energy to the focal zone. Breakage of model stones is very sensitive to the presence of air pockets at the coupling interface. The quality of routine coupling is highly variable, and it seems quite feasible that the way in which the coupling gel is applied may have a significant effect on the quality of coupling. Therefore, attempts to find the best coupling regime may be valuable to perform, and preliminary results of in vitro tests are presented in this report. Experiments were conducted using gel or castor oil as coupling agents. The test tank was coupled through a transparent Mylar membrane to the water-filled cushion of the treatment head, so that pockets of air trapped between the two coupling surfaces could be observed and photographed. It is shown that the quality of coupling can be improved by applying an excessive amount of gel to just the water cushion of the lithotripter, while applying gel to both the water cushion and the Mylar membrane typically gives poor coupling. Repeat decoupling and re-coupling substantially degraded the quality of coupling, reducing shock wave energy density at the target by ˜80%. It was also observed that using castor oil as a coupling medium does not guarantee air-free coupling.

  17. Management of vesical calculi: comparison of lithotripsy devices.

    PubMed

    Razvi, H A; Song, T Y; Denstedt, J D

    1996-12-01

    Although endoscopic lithotripsy of bladder stones has been well described and is widely practiced, comparison of the main modalities of mechanical, electrohydraulic, and ultrasonic lithotripsy is lacking. The exact role of these and other modalities such as the Swiss Lithoclast and extracorporeal shockwave lithotripsy is not clearly defined. The safety and efficacy of the various lithotripsy modalities available to treat bladder calculi were reviewed retrospectively over an 18-year period. A total of 106 patients were treated with some form of intracorporeal lithotripsy. In general, all devices proved to be effective with a low rate of complications. The addition of transurethral resection of the prostate to bladder stone management under the same anesthetic was also found to be a safe procedure for moderate benign prostatic hyperplasia. In summary, transurethral endoscopic lithotripsy is a safe and effective method of bladder stone management both alone and in combination with transurethral prostatectomy. All modalities of intracorporeal lithotripsy are effective; however, devices such as ultrasound lithotripters or the Swiss Lithoclast that utilize larger, rigid probes may be more efficient for patients with large or particularly hard vesical calculi.

  18. [Ureteroscopy versus in situ extracorporeal shockwave lithotripsy in the treatment of calculi of the distal ureter].

    PubMed

    Leblanc, B; Paquin, J M; Valiquette, L; Perreault, J P; Faucher, R; Mauffette, F; Benard, F

    1996-01-01

    In a retrospective study from a unique center (St. Luc Hospital, Montreal) stone clearance of 88 consecutive distal ureteral calculi (below pelvic brim) treated by extracorporeal shock wave lithotripsy in situ were compared to a group of 94 distal ureteral calculi treated by ureteroscopy during the same period. Our results show 84% success rate for ureteroscopy which is clearly superior than 58% stone clearance rate at 3 month follow-up for ESWL Success rate was influenced by stone size in the ESWL group but not in the ureteroscopy group. This study reveals similar success rate for calculi smaller than 6 mm but for larger calculi, success rate of ureteroscopy is significantly superior.

  19. [Treatment of kidney lithiasis with extracorporeal shockwave lithotripsy in horseshoe kidney].

    PubMed

    Iglesias, J I; Mancebo, J M; Massarra, J; Pérez-Castro, E

    1989-01-01

    Following a brief overview of the general features of the horseshoe kidney, we report on ten patients diagnosed as having this anomaly and renal calculi. One patient had bilateral renal calculi. The clinical cases are described and treatment with extracorporeal shock wave lithotripsy (ESWL1) and its advantages and disadvantages relative to other treatment modalities (PCN, open surgery) are discussed. Although we do not advocate the use of a single therapeutic approach, our results show the usefulness of ESWL1 in the treatment of this frequently recurring condition.

  20. [Initial experience with preorally administered dipotassium clorazepate and tilidine-naloxone in extracorporeal shockwave lithotripsy].

    PubMed

    Hankemeier, U; Herberhold, D

    1986-12-01

    After 70 treatments with extracorporeal shock wave lithotripsy (ESWL), using a combination of dipotassiumclorazepate p.o. 12 h before treatment and tilidin-naloxon 45 min before ESWL, 56 patients reported to be painfree or only minor, well-tolerable pain. Informed consent was obtained in all patients for this pilot study, leaving the possibility of further pain medication. 7 patients asked for an additional analgesic (fentanyl) and another 7 patients required a sedative (midazolam). No further anesthesiologic procedures were necessary. Nausea was observed in one patient as a possible side-effect of tilidin. To confirm these preliminary results, a prospective randomized study is currently conducted.

  1. Extracorporeal shockwave lithotripsy: role of the radiologist.

    PubMed

    Barth, K H; Pahira, J J; Elliott, L P

    1985-06-01

    Extracorporeal shockwave lithotripsy (ESWL) is a new noninvasive treatment modality for urinary calculi. ESWL may be applied to the majority of patients requiring stone removal and is expected to replace, to a large degree, percutaneous stone removal (PSR), now practiced jointly by interventional radiologists and endourologists in most institutions. In a number of cases, ESWL and PSR will be complementary procedures. Technically, ESWL can be considered a radiologic procedure; thus far, radiologists are not participating in its use. In the authors' opinion, ESWL should be a combined urologic radiologic procedure analogous to PSR; this will allow the most rational and effective treatment.

  2. Renal function following extracorporeal lithotripsy in children.

    PubMed

    Corbally, M T; Ryan, J; FitzPatrick, J; Fitzgerald, R J

    1991-05-01

    Although extracorporeal shockwave lithotripsy (ESWL) has revolutionised the management of urinary calculous disease, the long-term effects of ESWL on renal function are not known. This study of 18 children demonstrated a mild, statistically insignificant decrease of 15% in DTPA measured glomerular filtration rate following ESWL. In view of this, we recommend that pretherapy and posttherapy estimates of renal function be obtained in all patients undergoing ESWL. Long-term follow-up is necessary to further quantify the effects of ESWL on the developing kidney.

  3. The steinstrasse: a legacy of extracorporeal lithotripsy?

    PubMed

    Coptcoat, M J; Webb, D R; Kellet, M J; Whitfield, H N; Wickham, J E

    1988-01-01

    32 steinstrasse formations in the first 600 extracorporeal shockwave lithotripsy treatments required intervention. Their radiological appearance has been classified into 3 types and the aetiology of each type is discussed. 24 cases received a primary needle nephrostomy to relieve obstruction and of these 18 passed spontaneously, 5 required ureteroscopic manipulation and 1 underwent open surgery. Primary ureteroscopic removal was successful in 3 out of 5 cases. 3 upper ureteric steinstrassen were removed by a percutaneous intrarenal approach. A suggested plan of management for complicated steinstrassen is outlined.

  4. Superior mesenteric artery dissection after extracorporeal shockwave lithotripsy.

    PubMed

    Bakoyiannis, Christos; Anastasiou, Ioannis; Koutsoumpelis, Andreas; Fragiadis, Evangelos; Felesaki, Eleni; Kafeza, Marina; Georgopoulos, Sotirios; Tsigris, Christos

    2012-01-01

    The use of shockwave lithotripsy is currently the mainstay of treatment in renal calculosis. Several complications including vessel injuries have been implied to extracorporeal shockwave lithotripsy. We report an isolated dissection of the superior mesenteric artery in a 60-year-old male presenting with abdominal pain which occurred three days after extracorporeal shockwave lithotripsy. The patient was treated conservatively and the abdominal pain subsided 24 hours later. The patient's history, the course of his disease, and the timing may suggest a correlation between the dissection and the ESWL.

  5. Management of lower pole renal stones: the devil is in the details

    PubMed Central

    Issi, Yasar; Onem, Kadir; Germiyanoglu, Cankon

    2016-01-01

    Shock wave lithotripsy (SWL), retrograde intrarenal surgery (RIRS) and minimally invasive percutaneous nephrolithotomy (MIP) are highly effective treatment options for lower pole stones up to 2 cm. Selecting the best treatment modality represents a controversial area in urology, because each treatment methods have their own advantages and disadvantages. Donaldson and co-workers have recently published a very comprehensive review and meta-analysis to compare the benefits and harms of SWL, RIRS and PNL techniques. PMID:27047957

  6. Management of lower pole renal stones: the devil is in the details.

    PubMed

    Resorlu, Berkan; Issi, Yasar; Onem, Kadir; Germiyanoglu, Cankon

    2016-03-01

    Shock wave lithotripsy (SWL), retrograde intrarenal surgery (RIRS) and minimally invasive percutaneous nephrolithotomy (MIP) are highly effective treatment options for lower pole stones up to 2 cm. Selecting the best treatment modality represents a controversial area in urology, because each treatment methods have their own advantages and disadvantages. Donaldson and co-workers have recently published a very comprehensive review and meta-analysis to compare the benefits and harms of SWL, RIRS and PNL techniques. PMID:27047957

  7. Clinical results of piezoelectric gallstone lithotripsy.

    PubMed

    Deziel, D J; Jensen, D M; Faibisoff, J H; Silver, A; Silver, B; Sabesin, S M

    1992-04-01

    The safety and efficacy of piezoelectric extracorporeal shockwave lithotripsy in the treatment of symptomatic gallbladder stones were evaluated in 53 consecutively treated patients. All treatments were performed as outpatients without anesthesia; over 95 per cent of 109 treatments were performed without analgesia or sedation. Ursodeoxycholic acid was administered post-treatment. Seventy per cent of patients had multiple sessions. Cumulative stone-free rates of 38 per cent at 6 months, 65 per cent at 12 months, and 75 per cent at 15 months were achieved. There was no difference in eventual stone clearance between patients with single stones less than 20 mm diameter, single stones greater than or equal to 20 mm diameter, or multiple (two or three) stones, although patients with single smaller stones required significantly fewer total shocks to become stone-free (P = .02). Stone clearance correlated with estimated stone volume. Biliary pain occurred in 62 per cent of patients after treatment but ceased in stone-free patients. Biliary complications of pancreatitis (7.5%) and choledocholithiasis (3.8%) were successfully treated by endoscopic papillotomy. Nonbiliary complications were virtually nonexistent. Three patients (5.7%) had elective cholecystectomy. Results indicate that piezoelectric lithotripsy is a safe, minimally painful treatment that, in conjunction with oral bile acids, can produce stone-free rates of 75 to 100 per cent in selected patients.

  8. [Extracorporeal shockwave lithotripsy of the gallbladder: importance of selection criteria].

    PubMed

    Thorens, J; Schnegg, J F; Fasel, J; Deslarzes, C; Duvoisin, B; Schnyder, P; Gonvers, J J; Blum, A L

    1993-04-10

    In recent years, a number of alternatives to surgery for gallstones have been developed. Among them, extracorporeal shock-wave lithotripsy (ESWL) was promising, being non-invasive and risk-free. Nevertheless, its results vary according to the size, number and composition of the stones and according to the bile acids treatment used for fragment dissolution. To better evaluate the importance of these factors, we have widened the selection criteria currently used (1 to 3 non-calcified stones with a diameter below 30 mm) by including patients with large stones (up to 40 mm in diameter), multiple stones (up to 10 stones) and calcified stones. We also compared, for efficacy of fragment dissolution after ESWL, treatment by ursodeoxycholic acid alone as opposed to a mixture with chenodeoxycholic acid. Our results were (1) significant lessening of the fragmentation rate and of the number of gallbladders free of stones 1 year after ESWL when selection criteria are widened; (2) a mixture of ursodeoxycholic and chenodeoxycholic acids may favour fragment dissolution after ESWL compared to treatment by ursodeoxycholic acid alone.

  9. [Electromagnetic shockwave lithotripsy of gallstones. Preliminary clinical experiences].

    PubMed

    Neuhaus, H; Brandstetter, K; Hagenmüller, F; Gerhardt, P; Classen, M

    1990-01-26

    75 applications of extracorporeal electromagnetically produced shock-waves were performed on 40 patients with symptomatic gallbladder stones (27 women and 13 men; mean age 43.5 [25-69] years). The patients had up to three stones each, with a maximal diameter of 35 mm. Computed tomography revealed partial calcification of the stones in nine patients. Stone fragmentation succeeded in all patients. Two weeks after lithotripsy two patients were free of stone. Maximal fragment diameter, as measured by ultrasound, was less than 6 mm in 19 patients, 6-10 mm in 14, and 11-15 mm in five. At reexamination of 24 patients three months later, three additional patients were free of stone by ultrasound. No significant side effects were noted during the first 30 days after the procedure. But during further observation mild pancreatitis developed in two, while in one choledochal concrements caused obstructive jaundice which necessitated endoscopic papillotomy. These results demonstrate the effectiveness of this method of fragmenting gall-bladder stones.

  10. [A year experience with extracorporeal shockwave lithotripsy of gallstones].

    PubMed

    Rothenbühler, J M; Beglinger, C; Meyer, B; Marx, A; Ackermann, C; Stalder, G A; Harder, F

    1990-04-21

    43 patients with symptomatic gallbladder stones were treated by extracorporeal shockwave lithotripsy and oral bile acids. In all patients the stones were successfully fragmented during the first lithotripsy session. 33 patients underwent 2-4 treatment sessions. In 16 out of 43 patients the stones disappeared within 7.9 months. The rate of stone dissolution was dependent on the number and size of stones. 3 patients required surgery because of frequent colic in one case, cholecystitis in one case and lack of cooperation in one case. No important side effects were noted except mild pancreatitis 3 weeks after lithotripsy in one patient. Results at this center of extracorporeal shockwave lithotripsy combined with oral bile acids indicate that this treatment may become an alternative to cholecystectomy in patients with a small number (less than 3) of stones not exceeding 30 mm in diameter.

  11. Successful endoscopic treatment of colonic gallstone ileus using electrohydraulic lithotripsy

    PubMed Central

    Zielinski, Martin D; Ferreira, Lincoln E; Baron, Todd H

    2010-01-01

    The surgical management of gallstone ileus is complex and potentially highly morbid. Initial management requires enterolithotomy and is generally followed by fistula resection at a later date. There have been reports of gallstone extraction using various endoscopic modalities to relieve the obstruction, however, to date, there has never been a published case of endoscopic stone extraction from the colon using electrohydraulic lithotripsy. In this report, we present the technique employed to successfully perform an electrohydraulic lithotripsy for removal of a large gallstone impacted in the sigmoid colon. A cavity was excavated in an obstructing 4.1 cm lamellated stone in the sigmoid colon using electrohydraulic lithotripsy. A screw stent retractor and stent extractor bored a larger lumen which allowed for guidewire advancement and stone fracture via serial pneumatic balloon dilatation. The stone fragments were removed. Electrohydraulic lithotripsy is a safe and effective method to treat colonic obstruction in the setting of gallstone ileus. PMID:20333797

  12. [The history of extracorporeal shockwave lithotripsy in Spain].

    PubMed

    Ruíz Marcellán, Francisco Javier; Ibarz Servio, Luis

    2007-10-01

    We give a historical outline of urinary lithiasis with emphasis in the alternative therapeutic options to surgery. We expose the previous steps that led to the birth of extracorporeal shockwave lithotripsy and its implementation in our country.

  13. A novel ureter dilatation method for replacing hydromantic perfusion pump during ureteroscopic lithotripsy in patients with ureteral calculi and ibroepithelial polyps.

    PubMed

    Li, Tengcheng; Fang, Youqiang; Wu, Jieying; Zhou, Xiangfu

    2014-01-01

    This study aimed to evaluate the clinical value of a novel ureter dilatation method during ureteroscopic pneumatic lithotripsy in patients with ureteral calculi and polyps. Clinical information of 86 patients with ureter calculi and polyps who underwent ureteroscopic pneumatic lithotripsy was reviewed. A cavity-distention machine was used in 44 cases to inject normal saline for keeping clear operation view (cavity-distention machine-assisted group). A high handled water bag with artificial water injection (traditional pneumatic lithotripsy group) was used in 42 cases. The total operation time, time of stone removal, stone clearance rate and surgery complications were compared between two groups. All operations were successful with no patients transferred to open surgery. No ureter breakage or avulsion occurred in two groups. Two patients in traditional pneumatic lithotripsy group suffered from ureter perforation. In cavity-distention machine-assisted group and traditional pneumatic lithotripsy group, the total operation time was 30.1±4.8 min and 36.2±6.0 min, respectively (t=-5.22, P<0.01); the time of stone removal was 6.4±1.3 min and 9.3±1.5 min, respectively (t=-9.59, P<0.01); the stone clearance rate was 100% (44/44) and 95.2% (40/42; upper ureter stone immigrated to the renal pelvis in 2, and extraorgan shock wave lithotripsy was performed), respectively. Thus, intraoperative infusion of saline with a cavity-distention machine may replace the hydromantic perfusion pump to maintain a clear operation view and favor the stone removal in lesser time. This method has important clinical value in the treatment of ureteral calculi and polyps.

  14. Adaptable Design Improvements for Electromagnetic Shock Wave Lithotripters and Techniques for Controlling Cavitation

    NASA Astrophysics Data System (ADS)

    Smith, Nathan Birchard

    In this dissertation work, the aim was to garner better mechanistic understanding of how shock wave lithotripsy (SWL) breaks stones in order to guide design improvements to modern electromagnetic (EM) shock wave lithotripters. To accomplish this goal, experimental studies were carefully designed to isolate mechanisms of fragmentation, and models for wave propagation, fragmentation, and stone motion were developed. In the initial study, a representative EM lithotripter was characterized and tested for in vitro stone comminution efficiency at a variety of field positions and doses using phantom kidney stones of variable physical properties, and in different fluid mediums to isolate the contribution of cavitation. Through parametric analysis of the acoustic field measurements alongside comminution results, a logarithmic correlation was determined between average peak pressure incident on the stone surface and comminution efficiency. It was also noted that for a given stone type, the correlations converged to an average peak pressure threshold for fragmentation, independent of fluid medium in use. The correlation of average peak pressure to efficacy supports the rationale for the acoustic lens modifications, which were pursued to simultaneously enhance beam width and optimize the pulse profile of the lithotripter shock wave (LSW) via in situ pulse superposition for improved stone fragmentation by stress waves and cavitation, respectively. In parallel, a numerical model for wave propagation was used to investigate the variations of critical parameters with changes in lens geometry. A consensus was reached on a new lens design based on high-speed imaging and stone comminution experiments against the original lens at a fixed acoustic energy setting. The results have demonstrated that the new lens has improved efficacy away from the focus, where stones may move due to respiration, fragmentation, acoustic radiation forces, or voluntary

  15. [Percutaneous nephrostomy associated with extracorporeal shockwave lithotripsy in the treatment of renoureteral lithiasis].

    PubMed

    Larrea Masvidal, E; García Serrano, C; Hernández Silverio, D; Castillo Rodriguez, M; Valdes Gómez, A C; Báez Hernández, D; Ramirez Hernández, L

    1993-01-01

    From a series of 5000 cases that had undergone extracorporeal shock wave lithotripsy at the Hospital Clinico Quirúrgico "Hermanos Ameijeiras" from March, 1986 to April, 1988, 220 cases that required percutaneous nephrostomy due to obstructive hydronephrosis from stone fragments were studied. We analyzed the clinical, radiological and ultrasound features of these cases, as well as the criteria for performing percutaneous nephrostomy. We identified the risk factors that made the procedure necessary, particularly urinary tract infection. No important complications ascribable to the foregoing procedure were observed. Performing the procedure early improved patient clinical course and reduced cost of treatment. To eliminate stone fragments completely, percutaneous nephrostomy was combined with other procedures in 198 cases (90%). The stone fragments were passed spontaneously in 10 cases (4.5%) following diversion. At 2 months 190 cases (86%) were completely stone free, 18 (8%) had residual stones and 12 (6%) required open surgery. The foregoing results show that percutaneous nephrostomy is a very useful procedure in septic-obstructive complications following extracorporeal shock wave lithotripsy and acquiring the skill to perform it is essential.

  16. [Extracorporeal shockwave lithotripsy: experience with 1000 treatments].

    PubMed

    Zehntner, C; Ackermann, D; Zingg, E J

    1987-03-14

    6 1/2 years after the first clinical trials in Munich, extracorporeal shockwave lithotripsy is a well established method for the treatment of urinary tract calculi. The number of open surgical interventions in urolithiasis has therefore markedly diminished. In hospitals with lithotriptors open surgical procedures are less than 1% today. In the first 16 months the Department of Urology at the University of Berne performed 1000 treatments with a kidney stone lithotriptor. The treatment was successful in 93.8%, a result comparable with those of other stone centres. During the last few months the indication for the treatment has been considerably enlarged. The new lithotriptors differ in several respects from the standard model by Dornier, though basically the principle of shockwaves remains unchanged.

  17. Does extracorporeal shockwave lithotripsy cause hypertension?

    PubMed

    Montgomery, B S; Cole, R S; Palfrey, E L; Shuttleworth, K E

    1989-12-01

    Several series have suggested that the incidence of hypertension following extracorporeal shockwave lithotripsy (ESWL) may be as high as 8%. In this study, changes in blood pressure and the incidence of hypertension have been observed in 733 patients 12 to 44 months after renal ESWL on the Dornier HM3. The incidence of hypertension following ESWL was 8.1%. In patients with a pre-ESWL diastolic pressure less than 90 mmHg, the incidence of those with a diastolic greater than or equal to 100 mm Hg post-operatively was significantly greater than that predicted by historical data. There was no overall change in the mean blood pressure of the group. The hypertensive risk of ESWL remains unclear. However, blood pressure surveillance should be performed following ESWL and a prospective study is required.

  18. Radiation awareness program for extracorporeal shockwave lithotripsy using Medstone lithotripters.

    PubMed

    Ugarte, R R; Cass, A S

    1998-06-01

    To determine the effectiveness of a radiation awareness program in reducing the radiation exposure to patients treated by a Medstone lithotripter, the exposure was calculated at the end of each extracorporeal shockwave (SWL) treatment using a table of measurements of the estimated entrance exposure rates 70 cm from the X-ray tube port. The results, related to stone size and patient weight, were distributed every month to each radiologic technologist, and a summary was sent regularly to the treating urologists. The doses before and after the introduction of the radiation awareness program were compared to determine the effectiveness of the program, and the chi-square test was used to determine statistical significance. The average calculated radiation exposure before and after introduction of the radiation awareness program was 16.39 rad and 8.26 rad, respectively, for patients with single renal stones; 17.31 rad and 9.02 rad, respectively, with single ureteral stones; 18.45 rad and 9.39 rad, respectively, with multiple renal stones; and 20.59 rad and 11.28 rad, respectively with multiple ureteral stones. These reductions in calculated radiation exposure were statistically significant only with multiple ureteral stones (P = 0.03). The only statistically significant differences in the stone-free rates, retreatment rates, and post-SWL secondary procedure rates before and after the introduction of the radiation awareness program were seen in the stone-free rates with single renal stones: 70% v 65%, respectively (P = 0.02); in the retreatment rates with single ureteral stones: 10% v 6%, respectively ( P < .01); and in the post-SWL secondary procedure rates with single renal stones: 4% v 2%, respectively (P = 0.01), and single ureteral stones: 7% v 4%, respectively (P = 0.05). The radiation awareness program resulted in a 51% reduction in the estimated radiation exposure to patients during SWL using Medstone lithotripters.

  19. [The treatment of calculi in the iliac segment of the ureter by extracorporeal high-energy shockwave lithotripsy].

    PubMed

    Nikolov, S; Patrashkov, T; Mikhaĭlov, P

    1991-01-01

    Experience is recorded with the treatment of calculi in the iliac segment of the ureter by extracorporal lithotripsy with high-energy stroke waves with lithotriptor of the firm "Dornier", model HM-3. For a period of 2 1/2 years 18 patients at mean age 38 years have been treated. Retrograde catheterization was always performed before lithotripsy. Successful reposition was achieved in 6 patients. In all others lithotripsy was performed in prone position. Special supporting cushions were manufactured and used; they helped for a more stable position of the patient on the stand, facilitate calculus positioning, the load to the knee joints is reduced, the fluoroscopic time is shortened, thus reducing the radiation load to patient and attending personnel. All patients received antibacterial and spasmolytic therapy. The mean length of stay in the clinic was 3.2 days. The results were good in 94.1 per cent of the cases. No early or late complications of urologic or other nature were observed.

  20. [Treatment of renoureteral lithiasis using extracorporeal shockwave lithotripsy. Experience in Cuba].

    PubMed

    Larrea Masvidal, E; García Serrano, C; Hernández Silverio, D; Castillo Rodríguez, M; Casals Armada, J; Valdés Gómez, C; Báez Hernández, D

    1989-01-01

    Herein we present our experience in 5,000 cases of reno-ureteral lithiasis submitted to treatment at the Extracorporeal Lithotripsy Unit of Hermanos Ameijeiras Hospital in Havana, Cuba, from April 1986 and during a period spanning 30 months. Treatment was exclusively by extracorporeal shock wave lithotripsy (ESWL) in 85.5% of the patients and in combination with other procedures in 14.5% (endoscopic maneuvers in 5.9%, percutaneous nephrostomy 4.4%, open surgery 3.6%, and percutaneous nephrolithotripsy 0.6%). Complications were observed in 7% of the cases: ureteric obstruction (6.4%) with or without infection, perirenal hematoma (0.4%), and obstructive anuria (0.2%); acute urinary infection of different clinical types, some of which were very severe, were observed concomitantly in 2.6% of these patients. Two months following treatment, 86% of the cases were completely stone-free. At 6 months 96.2% were completely stone-free; the remaining 3.8% were classed as residual lithiasis. The pathologic conditions that put patients at high therapeutic risk and the possible complications that could arise were identified. The efficacy of the Dornier HM-3 lithotripter and the health care system that permits its extensive use are highlighted.

  1. Observations of the collapses and rebounds of millimeter-sized lithotripsy bubbles.

    PubMed

    Kreider, Wayne; Crum, Lawrence A; Bailey, Michael R; Sapozhnikov, Oleg A

    2011-11-01

    Bubbles excited by lithotripter shock waves undergo a prolonged growth followed by an inertial collapse and rebounds. In addition to the relevance for clinical lithotripsy treatments, such bubbles can be used to study the mechanics of inertial collapses. In particular, both phase change and diffusion among vapor and noncondensable gas molecules inside the bubble are known to alter the collapse dynamics of individual bubbles. Accordingly, the role of heat and mass transport during inertial collapses is explored by experimentally observing the collapses and rebounds of lithotripsy bubbles for water temperatures ranging from 20 to 60 °C and dissolved gas concentrations from 10 to 85% of saturation. Bubble responses were characterized through high-speed photography and acoustic measurements that identified the timing of individual bubble collapses. Maximum bubble diameters before and after collapse were estimated and the corresponding ratio of volumes was used to estimate the fraction of energy retained by the bubble through collapse. The rebounds demonstrated statistically significant dependencies on both dissolved gas concentration and temperature. In many observations, liquid jets indicating asymmetric bubble collapses were visible. Bubble rebounds were sensitive to these asymmetries primarily for water conditions corresponding to the most dissipative collapses.

  2. Observations of the collapses and rebounds of millimeter-sized lithotripsy bubbles

    PubMed Central

    Kreider, Wayne; Crum, Lawrence A.; Bailey, Michael R.; Sapozhnikov, Oleg A.

    2011-01-01

    Bubbles excited by lithotripter shock waves undergo a prolonged growth followed by an inertial collapse and rebounds. In addition to the relevance for clinical lithotripsy treatments, such bubbles can be used to study the mechanics of inertial collapses. In particular, both phase change and diffusion among vapor and noncondensable gas molecules inside the bubble are known to alter the collapse dynamics of individual bubbles. Accordingly, the role of heat and mass transport during inertial collapses is explored by experimentally observing the collapses and rebounds of lithotripsy bubbles for water temperatures ranging from 20 to 60 °C and dissolved gas concentrations from 10 to 85% of saturation. Bubble responses were characterized through high-speed photography and acoustic measurements that identified the timing of individual bubble collapses. Maximum bubble diameters before and after collapse were estimated and the corresponding ratio of volumes was used to estimate the fraction of energy retained by the bubble through collapse. The rebounds demonstrated statistically significant dependencies on both dissolved gas concentration and temperature. In many observations, liquid jets indicating asymmetric bubble collapses were visible. Bubble rebounds were sensitive to these asymmetries primarily for water conditions corresponding to the most dissipative collapses. PMID:22088027

  3. [Extracorporeal shockwave lithotripsy in gallstone perforation].

    PubMed

    Jakobeit, C

    1992-04-01

    A 78-year-old man with rheumatoid arthritis, arteriosclerosis and cardiac arrhythmias (Lown grade IVb) was admitted to hospital because of haematemesis. Gastroscopy revealed a narrow, deformed duodenal bulb with a bleeding ulcer crater on the posterior wall and a mucosal protrusion 1 cm in diameter. In the course of the illness the duodenal bulb obstruction increased further and there was recurrent vomiting. Repeat gastroscopy 7 days later showed a gallstone, about 4 cm in diameter, which had perforated into the duodenal bulb and could not be removed endoscopically. Because of the serious nature of the other diseases an operation was not undertaken, but an ultrasound-guided extracorporeal shockwave lithotripsy was performed. In three sessions this succeeded without complication to break up the stone, the larger fragments of which were then removed endoscopically while the small ones passed through the gut spontaneously. Subsequent ultrasonography demonstrated a shrunk, stone-free gallbladder with a cholecystoduodenal fistula. Afterwards the patient was again able to take food by mouth without any problems.

  4. Renal rupture following extracorporeal shockwave lithotripsy.

    PubMed

    Torbati, Sam S; Niku, Michelle; Vos, Elaine; Hogan, Shomari

    2014-09-01

    A 41-year-old woman presented to the emergency department with a chief complaint of hematuria three days status post extracorporeal shockwave lithotripsy. The patient described a three-day history of worsening left-sided abdominal pain immediately following the procedure. She denied any fever, chills, changes in bowel habits, hematochezia, increased urinary frequency, urinary urgency, or dysuria. Physical exam revealed tenderness to palpation in the left upper quadrant, left flank and periumbilical region with mild guarding. Laboratory studies revealed an anemic patient with downward trending hematocrit (red blood cell count of 3.41 10(6)/μL, hemoglobin of 10.6 g/dL, and a hematocrit of 31.3% down from 43% a week and a half prior). Urinalysis revealed red and cloudy urine with 3+ leukocytes. A chest radiograph was unremarkable. A computed tomography of the chest, abdomen, and pelvis showed a laceration to the lateral aspect of the mid left kidney with a hematoma measuring 3.2 cm in thickness (Figure). The patient was subsequently admitted to the hospital for monitoring and discharged on day nine.

  5. [Extracorporeal shockwave lithotripsy 5 years on].

    PubMed

    Lopatkin, N A; Dzeranov, N K; Golovanov, S A

    1994-01-01

    Investigations initiated in the Research Urological Institute headed by professor N. A. Lopatkin in 1984 on development of an original Russian lithotriptor URAT-II were successfully finished in 1987. Since that time the design has been advanced. The investigators plan to introduce a novel polyfunctional lithotriptor ARKO-LIT with double guidance system and several impulse heads. The unit is to have various forms of impulse generation and diverse physical parameters. When equipped with water cushion, the new lithotriptor will enable the physician to do endoscopic, x-ray diagnostic and therapeutic manipulations. It is emphasized that the main thing in prevention of lithotripsy complications is proper management of the apparatuses which implies sufficient knowledge of the impulse physics and impulse interaction with biologically active tissues. As for cell impairment, lipid peroxidation evaluation suggests that under adequate selection and performance of the procedure as well as proper preoperative preparation, changes in cell membranes are moderate and disappear within 7 posttreatment days. In case of underestimation of the patient's condition, renal function, in violation of the stone destruction technique the above changes may advance to serious and entail severe complications.

  6. [Gallstone treatment by electrohydraulic extracorporeal shockwave lithotripsy].

    PubMed

    Janowitz, P; Kratzer, W; Wechsler, J G; Kuhn, K; Janowitz, A; Swobodnik, W; Ditschuneit, H

    1991-08-30

    Extracorporeal shockwave lithotripsy (ESWL) with an electrohydraulic system was performed in 124 patients (33 men, 91 women; mean age 50.1 +/- 12.7 years). Sufficient stone fragmentation was achieved in 122 patients (98.3%). ESWL was repeated in 29 patients (23.3%), twice in 7 patients (5.6%). Average shockwave application per patient was 1,441 +/- 414 impulses, at a mean energy of 20.0 +/- 1.6 kV. Mean stone diameter before ESWL was 16.2 +/- 4.2 (7-30) mm, 7.1 +/- 4.1 (0-19) mm after ESWL. Computed tomography, performed immediately after ESWL in 88 patients demonstrated hypodense thickening (3-10 mm) of the gallbladder wall in 28.4% of patients. This was interpreted as wall oedema, reversible in all. One patient had a covered gallbladder rupture and two had biliary pancreatitis. None of the patients required emergency surgery. 93 patients (74.9%) had no stones 12 months later. A high success rate can be achieved if certain criteria are adhered to and suitable patients are selected.

  7. Preventing stone retropulsion during intracorporeal lithotripsy.

    PubMed

    Elashry, Osama M; Tawfik, Ahmad M

    2012-12-01

    Several studies of ureteroscopic treatment for ureteral stones have reported that most stone clearance failures can be attributed to stone fragment retropulsion. Stone retropulsion can result in increased operative time and cost-resulting from the need to change from the semi-rigid ureteroscope to a flexible instrument to chase migrated calculi-and additional procedures to treat residual migrated fragments are often required. The degree of migration depends mainly on the energy source used for lithotripsy; pneumatic and electrohydraulic lithotripters are associated with a greater degree of retropulsion than lasers. Different stone-trapping strategies and devices have been developed to minimize stone migration. Novel devices include the Lithovac(®) suction device, the Passport(™) balloon, the Stone Cone(™), the PercSys Accordion(®), the NTrap(®), and stone baskets such as the LithoCatch(™), the Parachute(™), and the Escape(®). Some authors have also reported on the use of lubricating jelly and BackStop(®) gel (a reverse thermosensitive polymeric plug); these devices are instilled proximal to the stone prior to the application of kinetic energy in order to prevent retrograde stone migration.

  8. Hyponatraemia and mental symptoms following vesical ultrasonic lithotripsy.

    PubMed

    Batra, Y K; Kapoor, R; Hemal, A K; Vaidyanathan, S

    1988-08-01

    A patient became confused and restless after vesical ultrasonic lithotripsy performed with distilled water as the irrigant. Serum sodium decreased to 120 mmol/litre from the pre-operative value of 138 mmol/litre. A cystogram revealed intraperitoneal extravasation of contrast. She recovered promptly after intravenous infusion of normal saline and emergency surgery for repair of the damaged bladder wall. This case illustrates that hyponatraemia and mental symptoms similar to those following transurethral resection syndrome also occur with ultrasonic lithotripsy when distilled water is used as the irrigant. PMID:3421461

  9. [Extracorporeal shock-wave lithotripsy in polycystic kidneys].

    PubMed

    Martínez Sarmiento, M; Broseta Rico, E; Sanz Chinesta, S; García Reboll, L; Martín Abad, L; Jiménez Cruz, J F

    1994-01-01

    Presentation of 6 cases (8 renal units) of lithiasis in polycystic kidneys treated with extracorporeal shockwave lithotrity (ESWL). One patient required puncture of a compressing cyst, prior to ESWL, to facilitate the stones removal. No complications were seen in any of the cases. Therefore, stones in polycystic kidneys can be safely and effectively treated by ESWL.

  10. Extracorporeal shock wave lithotripsy: status of second generation lithotripters.

    PubMed

    Alder, H C

    1986-04-01

    Since the Food and Drug Administration (FDA) approved the $2 million Dornier lithotripter for general distribution in December 1984, many hospitals and urology groups have expressed interest in acquiring this technology. In fact, more than 40 lithotripters were installed in the United States in 1985, and approximately 50 are scheduled for delivery in 1986. Although the Dornier lithotripter has wide appeal to urologists, many potential buyers cannot afford to purchase this technology. Even special interrelationships such as joint ventures among urologists, hospitals, and other third parties are not logistically or politically possible. As a result, a number of medical equipment firms have begun to develop so-called "second generation" lithotripters. These second generation units have generated a great deal of enthusiasm among those who are locked out of the Dornier market because of cost constraints. They are projected to cost less than one-half as much as the Dornier lithotripter, and may be capable of being used for a number of urological applications. As of March 1986, we have identified six firms in the United States and Europe that are developing second generation units. In the United States, International Biomedics, Inc., Medstone International, and Northgate Research, a Division of Monaghan Medical Corporation; and in France, Edap and Technomed International have all informed urologists and other interested parties in the U.S. about their research and development efforts. Several sources have also indicated that the Siemens Corporation in West Germany has begun to develop a second generation lithotripter.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:10304472

  11. Hazardous sound levels produced by extracorporeal shock wave lithotripsy

    SciTech Connect

    Lusk, R.P.; Tyler, R.S.

    1987-06-01

    Sound emitted from the Dornier system GmbH lithotriptor was found to be of sufficient intensity to warrant concern about noise-induced sensorineural hearing loss. The patients were exposed to impulses of 112 dB. peak sound pressure level. Operating room personnel were exposed to sounds of less intensity, although the number of impulses they were exposed to was much greater, thereby increasing the risk of hearing loss. Hearing protection is recommended for patients and operating room personnel.

  12. Calculus disease in duplex system--role of extracorporeal shockwave lithotripsy.

    PubMed

    Bhatia, V; Biyani, C S

    1993-01-01

    We report 8 patients with urolithiasis in a duplex system. These patients (7 males and 1 female) underwent 16 extracorporeal shock wave lithotripsy (ESWL) treatments. Five had renal and 3 had ureteral stones. The mean stone size was 21 mm (12-54 mm). Five patients had incomplete and 3 had complete duplication, of which one had an associated horseshoe kidney. Retrograde ureteropyelography was done in all the patients and in 7 a JJ stent was inserted. The JJ stent could not be inserted in 1 patient with incomplete duplication and retrograde catheterization with saline infusion was used as an auxiliary procedure. One patient with complete duplication had stones in both the ipsilateral ureters with a stone bulk of 54 mm and required two JJ stents. Only 1 paediatric patient required general anaesthesia. The 3-month stone-free rate was 100%.

  13. [Urologic interventional therapy of kidney calculi (I)--extracorporeal shockwave lithotripsy].

    PubMed

    Knoll, Th; Michel, M S; Köhrmann, K U; Alken, P

    2003-02-01

    With a prevalence of around 5% in western countries, urolithiasis is a frequently occurring disease but with a poorly understood pathogenesis. Effective prevention is not possible for most stone types, in particular for calcium-containing stones, which occur most frequently. Additionally, after occurrence, patient compliance is often inadequate. Interventional therapy becomes necessary after stone manifestation within the urinary tract. Not all stone compositions respond to a drug treatment. Whereas in the seventies, stone treatment meant open surgery newly developed minimally-invasive procedures have displaced this treatment. The clinical introduction of extracorporal shock wave lithotripsy (ESWL) has played a crucial role in this process. Today, more than 80% of all urinary stones can be treated by modern lithotripters. Combination with other minimally-invasive procedures further improve stone free rate. This article provides an overview of technique, application and results of ESWL treatment.

  14. A case of zosteriform lichen planus developing after extracorporeal shockwave lithotripsy.

    PubMed

    Turan, Enver; Akay, Alaaddin; Yesilova, Yavuz; Türkçü, Gül

    2012-09-01

    Lichen planus is a relatively common papulosquamous skin disease of unknown etiology. It is characterized by flat-topped, shiny pinkish-purple papules and plaques on the skin or mucous membranes. The zosteriform type is a rare variant of lichen planus with dermatomal or zonal distribution. A 29-year-old female patient was admitted to our clinic with a 2-month history of a pruritic eruption on the dermatomes on the left between T6-T10. Based on clinical and histological findings, the patient was diagnosed with zosteriform lichen planus. The patient had undergone extracorporeal shock wave lithotripsy (ESWL) for left kidney stones two weeks before the appearance of the lesions. There was no history of skin diseases with dermatomal distribution including herpes zoster in the lesion area. This condition was considered as an isomorphic response following ESWL.

  15. [Experience with extracorporeal shockwave lithotripsy based on 5 years' clinical use].

    PubMed

    Chaussy, C; Fuchs, G

    1985-11-01

    After 6 years of experimental research at the Departments of Urology and Surgical Research of the Ludwig-Maximilian University in Munich, extracorporeal shock-wave lithotripsy (ESWL) was introduced into clinical use in 1980. Uniquely successful and increasingly requested by stone patients, the method soon became widespread. Currently more than 70 lithotriptors are in operation worldwide and over 30,000 treatments have been carried out successfully. Clinical experience in all centers has proved the safety, reliability and reproducibility of the method. Currently, approximately 70% of nonselected stone patients are eligible to receive ESWL treatment and, when combined with endourological procedures, more than 95% of patients can benefit from this method and thus avoid open surgery.

  16. [Extracorporeal shockwave lithotripsy in the treatment of distal ureteral stones larger than 10 mm in diameter].

    PubMed

    Ishii, Nobuyuki; Yoshinaga, Atsushi; Ohno, Rena; Chiba, Koji; Hayashi, Tetsuo; Kamata, Shigeyoshi; Watanabe, Toru; Yamada, Takumi

    2004-06-01

    Optimal treatment for distal ureteral stones remains controversial. During a period of 10 years, from December 1992 to December 2002, 103 distal ureteral stones larger than 10 mm in diameter were treated at our institution with extracorporeal shock wave lithotripsy (ESWL) using the Siemens Lithostar. Only 2 patients had a ureteral stent in place at the time of treatment. The overall stone-free rate was 98% with 1-12 session and 3-month stone-free rate was 95.1%. These data reveal that a high success rate was achieved in multisession ESWL. Therefore, ESWL is considered to be acceptable as first-line therapy for fragmentation of distal ureteral stones larger than 10 mm in diameter.

  17. [Ultrasonography in the follow-up of patients after extracorporeal shockwave lithotripsy].

    PubMed

    Virgili, G; Rosi, P; Vespasiani, G; Dimitri, M; Pesce, F

    1992-06-01

    Extracorporeal shock wave lithotripsy (ESWL) has revolutionized treatment of urinary stones, but created new clinical situations and problems in the interpretation of which x-rays and ultrasonography have proved invaluable. This paper defined the role of ultrasound in the follow-up of patients who had undergone ESWL and assessed its advantages and limitations in evaluating the efficacy of this form of therapy and in monitoring the elimination of stone fragments. The utility of ultrasound in the diagnosis and monitoring of the complications due to ESWL has been emphasized. Finally ultrasound is a valid tool when performing those echo-guided procedures which are essential for the treatment of obstructive complications secondary to ESWL.

  18. [Gallstone treatment using extracorporeal shockwave lithotripsy and adjuvant oral lysis: status and perspective].

    PubMed

    Staritz, M

    1990-03-27

    Three years of clinical experience and the results of the "First International Symposium of Biliary Lithotripsy" showed that extracorporeal shock waves disintegrate cholesterol, pigment and calcified stones into fragments of 1 to 8 mm in diameter. Since spontaneous passage of fragments through the bile ducts is not possible, the therapeutic goal must be achieved with adjuvant oral lysis of the fragments. Therefore, only cholesterol stones are suitable, and a contractile gallbladder as well as a limited stone volume are prerequisites. After one year of treatment, in 45 to 80% of patients complete clearance of stone fragments from the gallbladder is observed. During this period one third of the patients experiences occasional colics. Further severe complications have not been reported.

  19. [Current status and future developments in noninvasive treatment of urinary calculi with extracorporeal shockwave lithotripsy (ESWL)].

    PubMed

    Hofbauer, J; Ludvik, G; Grbovic, M; Marberger, M

    1995-01-01

    Being a highly effective and minimally invasive treatment modality, extracorporeal shock wave lithotriopsy (ESWL) has come to be the therapy of choice in more than 80% of urinary stones. Apart from pregnancy and untreated coagulopathy as contraindications, generally accepted limiting factors are a stone size of > 2.5 cm and the presence of anatomical draining barriers. In such cases endourological procedures are indicated from the outset. Modern urinary stone therapy requires both extracorporeal and intracorporeal procedures of lithotripsy as indispensable complementary techniques. Third-generation lithotriptors are characterized by a dual stone location system (ultrasound and X-ray) and painless treatment without any need for analgesia. The current rapid development of lithotriptors is mainly driven by economic aspects and market requirements like multipurpose or mobile applicability. The "ideal" lithotriptor enabling even more effective, safer, and more comfortable treatment has yet to be developed.

  20. [Gallbladder morphology after extracorporeal shockwave lithotripsy of gallstones with the MPL-9000].

    PubMed

    Frick, T; Cerncic, P; Hoffmann, R; Stamm, B; Largiadèr, F

    1991-07-01

    The effects of extracorporeal spark-gap shockwave lithotripsy (ESWL) on human gallbladder-morphology are barely known. We studied the gallbladders of nine patients cholecystectomized 5 to 166 days after ESWL. Patients were treated one to three times receiving a mean of 1928 +/- 693 shockwaves per treatment, with a total of 3375 +/- 1307 per patient. Control gallbladders were of randomly selected patients after plain cholecystectomy (age and sex-matched). There was no difference in pathomorphology of the two groups. No signs of trauma related damage (hemorrhage, necrosis, ulceration, scar, or hemosiderin deposits) other than from surgical manipulation were found. Predominant pathomorphological changes were signs of chronic cholecystitis due to gallstone disease. In conclusion, spark-gap ESWL did not induce deleterious morphological damage to the gallbladder, although large numbers of shock waves were applied.

  1. New tunable flashlamp-pumped solid state Ti:sapphire laser for laser lithotripsy

    NASA Astrophysics Data System (ADS)

    Jiang, Zhi X.; Giannetas, V.; Charlton, Andrew; King, Terence A.

    1993-05-01

    Laser pulses from a flashlamp pumped, solid state Ti:sapphire laser (Vuman, free running untuned wavelength 792 nm, 2 microseconds pulse width and up to 240 mJ pulse energy) have been successfully and efficiently coupled into thin optical fibers. The coupling efficiency can be up to 67% for 300 micron and 43% for 200 micron core diameter optical fibers. With these two optical fibers in vitro laser lithotripsy has been performed successfully on various human calculi including gall bladder, kidney, ureter and salivary duct stones. The bright white flash of the induced plasma emission, strong shock waves, fiber recoil and stone propulsion and the splattering of the stone chips have been observed during the calculi fragmentation.

  2. Detection of acoustic emission from cavitation in tissue during clinical extracorporeal lithotripsy.

    PubMed

    Coleman, A J; Choi, M J; Saunders, J E

    1996-01-01

    A 1-MHz focused hydrophone has been used to search for acoustic emission expected to arise from cavitation occurring in tissue during clinical extracorporeal shock-wave lithotripsy (ESWL). The hydrophone is acoustically coupled to the patient's skin and the focus directed at depth in tissue under ultrasound guidance. The measured amplitude-time variation of the acoustic emission from tissue near the shock-wave focus of the Storz Modulith SL20 lithotripter has been examined in four patients. There is evidence of increased amplitude acoustic emission at 1 MHz from regions within tissue that also appear hyperechoic in simultaneously acquired ultrasound images. The acoustic emission from these regions decays from an initial peak to the noise level in about 500 microseconds following each shock-wave pulse. Within this period, a second peak, often of higher amplitude than the first, is typically observed about 100 microseconds after the shockwave. The time between the initial and second peaks is found to increase with increasing shock-wave amplitude. The results are similar to those previously observed from cavitation induced by shock-wave exposure in water and indicate that the 1-MHz acoustic emission arises from inertial cavitation in tissue during clinical ESWL.

  3. Shockwave lithotripsy of salivary duct stones.

    PubMed

    Iro, H; Schneider, H T; Födra, C; Waitz, G; Nitsche, N; Heinritz, H H; Benninger, J; Ell, C

    1992-05-30

    Surgical extirpation of the affected gland has been necessary for cases of sialolithiasis in which the stone cannot be removed by dilatation or dissection of the salivary duct. The ability of the piezoelectric lithotripter to deliver shockwaves to a small focus makes extracorporeal shockwave lithotripsy of salivary gland stones potentially safe. Its safety and efficacy have been assessed in 51 patients with symptomatic solitary salivary stones that could not be removed by conservative measures. The stones had a median diameter of 8 (range 4-18) mm and were located in the submandibular gland in 69% of patients and in the parotid gland in 31%. A total of 72 shockwave treatment sessions (maximum 3 per patient) were given under continuous sonographic monitoring. In 45 patients (88%) complete fragmentation (fragments less than or equal to 3 mm) of the concrements was achieved. No patient needed anaesthesia, sedatives, or analgesics. The only untoward effects were localised petechial haemorrhages after 10 (13%) out of 72 treatments and transient swelling of the gland immediately after delivery of shockwave in 2/72 (3%) sessions. 20 weeks after the first session 90% (46/51) of patients were free of discomfort, and 53% (27/51) were stone free. Stone-clearance rate was higher among patients with stones in the parotid gland (81%) than among those with stones of the submandibular gland (40%). Auxiliary measures such as dilatation or dissection of the salivary duct were required only in patients with stones in the submandibular gland (20%). No long-term damage to the treated salivary gland or to adjacent tissue structures was noted during the median follow-up of 9 (1-24) months. Extracorporeal piezoelectric shockwave therapy seems likely to be safe, comfortable, and effective minimally-invasive, non-surgical treatment for salivary stones.

  4. The complications of extracorporeal shockwave lithotripsy: management and prevention.

    PubMed

    Coptcoat, M J; Webb, D R; Kellett, M J; Fletcher, M S; McNicholas, T A; Dickinson, I K; Whitfield, H N; Wickham, J E

    1986-12-01

    Extracorporeal shockwave lithotripsy has been shown to be a safe and effective method of treating most upper urinary tract stones. Major complications, although few, include haemorrhage, septicaemia, "Steinstrasse" formation and cardiac arrhythmias. The experience from 600 consecutive cases is reviewed and methods of prevention are discussed.

  5. [Methods optimizing the efficiency of the extracorporeal shockwave lithotripsy (ESWL)].

    PubMed

    Bonev, K; Panchev, P; Simeonov, P

    2007-01-01

    The medicine science is in a progressive mode. One of the ever discussed problems is the stone kidney disease and the optimizing methods of its treatment. In this article the authors announced a new method of applying jelly, thus improving the efficiency of the Extracorporeal Shockwave Lithotripsy (ESWL).

  6. Root cause analysis following nephrectomy after extracorporeal shockwave lithotripsy (ESWL).

    PubMed

    Cahill, Katie; Cruz, Eneida; Guilbert, Mary Beth; Oser, Meg O'Toole

    2008-12-01

    An adverse event after a routine extracorporeal shockwave lithotripsy procedure set into motion a root cause analysis methodology to decipher why and how the event occurred and offer a solution to prevent it from happening again. The process of performing a root cause analysis is discussed in detail.

  7. [Extracorporeal shockwave lithotripsy and ureteroscopic lithotripsy for ureteral stones. A comparative study].

    PubMed

    Xue, Z Y

    1991-04-01

    From June 1987 to December 1988, 212 cases of ureteral calculi were treated with ESWL and ureteroscopic lithotripsy (URSL) respectively. The lithotriptic success rates of ESWL for upper, mid and distal ureteric stones were 100.0%, 100.0% and 93.4% respectively as compared with 62.5%, 85.7% and 93.7% of URSL. ESWL for upper and mid ureteral stones was obviously superior to URSL (P less than 0.001). The incidence rate of complications of ESWL was lower than that of URSL (P less than 0.05). In the 212 cases, urinary extravasation caused by ureteral injury occurred in 4 cases treated by URSL. We suggest that ESWL should be the first treatment of choice for ureteral calculi and URSL is not recommended for the treatment of upper ureteral calculi, but it may be used as an adjunctive method.

  8. [Extracorporeal shockwave lithotripsy of the ureteral calculus--clinical results with local shockwave lithotripsy].

    PubMed

    Wilbert, D M; Voges, G E; Müller, S C; Alken, P

    1987-11-01

    Second generation local shockwave lithotripsy appliances (Lithostar) were used for the treatment of upper and lower ureteral stones in 199 patients, 145 of whom had upper ureteral stones. In 78 patients the calculi were pushed back and all but one disintegrated. In 33 patients a catheter was inserted past the stone, which resulted of primary disintegration in 66%. In 19 of 34 patients (56%) in whom the stones could not be moved, primary disintegration was achieved. Distal ureteral stones were present in 54 patients and these were treated successfully by ESWL alone in 83.3%. Auxiliary measures (total 10%) included ureteroscopy, percutaneous extraction and ureterolithotomy. The results are discussed under the aspects of 'in situ' versus 'push-and-smash' procedures.

  9. [The therapeutic value of ambulatory extracorporeal shockwave lithotripsy of salivary calculi. Results of a prospective study].

    PubMed

    Hessling, K H; Schlick, R W; Luckey, R; Gratz, K; Qaiyumi, S A; Allhoff, E P

    1993-03-01

    In a prospective study, results of the extracorporeal shock wave lithotripsy of salivary stones were evaluated. The study was performed with the currently available technical possibilities of electromagnetic systems to get indication criteria for this procedure. Using the Modulith SL 20-lithotripter of Storz Medical AG, 33 concrements in 25 patients were treated in 89 lithotripsy sections. The stone sizes, localized by ultrasound, ranged from 3 to 13 mm diameter (phi 6.9 mm). After application of local anaesthesia, per session on an average 1300 shock waves with raising energy levels were applied, the succession of shocks fixed to 1 MHz. With the help of ultrasound localisation, a therapeutic success with complete emission of the concrement or an adequate disintegration of these stones could be achieved in 82% of the parotid gland stones (n = 11) and in 14% of the submandibular gland stones (n = 22). Since the unhampered functioning of these salivary glands is an inevitable pre-condition for the spontaneous emission of the disintegrated fragments, the status of function of salivary glands should be established by a scintigraphy before performing the ESWL. Even though complete emission of the stone could be achieved in only 4 patients, all patients were clinically free of symptoms after the treatment. In 3 of 25 patients, discrete bleeding of a passing nature occurred coming from the salivary duct. In 2 patients, formation of haematoma of varying dimensions could be visualized by ultrasound. 3 patients showed petechial skin bleeding. The tinnitus aurium which affected one patient eased after 3 days. In our patients collective a facial nerve damage did not occur.2+ longterm prognosis after this procedure.

  10. Study of cavitation bubble dynamics during Ho:YAG laser lithotripsy by high-speed camera

    NASA Astrophysics Data System (ADS)

    Zhang, Jian J.; Xuan, Jason R.; Yu, Honggang; Devincentis, Dennis

    2016-02-01

    Although laser lithotripsy is now the preferred treatment option for urolithiasis, the mechanism of laser pulse induced calculus damage is still not fully understood. This is because the process of laser pulse induced calculus damage involves quite a few physical and chemical processes and their time-scales are very short (down to sub micro second level). For laser lithotripsy, the laser pulse induced impact by energy flow can be summarized as: Photon energy in the laser pulse --> photon absorption generated heat in the water liquid and vapor (super heat water or plasma effect) --> shock wave (Bow shock, acoustic wave) --> cavitation bubble dynamics (oscillation, and center of bubble movement , super heat water at collapse, sonoluminscence) --> calculus damage and motion (calculus heat up, spallation/melt of stone, breaking of mechanical/chemical bond, debris ejection, and retropulsion of remaining calculus body). Cavitation bubble dynamics is the center piece of the physical processes that links the whole energy flow chain from laser pulse to calculus damage. In this study, cavitation bubble dynamics was investigated by a high-speed camera and a needle hydrophone. A commercialized, pulsed Ho:YAG laser at 2.1 mu;m, StoneLightTM 30, with pulse energy from 0.5J up to 3.0 J, and pulse width from 150 mu;s up to 800 μs, was used as laser pulse source. The fiber used in the investigation is SureFlexTM fiber, Model S-LLF365, a 365 um core diameter fiber. A high-speed camera with frame rate up to 1 million fps was used in this study. The results revealed the cavitation bubble dynamics (oscillation and center of bubble movement) by laser pulse at different energy level and pulse width. More detailed investigation on bubble dynamics by different type of laser, the relationship between cavitation bubble dynamics and calculus damage (fragmentation/dusting) will be conducted as a future study.

  11. Acoustic field distribution of sawtooth wave with nonlinear SBE model

    SciTech Connect

    Liu, Xiaozhou Zhang, Lue; Wang, Xiangda; Gong, Xiufen

    2015-10-28

    For precise prediction of the acoustic field distribution of extracorporeal shock wave lithotripsy with an ellipsoid transducer, the nonlinear spheroidal beam equations (SBE) are employed to model acoustic wave propagation in medium. To solve the SBE model with frequency domain algorithm, boundary conditions are obtained for monochromatic and sawtooth waves based on the phase compensation. In numerical analysis, the influence of sinusoidal wave and sawtooth wave on axial pressure distributions are investigated.

  12. Repeated piezoelectric lithotripsy for gallstones with and without ursodeoxycholic acid dissolution: a multicenter study.

    PubMed

    Tsuchiya, Y; Ishihara, F; Kajiyama, G; Nakazawa, S; Otho, M; Tanimura, H; Akura, Y; Harada, M; Hihara, M; Kawai, Y

    1995-12-01

    The use of bile acid dissolution therapy in extracorporeal shockwave lithotripsy of gallstones, remains controversial. Our study examined whether chemolitholysis after sufficient disintegration enhanced stone clearance within 6 months of the first lithotripsy. A total of 143 patients who developed one to three radiolucent stones measuring < or = 30 mm in diameter were randomly separated into two treatment groups: 47% were given lithotripsy alone, and 53% lithotripsy plus ursodeoxycholic acid (UDCA). Repeated piezoelectric lithotripsy was given, with no limit on the total number of treatment sessions, to pulverize or disintegrate stones into fragments < 3 mm. Stones were disintegrated in 97% of all patients, and the fragments were < or = 2 mm in 50% of these patients. According to an intention-to-treat analysis, 52% in the lithotripsy alone group and 58% in the UDCA group were free of stones 6 months after the first lithotripsy (P = 0.61). Of the patients with fragments < or = 2 mm, 71% in the former and 86% in the latter group were free of stones 6 months after the first lithotripsy, with no significant difference between the groups. Biliary pain occurred in 25% of all patients, including 3 with acute cholecystitis. We concluded that the sufficient disintegration of gallstones achieved with repeated lithotripsy enhanced the early clearance of fragments, regardless of whether chemolitholysis was employed.

  13. [The prognosis of the efficacy of extracorporeal shockwave lithotripsy of the kidneys and ureters].

    PubMed

    Dzhavad-Zade, S M

    1996-01-01

    A retrospective analysis of the data on 300 patients revealed a relationship between basic clinical and history evidence, location of the concrement and efficacy of a single lithotripsy. The author presents factors influencing concrement disintegration. Basing on the relations between efficacy of lithotripsy and clinical signs three-score system for estimation of each sign is proposed. The highest effect of the concrement fragmentation occurred within 10 scores (in 97.1% of the patients). The score above 16 is indicative of lowering efficacy of lithotripsy. This system of calculation is efficient in prognostication of efficacy of extracorporeal impulse lithotripsy of the kidneys and ureters.

  14. [Extracorporeal piezogenerated shockwave lithotripsy. Our experience in 500 cases].

    PubMed

    Vargas Blasco, C; Alcover García, J; Gil-Vernet Sedo, J M; Bianchi Cardona, L

    1990-01-01

    Between April 1987 and August 1988, 498 patients suffering renal or ureteral lithiasis, all of them with a 6 months or more follow-up period, have been treated in our Unit. Patients were treated in an ambulatory regime without need for anesthesia or analgesia. Up to 27% of the cases has surgical background for lithiasis. One hundred and twenty-six patients had a double J ureteral catheter placed prior to lithotripsy treatment. Fourty-four percent cases needed only one session, 25% two, 12% three and 18% more than three sessions. At the time of discharge 86% patients had no lithiasis or fragments less than 3 mm. Only 9% had fragments larger that 3 mm. It is our opinion than piezoelectric extracorporeal lithotripsy has been proven as a safe, effective and painless procedure in most renal lithiasis.

  15. A fruitful demonstration in sensors based on upconversion luminescence of Yb3+/Er3+codoped Sb2O3-WO3-Li2O (SWL) glass-ceramic

    NASA Astrophysics Data System (ADS)

    Prasad Sukul, Prasenjit; Kumar, Kaushal

    2016-07-01

    In this article, erbium and ytterbium doped lithium tungsten antimonate (Yb3+/Er3+:Sb2O3-WO3-Li2O) glass-ceramics (GC) is synthesized and its novel applications in temperature sensing and detection of latent fingerprints is studied. It is also estimated that this material could be useful as a solar cell concentrator. The upconversion emission studies on Yb3+/Er3+:SWL glass-ceramics have shown intense green emission at 525 nm (2H11/2 → 4I15/2) & 545 nm (4s3/2 → 4I15/2). The variation of UC intensities with external temperature have shown a well-fashioned pattern, which suggests that the 2H11/2 and 4S3/2 levels of Er3+ ion are thermally coupled and can act as a temperature sensor in the 300–500 K temperature range. Dry powder of Yb3+/Er3+:SWL glass-ceramic is used to develop latent fingerprint with high contrast in green color on glass slide.

  16. A fruitful demonstration in sensors based on upconversion luminescence of Yb3+/Er3+codoped Sb2O3-WO3-Li2O (SWL) glass-ceramic

    NASA Astrophysics Data System (ADS)

    Prasad Sukul, Prasenjit; Kumar, Kaushal

    2016-07-01

    In this article, erbium and ytterbium doped lithium tungsten antimonate (Yb3+/Er3+:Sb2O3-WO3-Li2O) glass-ceramics (GC) is synthesized and its novel applications in temperature sensing and detection of latent fingerprints is studied. It is also estimated that this material could be useful as a solar cell concentrator. The upconversion emission studies on Yb3+/Er3+:SWL glass-ceramics have shown intense green emission at 525 nm (2H11/2 → 4I15/2) & 545 nm (4s3/2 → 4I15/2). The variation of UC intensities with external temperature have shown a well-fashioned pattern, which suggests that the 2H11/2 and 4S3/2 levels of Er3+ ion are thermally coupled and can act as a temperature sensor in the 300-500 K temperature range. Dry powder of Yb3+/Er3+:SWL glass-ceramic is used to develop latent fingerprint with high contrast in green color on glass slide.

  17. Do not treat staghorn calculi by extracorporeal shockwave lithotripsy alone!

    PubMed

    Delaney, C P; Creagh, T A; Smith, J M; Fitzpatrick, J M

    1993-01-01

    A review of 84 patients with triple phosphate (staghorn) calculi treated by extracorporeal shockwave lithotripsy (ESWL) revealed a 67% stone clearance at 6 months. Classification of calculi according to morphology showed a variation in stone clearance from 47 to 82%. A significant number of patients developed complications (25%) or required additional procedures (27%). ESWL monotherapy is not a suitable treatment option for most patients with staghorn calculi.

  18. Flexible cystoscopy as an adjunct to extracorporeal shockwave lithotripsy.

    PubMed

    Mark, S D; Gray, J M; Wright, W L

    1990-09-01

    Ancillary procedures associated with extracorporeal shockwave lithotripsy (ESWL) include placement and subsequent removal of double pigtail ureteric stents. A simple new technique has been developed for the insertion of these stents. Using the flexible cystoscope, the procedure is performed on an out-patient basis under local anaesthesia. Placement of the stents was successful in 30/34 patients and removal was successful in 14/14 patients.

  19. Laser and acoustic lens for lithotripsy

    DOEpatents

    Visuri, Steven R.; Makarewicz, Anthony J.; London, Richard A.; Benett, William J.; Krulevitch, Peter; Da Silva, Luiz B.

    2002-01-01

    An acoustic focusing device whose acoustic waves are generated by laser radiation through an optical fiber. The acoustic energy is capable of efficient destruction of renal and biliary calculi and deliverable to the site of the calculi via an endoscopic procedure. The device includes a transducer tip attached to the distal end of an optical fiber through which laser energy is directed. The transducer tip encapsulates an exogenous absorbing dye. Under proper irradiation conditions (high absorbed energy density, short pulse duration) a stress wave is produced via thermoelastic expansion of the absorber for the destruction of the calculi. The transducer tip can be configured into an acoustic lens such that the transmitted acoustic wave is shaped or focused. Also, compressive stress waves can be reflected off a high density/low density interface to invert the compressive wave into a tensile stress wave, and tensile stresses may be more effective in some instances in disrupting material as most materials are weaker in tension than compression. Estimations indicate that stress amplitudes provided by this device can be magnified more than 100 times, greatly improving the efficiency of optical energy for targeted material destruction.

  20. [Intracorporeal shockwave lithotripsy using the neodymium YAG laser].

    PubMed

    Schmeller, N T; Hofstetter, A; Kriegmair, M; Frank, F; Wondrazek, F

    1989-09-10

    The problem of suitable energy transfer and conversion for intraureteral lithotripsy has not yet been solved satisfactorily. Laser-induced shockwave lithotripsy (LISL) appears to be a very promising solution to this problem. We report on initial clinical experience using a Q-switched Nd:YAG laser generating a shockwave on the metallic surface of an optomechanic coupler. This leads to the fine fragmentation of a urinary calculus situated close to or in contact with the coupler. Only minimal side effects occur in biological tissue. Further development of the coupler resulted in considerable increase of its fragmentation capability with no increase in side-effects. As a result, application under fluoroscopic control alone became possible, which appears adequate in approximately half of the cases. In the other half visual inspection via ureteroscopy is required. Laser-induced lithotripsy is the only technique that uses a flexible transmission system, results in the fine fragmentation of calculi, and is free of serious side effects on tissue, i.e. does not lead to perforation of the wall of the ureter.

  1. Influence of Saline on Temperature Profile of Laser Lithotripsy Activation

    PubMed Central

    Silva, Igor N.; Donalisio da Silva, Rodrigo; Gustafson, Diedra; Sehrt, David; Kim, Fernando J.

    2015-01-01

    Abstract Purpose: We established an ex vivo model to evaluate the temperature profile of the ureter during laser lithotripsy, the influence of irrigation on temperature, and thermal spread during lithotripsy with the holmium:yttrium-aluminum-garnet (Ho:YAG) laser. Materials and Methods: Two ex vivo models of Ovis aries urinary tract and human calcium oxalate calculi were used. The Open Ureteral Model was opened longitudinally to measure the thermal profile of the urothelium. On the Clinical Model, anterograde ureteroscopy was performed in an intact urinary system. Temperatures were measured on the external portion of the ureter and the urothelium during lithotripsy and intentional perforation. The lithotripsy group (n=20) was divided into irrigated (n=10) and nonirrigated (n=10), which were compared for thermal spread length and values during laser activation. The intentional perforation group (n=10) was evaluated under saline flow. The Ho:YAG laser with a 365 μm laser fiber and power at 10W was used (1J/Pulse at 10 Hz). Infrared Fluke Ti55 Thermal Imager was used for evaluation. Maximum temperature values were recorded and compared. Results: On the Clinical Model, the external ureteral wall obtained a temperature of 37.4°C±2.5° and 49.5°C±2.3° (P=0.003) and in the Open Ureteral Model, 49.7°C and 112.4°C with and without irrigation, respectively (P<0.05). The thermal spread along the external ureter wall was not statically significant with or without irrigation (P=0.065). During intentional perforation, differences in temperatures were found between groups (opened with and without irrigation): 81.8°±8.8° and 145.0°±15.0°, respectively (P<0.005). Conclusion: There is an increase in the external ureteral temperature during laser activation, but ureteral thermal values decreased when saline flow was applied. Ureter thermal spread showed no difference between irrigated and nonirrigated subgroups. This is the first laser lithotripsy thermography study

  2. Extracorporeal shockwave lithotripsy: first 1000 cases at the London Stone Clinic.

    PubMed

    Das, G; Dick, J; Bailey, M J; Fletcher, M S; Webb, D R; Kellett, M J; Whitfield, H N; Wickham, J E

    1987-10-10

    One thousand patients underwent extracorporeal shockwave lithotripsy for renal and ureteric calculi at this clinic. An overall success rate of 91.8% was achieved (stone free or less than 2 mm fragments at three months) and for stones measuring 1 cm 96.3%. Lithotripsy produced extremely low morbidity, and no deaths have occurred at the clinic. Patients who had lithotripsy alone had a mean hospital stay of three days and in most instances were able to perform their full range of activities on discharge. Planned combination of lithotripsy with minimally invasive endourological procedures such as percutaneous nephrolithotomy and ureterorenoscopy has allowed us to extend the range of treatable cases to include large stones. Prophylactic use of Double-J ureteric stents in selected cases has reduced the incidence of obstruction by stone fragments after lithotripsy, thereby decreasing morbidity and hospital stay.

  3. Quantification of the Range of Motion of Kidney and Ureteral Stones During Shockwave Lithotripsy in Conscious Patients.

    PubMed

    Harrogate, Suzanne R; Yick, L M Shirley; Williams, James C; Cleveland, Robin O; Turney, Benjamin W

    2016-04-01

    Effective shockwave lithotripsy requires accurate targeting of the stone throughout the course of treatment. Stone movement secondary to respiratory movement can make this more difficult. In vitro work has shown that stone motion outside the focal region reduces the efficacy of stone fragmentation; however, there are few clinical data on the degree of stone movement in patients during treatment. To investigate this, X-ray fluoroscopic images of the kidney and ureteral stones at the upper and lower limits of the normal respiratory cycle were acquired during shock wave lithotripsy of 58 conscious patients, and stone excursion was calculated from these images. In addition, the respiration rate and patient perceived pain were recorded during the course of the treatment. It was found that stone motion secondary to respiration was 7.7 ± 2.9 mm for kidney stones and 3.6 ± 2.1 mm for ureteral stones-less than has been reported in studies with anesthetized patients. There was no significant change of motion over the course of treatment although pain was found to increase. These data suggest that stone motion in conscious patients is less than in anesthetized patients. Furthermore, it suggests that lithotripters with focal regions of 8 mm or greater should not suffer from a marked drop in fragmentation efficiency due to stone motion.

  4. [Extracorporeal shockwave lithotripsy of pancreatic calculi].

    PubMed

    Neuhaus, H; Hagenmüller, F; Classen, M

    1990-08-01

    Extracorporeal shock-wave fragmentation of pancreatic stones is a complementary non-surgical treatment in selected patients with chronic pancreatitis. The procedure has proven to be safe and technically effective. Preliminary clinical results indicate therapeutic success rates in terms of pain disappearance or reduction in more than 90% of the patients. The indication should be taken into consideration before surgical intervention.

  5. [Extracorporeal shockwave lithotripsy. Current status in treatment of kidney calculus disease].

    PubMed

    Rassweiler, J; Eisenberger, F; Bub, P; Schmidt, A

    1989-08-10

    The introduction of extracorporal shock wave lithotripsy has led to a revolution in stone management. After five years of clinical experience with increasing use of second generation lithotripters, the following conclusions can be drawn: There is an increasing tendency to employ ESWL for ureteral calculi, although only 60% of those can be located by ultrasound. In the case of staghorn stones, a differentiated approach is adopted (ESWL-, PCNL-monotherapy or a combination of the two) depending on stone size, localisation, chemical composition, radiodensity, and the state of the collecting system. With almost all second generation lithotripters, ESWL can be performed under i.v.-analgesia. Some machines with a large-aperture shock wave source (i.e. Wolf Piezolith, Edap LT 01, Dornier MPL 9000) even permit painfree treatment without the need for analgesia. However, this is associated with a 30% increase in retreatment rate. Further development of low-cost lithotripters and increasing use of ESWL for biliary stones make it necessary for ever more hospitals to face the question of installing such a machine. In this situation, the choice must be based on the local situation (i.e. number of patients, interdisciplinary use of ESWL).

  6. Biliary extracorporeal shockwave lithotripsy: short-term and long-term observations in an animal model.

    PubMed

    Vergunst, H; Terpstra, O T; Brakel, K; Nijs, H G; Laméris, J S; ten Kate, F J; Schröder, F H

    1993-08-01

    The short- and long-term effects of biliary extracorporeal shockwave lithotripsy (ESWL) using an electromagnetic lithotriptor were investigated in 26 pigs. After implantation of single human gallstones into their gallbladders, all but 4 control pigs were subjected to 4,000 or 8,000 shock waves and killed one day (n = 9), one week (n = 7), or one year (n = 6) thereafter. Post-ESWL, no abnormalities of chest radiographs or laboratory tests were detected. Apart from focal injury of the gallbladder and liver, in 4 out of 9 pigs subpleural pulmonary hemorrhages were found one day post-ESWL. However, tissue damage was largely reversed within one week and after one year only small hepatic scars persisted as permanent damage. Stone fragmentation occurred in 19 (86%) out of 22 pigs, and was adequate (fragments < or = 5 mm) in 9 (41%) pigs. Tissue damage and stone fragmentation after 4,000 as compared with 8,000 shock waves were not significantly different. These data warrant further evaluation of this lithotriptor in human studies.

  7. [Extrasystoles during extracorporeal biliary shockwave lithotripsy. Their incidence and clinical significance].

    PubMed

    Rambow, A; Staritz, M; Grosse, A; Treese, N; Mayer, K; Meyer zum Büschenfelde, K H

    1991-02-15

    Incidence and clinical significance of cardiac side effects of extracorporeal shock-wave lithotripsy (ESWL) were prospectively analysed for 85 patients (26 men, 59 women; mean age 44 [17-81] years) with cholecystolithiasis (n = 70) or choledocholithiasis (n = 15). 24-hour ECG monitoring was undertaken on the day of treatment. Additionally, during ESWL cardiac rhythm and blood pressure were monitored. ESWL was performed with an electromagnetic lithotriptor under light anaesthesia with intravenous diazepam (10 mg) and pethidine (75-100 mg). There were no superventricular premature systoles in any of the patients during treatment. In 15 patients with occasional ventricular premature systoles (VPS) (6-81 per 23 hours) in the 24-hour ECG the number of VPS increased during the one-hour ESWL procedure significantly to 6-55 (P less than 0.05). 14 of these patients had an unremarkable cardiac history. Changing the lithotriptor coupling angle failed to suppress the VPS in only two patients. In these two it was necessary to trigger the shock wave with the ECG. Blood pressure rose markedly (up to 220 mm Hg systolic) during ESWL in only three patients, known hypertensives. But this rise was easily controlled with nifedipine, 10 mg sublingually. These data demonstrate that ESWL is a safe alternative to operative treatment, even in the presence of existing cardiac disease. Nonetheless, precautions should be taken in case there are complications.

  8. [Extracorporeal shockwave lithotripsy in the treatment of gallbladder lithiasis. The first 109 patients].

    PubMed

    Correia, A P; Ribeiro, L C; Contente, L F; de Moura, M C

    1993-07-01

    The AA report their 15-month experience with extracorporeal shock-wave lithotripsy (ESWL) in the treatment of gallbladder stones (GS). The selection criteria included symptomatic patients, with 1 to 3 radiolucent stones in a functioning gallbladder. All patients were put on adjuvant therapy with 10 mg/Kg weight/day of ursodeoxycholic acid (ursodiol). ESWL sessions were performed in an ambulatory setting, using high-energy shock-waves (mean: 23 Kv) until fragments < or = 4mm were obtained, if possible. By the end of December 1992, 109 patients had completed the ESWL protocol, undergoing a total of 265 sessions (mean: 2.4 sessions per patient, variation 1-5). The stone-free (SF) rates and respective 95% confidence intervals were 31% (22%-43%) at 6 months and 59% (38%-76%) at 1 year of follow-up. For the subset of patients with a single stone < or = 2 cm (n = 59), were 47% (33%-63%) at 6 months and 77% (40%-95%) at 1 year. The most significant complication was acute biliary pancreatitis, of which we report 4 cases (4%). They were always mild and non-complicated. There was no mortality. The AA conclude that ESWL is a safe and effective treatment for selected patients with GS.

  9. Damage attributable to extracorporeal shockwave lithotripsy and deposition of calcium oxalate crystals on ureteral stents.

    PubMed

    Ikeda, R; Suzuki, K; Tsugawa, R

    1997-04-01

    Ureteral stents have been widely used during and after SWL depending on the size of the stones and the condition of the urinary tracts. The use of stents can help to reduce complications and contributes to stone passage. However, some reports note complications that were attributed to indwelling ureteral stents. We attended to the role of obstruction of ureteral stents in those complications. The aim of this study was to analyze factors that influence ureteral stent obstruction and damage caused by SWL. Crystal deposition and the damage by SWL were examined in all ureteral stents by the use of continuous flow system and were evaluated by scanning electron microscopy. The degree of crystal deposition and damage differed depending on the individual stent. The material properties of the stent surface are the major factor influencing crystal deposition and the degree of damage by SWL. The indications for ureteral stenting must be considered in each case, because the routine use of ureteral stents has a possibility to increase complications.

  10. Clinical factors associated with postoperative hydronephrosis after ureteroscopic lithotripsy

    PubMed Central

    Kim, Sun Woo; Ahn, Ji Hoon; Yim, Sang Un; Cho, Yang Hyun; Shin, Bo Sung; Chung, Ho Seok; Yu, Ho Song; Oh, Kyung Jin; Kim, Sun-Ouck; Jung, Seung Il; Kang, Taek Won; Kwon, Dong Deuk; Park, Kwangsung

    2016-01-01

    Purpose This study aimed to determine the predictors of ipsilateral hydronephrosis after ureteroscopic lithotripsy for ureteral calculi. Materials and Methods From January 2010 to December 2014, a total of 204 patients with ureteral calculi who underwent ureteroscopic lithotripsy were reviewed. Patients with lack of clinical data, presence of ureteral rupture, and who underwent simultaneous percutaneous nephrolithotomy (PNL) were excluded. Postoperative hydronephrosis was determined via computed tomographic scan or renal ultrasonography, at 6 months after ureteroscopic lithotripsy. Multivariable analysis was performed to determine clinical factors associated with ipsilateral hydronephrosis. Results A total of 137 patients were enrolled in this study. The mean age of the patients was 58.8±14.2 years and the mean stone size was 10.0±4.6 mm. The stone-free rate was 85.4%. Overall, 44 of the 137 patients (32.1%) had postoperative hydronephrosis. Significant differences between the hydronephrosis and nonhydronephrosis groups were noted in terms of stone location, preoperative hydronephrosis, impacted stone, operation time, and ureteral stent duration (all, p<0.05). On multivariable analysis, increasing preoperative diameter of the hydronephrotic kidney (adjusted odds ratio [OR], 1.21; 95% confidence interval [CI], 1.12–1.31; p=0.001) and impacted stone (adjusted OR, 3.01; 95% CI, 1.15–7.61; p=0.031) independently predicted the occurrence of postoperative hydronpehrosis. Conclusions Large preoperative diameter of the hydronephrotic kidney and presence of impacted stones were associated with hydronephrosis after ureteroscopic stone removal. Therefore, patients with these predictive factors undergo more intensive imaging follow-up in order to prevent renal deterioration due to postoperative hydronephrosis. PMID:27617316

  11. Intracorporeal lithotripsy with the holmium:YAG laser

    NASA Astrophysics Data System (ADS)

    Denstedt, John D.; Razvi, Hassan A.; Chun, Samuel S.; Sales, Jack L.

    1995-05-01

    A variety of devices are currently available for intracorporeal stone fragmentation. Recently a new wavelength of laser, the Holmium:YAG, has demonstrated a variety of potential urologic applications including ablation of soft tissue lesions as well as stone fragmentation. This laser has a wavelength of 2100 nm and operates in a pulsed mode. Energy is delivered through a 400 um quartz end-firing fiber. In this presentation we review our clinical experience with the Holmium:YAG laser for the treatment of renal and ureteral calculi. Over a 23 month period, 63 patients underwent 67 procedures. Seven procedures consisted of percutaneous nephrolithotripsy for large or staghorn renal calculi. Sixty procedures were performed for ureteral stones. Procedures for proximal ureteral stones (6) employed a retrograde approach using flexible ureteroscopes (8.5 or 9.8). Stones in the mid ureter (12) and distal ureter (42) were approached transurethrally using a 6.9 rigid ureteroscope. Complete stone fragmentation without the need for additional procedures was achieved in 82% of cases. Treatment failures included 1 stone migration into the renal pelvis during laser activation, 6 patients who had incomplete fragmentation and 3 patients in which laser malfunction precluded complete fragmentation. Stone analysis available in 23 patients revealed calcium oxalate monohydrate (15), calcium oxalate dihydrate (2), cystine (2), uric acid (3) and calcium phosphate (1). A single complication of ureteral perforation occurred when the laser was fired without direct visual guidance. Radiographic follow-up at an average of 16 weeks is available in 22 patients and has identified 2 patients with ureteral strictures that are not believed to be related to laser lithotripsy. In summary, we have found the Holmium:YAG laser to be a reliable and versatile device for intracorporeal lithotripsy. Its safety and efficacy make it a suitable alternative for performing intracorporeal lithotripsy of urinary

  12. Clinical factors associated with postoperative hydronephrosis after ureteroscopic lithotripsy

    PubMed Central

    Kim, Sun Woo; Ahn, Ji Hoon; Yim, Sang Un; Cho, Yang Hyun; Shin, Bo Sung; Chung, Ho Seok; Yu, Ho Song; Oh, Kyung Jin; Kim, Sun-Ouck; Jung, Seung Il; Kang, Taek Won; Kwon, Dong Deuk; Park, Kwangsung

    2016-01-01

    Purpose This study aimed to determine the predictors of ipsilateral hydronephrosis after ureteroscopic lithotripsy for ureteral calculi. Materials and Methods From January 2010 to December 2014, a total of 204 patients with ureteral calculi who underwent ureteroscopic lithotripsy were reviewed. Patients with lack of clinical data, presence of ureteral rupture, and who underwent simultaneous percutaneous nephrolithotomy (PNL) were excluded. Postoperative hydronephrosis was determined via computed tomographic scan or renal ultrasonography, at 6 months after ureteroscopic lithotripsy. Multivariable analysis was performed to determine clinical factors associated with ipsilateral hydronephrosis. Results A total of 137 patients were enrolled in this study. The mean age of the patients was 58.8±14.2 years and the mean stone size was 10.0±4.6 mm. The stone-free rate was 85.4%. Overall, 44 of the 137 patients (32.1%) had postoperative hydronephrosis. Significant differences between the hydronephrosis and nonhydronephrosis groups were noted in terms of stone location, preoperative hydronephrosis, impacted stone, operation time, and ureteral stent duration (all, p<0.05). On multivariable analysis, increasing preoperative diameter of the hydronephrotic kidney (adjusted odds ratio [OR], 1.21; 95% confidence interval [CI], 1.12–1.31; p=0.001) and impacted stone (adjusted OR, 3.01; 95% CI, 1.15–7.61; p=0.031) independently predicted the occurrence of postoperative hydronpehrosis. Conclusions Large preoperative diameter of the hydronephrotic kidney and presence of impacted stones were associated with hydronephrosis after ureteroscopic stone removal. Therefore, patients with these predictive factors undergo more intensive imaging follow-up in order to prevent renal deterioration due to postoperative hydronephrosis.

  13. Routine liver function tests and serum amylase determinations after biliary lithotripsy: are they necessary?

    PubMed

    Goodacre, B W; Malone, D E; Fache, J S; Rawat, B; Burhenne, H J

    1990-10-01

    Shock-wave-induced soft-tissue damage after biliary extracorporeal shock-wave lithotripsy (BESWL) has been reported. Every patient treated in Vancouver has, therefore, had liver function tests and serum amylase levels measured before and within 6 days after BESWL. All patients had symptomatic cholecystolithiasis with normal pre-BESWL biochemistry. Analysis of 311 patients after treatment with the Siemens Lithostar unit showed elevation of one or more laboratory value in 19% (60/311). Serum aspartate transaminase level was most frequently abnormal (38 cases). The majority of abnormalities were mild, less than two times normal levels. Clinically significant complications occurred in five patients (three pancreatitis, one cholecystitis, one common bile duct obstruction); four of these occurred 1 week or more after treatment. The results of routine laboratory tests could not be used to predict complications. No correlation was seen between abnormal values and number of shock waves administered or peak shock-wave pressure. Of 112 patients surveyed at the time of post-BESWL enzyme measurement, 49 (44%) reported a degree of pain, which was severe in eight cases. Presence of severe pain correlated strongly (p less than .001) with abnormal laboratory findings, however not with the degree of abnormality. As results of these laboratory tests are nonspecific, have not been shown to correlate with the degree of severity of BESWL-induced tissue damage, and do not predict complications, the tests are of little value in the absence of clinical signs and symptoms. These conclusions, however, apply only to the Siemens Lithostar Plus with patients treated in the steep left posterior oblique position. Cost savings can be expected if routine post-BESWL biochemical tests are abandoned.

  14. Second-generation lithotripsy: a safe, noninvasive, ambulatory procedure.

    PubMed

    Baert, L; Claes, H; Billiet, I; D'Hallewin, M; Vandeursen, H; Van Poppel, H

    1989-01-01

    A total of 600 patients underwent 696 treatments of extracorporeal shockwave lithotripsy (ESWL) during the period between June and November 1987. Our progressively increasing experience with the second-generation device shows that this new unit is as effective as the conventional one, and reveals several advantages. The focusing of the stone is easier; therapy time is shorter; general or regional anesthesia is no longer necessary; distal ureteral stones can be disintegrated, and adjuvant procedures are easily performed during the ESWL session. Of the last 400 patients of our series, 76% were treated on an outpatient basis without any major complications.

  15. A death due to perirenal hematoma complicating extracorporeal shockwave lithotripsy.

    PubMed

    Uemura, Koichi; Takahashi, Sayuri; Shintani-Ishida, Kaori; Nakajima, Makoto; Saka, Kanju; Yoshida, Ken-ichi

    2008-03-01

    Perirenal hematoma is an occasional complication of extracorporeal shockwave lithotripsy (ESWL) which does not usually require treatment. A 79-year-old woman died 23 h after ESWL. Forensic autopsy was performed to determine whether medical treatment contributed to her death. The cause of death was hemorrhagic shock due to massive hematoma from a ruptured small vein in the perirenal adipose capsule. No injury to other organs was found and the patient had neither coagulation abnormality nor venous disease. Perirenal hematoma can easily be diagnosed with abdominal sonography, if pain or symptoms of anemia develop. Doctors must be aware of the possibilities of severe renal hematomas after ESWL.

  16. Extracorporeal shockwave lithotripsy monotherapy for paediatric urinary tract calculi.

    PubMed

    Thornhill, J A; Moran, K; Mooney, E E; Sheehan, S; Smith, J M; Fitzpatrick, J M

    1990-06-01

    The role of extracorporeal shockwave lithotripsy (ESWL) in the management of paediatric urinary tract calculi was evaluated. The study group included 22 children (13 male, 9 female) with an age range of 2 to 13 years. The renal calculi, including staghorn and ureteric calculi, varied in size from 0.3 to 5 cm. Overall stone clearance at 3 months was 79% with a low incidence of complications (2 children required nephrostomy drainage for sepsis). ESWL is a non-invasive method of managing even complex stones in children of all ages, irrespective of size or position.

  17. Extracorporeal shockwave lithotripsy monotherapy for large renal calculi.

    PubMed

    Gleeson, M J; Griffith, D P

    1989-10-01

    Extracorporeal shockwave lithotripsy (ESWL) monotherapy with a Dornier HM3 lithotripter was used to treat 199 large (greater than or equal to 3 cm) renal calculi. Calculi were classified as solitary (29), multiple (152) or staghorn (18) with stone-free rates of 55.2, 39.5 and 55.6% respectively. The stone-free rate was not statistically related to stone size, site or multiplicity. Complications occurred in 24 patients (12.8%) and were more common with solitary and staghorn calculi. ESWL is not recommended as primary treatment for most patients with large renal calculi.

  18. [Extracorporeal shockwave lithotripsy with combined ultrasound and roentgenologic calculus localization. Initial clinical experiences with the Lithostar plus].

    PubMed

    Zöller, G; Wassmann, K; Ludewig, M; Blech, M; Ringert, R H

    1990-11-01

    Since the introduction of extracorporeal shock wave lithotripsy for non-invasive treatment of renal and ureteral stones, lithotripter units have relied on either fluoroscopic or ultrasound stone localization. While ultrasound stone localization reduces X-ray exposure and facilitates treatment of radiolucent renal stones, fluoroscopic stone localization is superior in the detection of ureteral stones. Since April 1989 we have been using the Lithostar plus, a new lithotriptor system, which provides both fluoroscopic and ultrasound stone localization. After treatment of 108 patients, the initial data suggest that this system combines the advantages of both localization principles, while being as efficient as other second-generation lithotriptor units in bringing about the disintegration of renal and ureteral stones.

  19. [Comparative studies of the postoperative phase following opioid analgesia using fentanyl and alfentanil within the scope of extracorporeal shockwave lithotripsy].

    PubMed

    Schockenhoff, B; Daub, D; Stadermann, D; Hohaus, J

    1987-02-01

    30 patients (ASA Class I-III) received opioid analgesia with fentanyl and alfentanil for extracorporeal shock wave lithotripsy. Average doses were 0.41 mg for fentanyl and 4.14 mg for alfentanil. Blood pressure, respiratory frequency, and blood gases were investigated postoperatively until the 240th min under spontaneous breathing of room air. Blood pressure varied less than 10% from initial values in both groups. The respiratory rate decreased by 13% in the alfentanil group and by 20% in the fentanyl group until the 120th min. The blood gases (paCO2, paO2) showed a slow increase of about 10% in the paCO2 in both groups. The paO2 lay at 5.8% below the baseline after 240 min in the fentanyl group and there was roughly 3% below the baseline after 60 min in the alfentanil group.

  20. Risk factors predisposing to repeated extracorporeal shockwave lithotripsy.

    PubMed

    Bolton, D M; Lenaghan, D

    1994-01-01

    The Victorian Lithotripsy Service is geographically unique, representing the only Australian lithotripter for a 900-km radius and serving a patient population of over 3 million, and 26 accredited operator urologists. Because of distance and health service constraints few patients treated for renal calculi on this machine have the opportunity to seek additional treatment by extracorporeal shockwave lithotripsy (ESWL) elsewhere. The treatment histories of all patients who underwent ESWL at this center over a 4-year period were examined, with those patients who required ESWL on more than one occasion being identified and their treatment details reviewed. The retreatment rate was approximately 6%. In patients who required three or more ESWL treatments multiple calculi were present significantly more often than in the overall cohort (p < 0.05), and ESWL alone was ultimately successful in obtaining satisfactory stone fragmentation in only 62% of this group. In view of the high cost of repeated treatments by ESWL the applicability of this treatment method in cases of multiple calculi should be questioned. Initial undertreatment of calculi may also represent a significant factor in the retreatment of some radiopaque calculi.

  1. Extracorporeal shockwave lithotripsy using ultrasonic imaging: urologists' experience.

    PubMed

    Kiely, E A; Ryan, P C; McDermott, T E; Butler, M R

    1989-07-01

    The EDAP LT.01 is a second generation shockwave lithotripter which employs ultrasound imaging and piezoelectric shockwave generation. We describe the first 12 months of its use in the treatment of urinary calculi by urologists with no previous practical experience of ultrasonography. A total of 406 calculi (359 renal and 47 ureteric) in 317 patients were treated. Analgesia or sedation was not routinely used and 59% of all treatments were performed as outpatient procedures. The clearance rate of renal calculi smaller than 1 cm was 81%, while that of calculi larger than 3 cm was 80% (mean clearance 77.5%). Lithotripsy of ureteric calculi following retrograde manipulation to a renal site resulted in 94.4% clearance compared with 39% for those treated at a ureteric site; 93% of 684 lithotripsy treatments were either painless or caused only mild pain. Our experience with imaging and treating urinary calculi with the EDAP LT.01 lithotripter has been excellent. Patients are treated effectively and inexpensively as out-patients without analgesia or sedation.

  2. A passive acoustic monitor of treatment effectiveness during extracorporeal lithotripsy

    NASA Astrophysics Data System (ADS)

    Fedele, F.; Thomas, K.; Leighton, T. G.; Ryves, S.; Phillips, D.; Coleman, A. J.

    2011-02-01

    Although extracorporeal shockwave lithotripsy (ESWL) has now been in the clinic for at least three decades, there has been little advance in efforts (i) to estimate the efficacy of the treatment whilst it is in progress, or (ii) to determine the end-point of a treatment session in terms of the degree of stone fragmentation achieved. Previous in vitro experimentation and clinical trials have shown that a passive acoustic monitor has the potential to provide evidence of the effectiveness and end-point of lithotripsy. The system exploits secondary emissions generated during shock-tissue interaction, whose features depend on the quality of tissue at the beam focus. This prototype was developed into the first commercially available clinical ESWL treatment monitor (Precision Acoustic Ltd, Dorchester, UK), and a unit has been acquired and tested in the clinical routine by urologists at Guy's and St Thomas NHS Trust in March 2009. This paper critically assesses the performance of the new system for the first 25 treatments monitored. The ESWL monitor correctly predicted the treatment outcome of 15 of the 18 treatments that were followed-up clinically. In addition, it was noted that the measure of treatment effectiveness provided by the monitor after 500 shocks was predictive of the final treatment outcome (p < 0.001). This suggests that the system could be used in pre-assessment; indicating if the stone is susceptible to ESWL or if the patient should be sent for surgery.

  3. Numerical simulation of shock and bubble dynamics in shockwave lithotripsy

    NASA Astrophysics Data System (ADS)

    Colonius, Tim; Tanguay, Michel

    2002-11-01

    Theoretical evaluation of the efficacy of stone comminution (and potential for tissue damage) during shockwave lithotripsy requires knowledge of the complex stress fields associated with both the incident focussing shock and the dynamics of cavitation bubbles that it induces. While simple models from geometrical acoustics and subsequent modeling of spherical bubbles in isolation (Gilmore equation) can provide estimates, high-speed photography in vitro reveals a far more complex flow with bubble number densities that are sufficiently high such that collective effects associated with a cloud of bubbles are important. This talk will describe a modeling effort aimed at estimating stresses from these complex lithotripter generated flow fields. We compute the time-dependent, compressible, ensemble-averaged two-phase flow equations with a finite-difference scheme. Detailed modeling of the dynamics of bubbles (on the microscale) and high-order weighted essentially nonoscillatory shock-capturing schemes are employed. The model is compared to hydrophone and passive cavitation detection measurements, as well as qualitative comparison with high-speed photography. Finally, we explore collective bubble mechanisms ranging from defocusing and shielding of the stone (for high bubble densities in the focal region) to enhanced stresses due to concerted cloud collapse in a dual-pulse lithotripsy configuration. [Work supported by NIH P01 DK-43881 and NSF under grant CTS-9979258.

  4. Acoustic streaming in lithotripsy fields: preliminary observation using a particle image velocimetry method.

    PubMed

    Choi, Min Joo; Doh, Doeg Hee; Hwang, Tae Gyu; Cho, Chu Hyun; Paeng, Dong Guk; Rim, Gun Hee; Coleman, A J

    2006-02-01

    This study considers the acoustic streaming in water produced by a lithotripsy pulse. Particle image velocimetry (PIV) method was employed to visualize the acoustic streaming produced by an electromagnetic shock wave generator using video images of the light scattering particles suspended in water. Visualized streaming features including several local peaks and vortexes around or at the beam focus were easily seen with naked eyes over all settings of the lithotripter from 10 to 18 kV. Magnitudes of the peak streaming velocity measured vary in the range of 10-40 mm s(-1) with charging voltage settings. Since the streaming velocity was estimated on the basis of a series of the video images of particles averaged over 1/60s, the time resolution limited by the video frame rate which is 1-2 orders of magnitude larger than driving acoustic activities, measured velocities are expected to be underestimated and were shown a similar order of magnitude lower than those calculated from a simple theoretical consideration. Despite such an underestimation, it was shown that, as predicted by theory, the magnitude of the streaming velocity measured by the present PIV method was proportional to acoustic intensity. In particular it has almost a linear correlation with peak negative pressures (r=0.98683, p=0.0018). PMID:16376400

  5. Transient oscillation of cavitation bubbles near stone surface during electrohydraulic lithotripsy.

    PubMed

    Zhong, P; Tong, H L; Cocks, F H; Preminger, G M

    1997-02-01

    Using high-speed photography and acoustic emission measurements, we studied the dynamics of a transient cavitation bubble near a stone surface and the concomitant shockwaves generated during electrohydraulic lithotripsy (EHL). At each spark discharge, a vapor plasma and subsequently a cavitation bubble oscillating around the tip of an EHL probe are produced. Simultaneously, three distinctive shockwave pulses are generated. The first shockwave is produced by the rapid expansion of the vapor plasma, while the second and third waves are produced by rebounds of the cavitation bubble. Depending on the proximity of the probe to the stone surface, the collapse of the cavitation bubble may be symmetric, resulting in a strong shockwave emission; or asymmetric, leading to the formation of a liquid jet. For the Nortech AUTOLITH lithotripter with a 1.9F probe that was used in this study, maximum shockwave emission is produced when the probe is about 1 mm from the stone surface, whereas the maximum jet velocity is produced when the probe tip is at distance equivalent to the maximum bubble radius of about 3 mm. These findings are consistent with clinical experience, which suggests that for optimal treatment results, the EHL probe should be placed close to the stone surface.

  6. Shock-induced collapse of a gas bubble in shockwave lithotripsy.

    PubMed

    Johnsen, Eric; Colonius, Tim

    2008-10-01

    The shock-induced collapse of a pre-existing nucleus near a solid surface in the focal region of a lithotripter is investigated. The entire flow field of the collapse of a single gas bubble subjected to a lithotripter pulse is simulated using a high-order accurate shock- and interface-capturing scheme, and the wall pressure is considered as an indication of potential damage. Results from the computations show the same qualitative behavior as that observed in experiments: a re-entrant jet forms in the direction of propagation of the pulse and penetrates the bubble during collapse, ultimately hitting the distal side and generating a water-hammer shock. As a result of the propagation of this wave, wall pressures on the order of 1 GPa may be achieved for bubbles collapsing close to the wall. The wall pressure decreases with initial stand-off distance and pulse width and increases with pulse amplitude. For the stand-off distances considered in the present work, the wall pressure due to bubble collapse is larger than that due to the incoming shockwave; the region over which this holds may extend to ten initial radii. The present results indicate that shock-induced collapse is a mechanism with high potential for damage in shockwave lithotripsy.

  7. [Diverticular calculi of the kidney calices--extracorporeal shockwave lithotripsy, percutaneous extraction or open surgery].

    PubMed

    Kriegmair, M; Schüller, J; Schmeller, N; Knipper, A; Muschter, R; Hofstetter, A G

    1990-07-01

    The incidence of caliceal diverticula, mostly found on routine excretory urography, is very low. The indications for treatment include chronic or recurrent pyelonephritis, pain, gross hematuria and renal damage. There is controversy as to which treatment is best: extracorporeal shock-wave lithotripsy (ESWL), percutaneous techniques, or traditional open surgery. Since 1984, 27 patients with 28 caliceal diverticula calculi have been treated. Ten patients underwent ESWL, 13 patients percutaneous treatment, and 4 patients open surgery. The success rates as far as a stone-free status is concerned were: 1 patient (ESWL), 10 (percutaneous), and 4 (open surgery). There were no complications due to ESWL or open surgical treatment. Direct traumata such as severe bleeding in two and hydrothorax in one patient occurred during the training phase of the percutaneous techniques. Due to the low complication rate, non-invasive ESWL treatment should be tried first. The indications for percutaneous removal of calculi in caliceal diverticula depend on two aspects: it should be possible to puncture the caliceal diverticula via by a short parenchymal route coaxial to the axis of the calix and, if the intercostal approach is used, a pleural lesion must be excluded. If these requirements cannot be fulfilled, open surgical treatment should be performed, especially if the diverticula are located in the upper and anterior part of the kidney.

  8. [Shockwave lithotripsy in the pancreas; the first 16 patients treated in Rotterdam-Dijkzigt].

    PubMed

    van der Hul, R L; Plaisier, P W; den Toom, R; van Blankenstein, M; Terpstra, O T; Jeekel, J

    1993-04-10

    Sixteen patients, 7 women and 9 men, with a mean age of 42 years and with recurrent attacks of abdominal pain as a result of chronic calcifying pancreatitis, were treated with extracorporeal shock wave lithotripsy (ESWL), after endoscopical removal of one or more stones from the main pancreatic duct had proved impossible. In all patients fragmentation by ESWL of the stone situated farthest distally was attempted, after which the remaining calculi and fragments could be voided spontaneously or could be flushed via a drain placed endoscopically in the main pancreatic duct. In 12 patients (75%) fragmentation of stones was achieved, 11 of them had a dramatic relief of pain immediately after ESWL. In 7 patients (44%) stone clearance was achieved; at follow-up (1-38 months after ESWL) none of these had complaints. Of the 5 patients with stone fragmentation without stone clearance, 2 were operated on because of recurrent symptoms. The only complication seen after ESWL, was an exacerbation of pancreatitis in 1 patient, which could be treated conservatively. If pancreatic stones cannot be removed endoscopically, ESWL appears to be an attractive alternative to an operation. It is important to achieve stone clearance.

  9. [Percutaneous nephrolithotomy after failure of extracorporeal shockwave lithotripsy. Indications, results, perspectives].

    PubMed

    Bon, D; Doré, B; Fournier, F; Houndete, F; Irani, J; Aubert, J

    1993-12-01

    Eighty-one of the 579 extracorporeal lithotripsies (ECL) performed between 1987 and 1992 with an ultrasound-guided hydroelectric lithotriptor required the use of another treatment modality. 53 percutaneous nephrolithotomies (PCNL) were performed in these 81 patients after failure of ECL (21 for non-fragmentation, 32 for residual fragments). The authors analyse the factors responsible for failure in order to select the more appropriate type of treatment for different types of stones. The site of the stones, their size, their radiographic appearance, their chemical composition, the number of ECL sessions and the number of days spent in hospital were compared between the PCNL and ECL groups. Smooth, homogeneous stones denser than bone and larger than 15 mm in diameter were significantly more resistant to ECL, despite an increased number of shock waves. PCNL was successful in 92% of cases of non-fragmented stones (with no residual fragments). The success rate for multiple residual fragments was 64%. In view of the risk of complications associated with residual fragments, regardless of their size, the potential risks of ECL and cost imperatives, the authors recommend that these stones, considered to be resistant, should be treated immediately by PCNL, as the results of PCNL after ECL are less satisfactory.

  10. A decrease in blood pressure following pyelolithotomy but not extracorporeal lithotripsy.

    PubMed

    Eterović, Davor; Situm, Marijan; Juretić-Kuscić, Ljubica; Dujić, Zeljko

    2005-05-01

    Our aim was to evaluate the hypothesis that relief of renal obstruction lowers the arterial blood pressure if the procedure of stone removal does not injure the kidney itself. Sixty patients with unilateral renal stone were evaluated at baseline and 3 months after electrical shockwave lithotripsy (ESWL, n=30) or Gil-Vernet intrasinus pyelolithotomy (n=30). Blood pressures were measured noninvasively and renal vascular resistances were obtained from radionuclide measurements of renal blood flow. At baseline, the renal vascular resistance of the obstructed kidney was 2 and 2.5 times greater than of the unobstructed kidney in the ESWL and pyelolithotomy groups, respectively. After 3 months in operated patients, the blood pressure decreased (from 87 to 81 mm Hg, P=0.002, in case of diastolic, and from 140 to 132 mm Hg, P<0.0001, in case of systolic pressure), while the vascular resistances of both kidneys were equal and normal. In contrast, in the ESWL group the blood pressures and vascular resistances of the treated kidney did not differ from the baseline values. Surgical relief of renal obstruction chronically lowers the arterial blood pressure, possibly by normalizing the renal vascular resistance. ESWL does not change the blood pressure or renal vascular resistance, which could reflect a balance between the relief of obstruction and kidney lesions induced by shock waves.

  11. Shock-induced collapse of a gas bubble in shockwave lithotripsy

    PubMed Central

    Johnsen, Eric; Colonius, Tim

    2008-01-01

    The shock-induced collapse of a pre-existing nucleus near a solid surface in the focal region of a lithotripter is investigated. The entire flow field of the collapse of a single gas bubble subjected to a lithotripter pulse is simulated using a high-order accurate shock- and interface-capturing scheme, and the wall pressure is considered as an indication of potential damage. Results from the computations show the same qualitative behavior as that observed in experiments: a re-entrant jet forms in the direction of propagation of the pulse and penetrates the bubble during collapse, ultimately hitting the distal side and generating a water-hammer shock. As a result of the propagation of this wave, wall pressures on the order of 1 GPa may be achieved for bubbles collapsing close to the wall. The wall pressure decreases with initial stand-off distance and pulse width and increases with pulse amplitude. For the stand-off distances considered in the present work, the wall pressure due to bubble collapse is larger than that due to the incoming shockwave; the region over which this holds may extend to ten initial radii. The present results indicate that shock-induced collapse is a mechanism with high potential for damage in shockwave lithotripsy. PMID:19062841

  12. A decrease in blood pressure following pyelolithotomy but not extracorporeal lithotripsy.

    PubMed

    Eterović, Davor; Situm, Marijan; Juretić-Kuscić, Ljubica; Dujić, Zeljko

    2005-05-01

    Our aim was to evaluate the hypothesis that relief of renal obstruction lowers the arterial blood pressure if the procedure of stone removal does not injure the kidney itself. Sixty patients with unilateral renal stone were evaluated at baseline and 3 months after electrical shockwave lithotripsy (ESWL, n=30) or Gil-Vernet intrasinus pyelolithotomy (n=30). Blood pressures were measured noninvasively and renal vascular resistances were obtained from radionuclide measurements of renal blood flow. At baseline, the renal vascular resistance of the obstructed kidney was 2 and 2.5 times greater than of the unobstructed kidney in the ESWL and pyelolithotomy groups, respectively. After 3 months in operated patients, the blood pressure decreased (from 87 to 81 mm Hg, P=0.002, in case of diastolic, and from 140 to 132 mm Hg, P<0.0001, in case of systolic pressure), while the vascular resistances of both kidneys were equal and normal. In contrast, in the ESWL group the blood pressures and vascular resistances of the treated kidney did not differ from the baseline values. Surgical relief of renal obstruction chronically lowers the arterial blood pressure, possibly by normalizing the renal vascular resistance. ESWL does not change the blood pressure or renal vascular resistance, which could reflect a balance between the relief of obstruction and kidney lesions induced by shock waves. PMID:15619123

  13. The current status and possible future for lithotripsy of salivary calculi.

    PubMed

    Escudier, M P

    1998-03-01

    Extracorporeal and intracorporeal shockwave lithotripsy are effective in at least 30% of cases, particularly when combined with adjuvant techniques. Factors that appear to affect outcome adversely are stone size, partial fragmentation with reduced clearance, duct stenosis, and poor gland function.

  14. Applicability of Iceland spar as a stone model standard for lithotripsy devices.

    PubMed

    Blitz, B F; Lyon, E S; Gerber, G S

    1995-12-01

    The identification of a universal stone model standard would enable reproducible fragmentation data useful for the design, evaluation, and comparison of various lithotripsy devices. The clinical benefits of such a stone model include the elucidation of setting parameters that would optimize fragmentation strategies. Iceland spar is a pure form of calcite (CaCO3) that was subjected to experimental disintegration by electrohydraulic lithotripsy and extracorporeal shockwave lithotripsy. Iceland spar was fragmented with both lithotripsy methods in a reproducible fashion. The degree of fragmentation was directly related to alterations in either power or shock frequency. Iceland spar is radiopaque, inexpensive, easily obtained, homogenous in composition, and sizable. Iceland spar meets a variety of stone model criteria, warranting its continued investigation as a potential stone model standard.

  15. [Computed tomographic and sonographic detection of renal and perirenal changes following shockwave lithotripsy].

    PubMed

    Grote, R; Döhring, W; Aeikens, B

    1986-04-01

    The finding of a major haemorrhage after lithotripsy induced us to look at 42 patients undergoing extracorporeal lithotripsy by CT and by sonography, both before and after the procedure, in order to determine the frequency of bleeding. In 37 patients, significant bleeding was found in the perirenal tract and in Gerota's capsule. There were six small sub-capsular haematomas which were not found by sonography and two extensive renal haematomas.

  16. Safety and efficacy of holmium:YAG laser lithotripsy in patients with bleeding diatheses

    NASA Astrophysics Data System (ADS)

    Watterson, James D.; Girvan, Andrew R.; Cook, Anthony J.; Beiko, Darren T.; Nott, Linda; Auge, Brian K.; Preminger, Glenn M.; Denstedt, John D.

    2003-06-01

    Purpose: To assess the safety and efficacy of ureteroscopy and holmium:YAG (yttrium-aluminum-garnet) laser lithotripsy in the treatment of upper urinary tract calculi in patients with known and uncorrected bleeding diatheses. Materials and Methods: A retrospective chart review from 2 tertiary stone centers was performed to identify patients with known bleeding diatheses who were treated with holmium:YAG laser lithotripsy for upper urinary tract calculi. Twenty-five patients with 29 upper urinary tract calculi were treated with ureteroscopic holmium laser lithotripsy. Bleeding diatheses identified were coumadin administration for various conditions (17), liver dysfunction (3), thrombocytopenia (4), and von Willebrand's disease (1). Mean international normalized ratio (INR), platelet count and bleeding time were 2.3, 50 x 109/L, and > 16 minutes, for patients receiving coumadin or with liver dysfunction, thrombocytopenia, or von Willebrand's disease, respectively. Results: Overall, the stone-free rate was 96% (27/28) and 29 of 30 procedures were completed successfully without significant complication. One patient who was treated concomitantly with electrohydraulic lithotripsy (EHL) had a significant retroperitoneal hemorrhage that required blood transfusion. Conclusions: Treatment of upper tract urinary calculi in patients with uncorrected bleeding diatheses can be safely performed using contemporary small caliber ureteroscopes and holmium laser as the sole modality of lithotripsy. Ureteroscopic holmium laser lithotripsy without preoperative correction of hemostatic parameters limits the risk of thromboembolic complications and costs associated with an extended hospital stay. Avoidance of the use of EHL is crucial in reducing bleeding complications in this cohort of patients.

  17. [Urinary excretion of N-acetyl-glucosaminidase after extracorporeal shockwave lithotripsy: a marker of renal tubule injury].

    PubMed

    Trinchieri, A; Zanetti, G; Tombolini, P; Ruoppolo, M; Montanari, E; Mazza, L; Tura, M

    1989-12-01

    The major complications of extracorporeal shock wave lithotripsy (ESWL) are perirenal hematomas for an incidence of less than 1 per cent. However in animal experiments histopathological effects of focused electrohydraulic shock waves on renal parenchyma have been reported, the most significant of which are hemorrhagic foci healing rapidly by cicatrization. Furthermore imaging studies have demonstrated morphological changes limited to the area of the kidney exposed to shock waves. Liver, skeletal muscle and pancreatic enzyme changes have been documented after ESWL. In our experience the urinary ratio of NAG (N-acetyl-glucosaminidase) to creatinine, a good marker of renal tubular damage, increased after treatment with both the original and the modified spark gap Dornier HM3 lithotripters and with the piezoelectric Wolf Piezolith 2200. Particularly the threshold of pathological urinary NAG excretion were 2,000 and 2,600 shocks respectively using the original and the modified Dornier HM3 and 7,000 shocks using the Wolf Piezolith 2200. The functional significance of the changes is not known, however in clinical practice it would seem prudent to avoid excessive exposure to shock waves.

  18. Thulium fiber laser lithotripsy in an in vitro ureter model.

    PubMed

    Hardy, Luke A; Wilson, Christopher R; Irby, Pierce B; Fried, Nathaniel M

    2014-12-01

    Using a validated in vitro ureter model for laser lithotripsy, the performance of an experimental thulium fiber laser (TFL) was studied and compared to the clinical gold standard holmium:YAG laser. The holmium laser (λ = 2120 nm) was operated with standard parameters of 600 mJ, 350 μs, 6 Hz, and 270-μm-core optical fiber. The TFL (λ=1908 nm) was operated with 35 mJ, 500 μs, 150 to 500 Hz, and a 100-μm-core fiber. Urinary stones (60% calcium oxalate monohydrate/40% calcium phosphate) of uniform mass and diameter (4 to 5 mm) were laser ablated with fibers through a flexible video-ureteroscope under saline irrigation with flow rates of 22.7 and 13.7 ml/ min for the TFL and holmium laser, respectively. The temperature 3 mm from the tube's center and 1 mm above the mesh sieve was measured by a thermocouple and recorded throughout each experiment for both lasers. Total laser and operation times were recorded once all stone fragments passed through a 1.5-mm sieve. The holmium laser time measured 167±41 s (n=12). TFL times measured 111±49, 39±11, and 23±4 s, for pulse rates of 150, 300, and 500 Hz, respectively (n=12 each). Mean peak saline irrigation temperatures reached 24±1°C for holmium, and 33±3°C, 33±7°C, and 39±6°C, for TFL at pulse rates of 150, 300, and 500 Hz, respectively. To avoid thermal buildup and provide a sufficient safety margin, TFL lithotripsy should be performed with pulse rates below 500 Hz and/or increased saline irrigation rates. The TFL rapidly fragmented kidney stones due in part to its high pulse rate, high power density, high average power, and observation of reduced stone retropulsion and may provide a clinical alternative to the conventional holmium laser for lithotripsy. PMID:25518001

  19. Thulium fiber laser lithotripsy in an in vitro ureter model

    NASA Astrophysics Data System (ADS)

    Hardy, Luke A.; Wilson, Christopher R.; Irby, Pierce B.; Fried, Nathaniel M.

    2014-12-01

    Using a validated in vitro ureter model for laser lithotripsy, the performance of an experimental thulium fiber laser (TFL) was studied and compared to the clinical gold standard holmium:YAG laser. The holmium laser (λ=2120 nm) was operated with standard parameters of 600 mJ, 350 μs, 6 Hz, and 270-μm-core optical fiber. The TFL (λ=1908 nm) was operated with 35 mJ, 500 μs, 150 to 500 Hz, and a 100-μm-core fiber. Urinary stones (60% calcium oxalate monohydrate/40% calcium phosphate) of uniform mass and diameter (4 to 5 mm) were laser ablated with fibers through a flexible video-ureteroscope under saline irrigation with flow rates of 22.7 and 13.7 ml/min for the TFL and holmium laser, respectively. The temperature 3 mm from the tube's center and 1 mm above the mesh sieve was measured by a thermocouple and recorded throughout each experiment for both lasers. Total laser and operation times were recorded once all stone fragments passed through a 1.5-mm sieve. The holmium laser time measured 167±41 s (n=12). TFL times measured 111±49, 39±11, and 23±4 s, for pulse rates of 150, 300, and 500 Hz, respectively (n=12 each). Mean peak saline irrigation temperatures reached 24±1°C for holmium, and 33±3°C, 33±7°C, and 39±6°C, for TFL at pulse rates of 150, 300, and 500 Hz, respectively. To avoid thermal buildup and provide a sufficient safety margin, TFL lithotripsy should be performed with pulse rates below 500 Hz and/or increased saline irrigation rates. The TFL rapidly fragmented kidney stones due in part to its high pulse rate, high power density, high average power, and observation of reduced stone retropulsion and may provide a clinical alternative to the conventional holmium laser for lithotripsy.

  20. Thulium fiber laser lithotripsy in an in vitro ureter model.

    PubMed

    Hardy, Luke A; Wilson, Christopher R; Irby, Pierce B; Fried, Nathaniel M

    2014-12-01

    Using a validated in vitro ureter model for laser lithotripsy, the performance of an experimental thulium fiber laser (TFL) was studied and compared to the clinical gold standard holmium:YAG laser. The holmium laser (λ = 2120 nm) was operated with standard parameters of 600 mJ, 350 μs, 6 Hz, and 270-μm-core optical fiber. The TFL (λ=1908 nm) was operated with 35 mJ, 500 μs, 150 to 500 Hz, and a 100-μm-core fiber. Urinary stones (60% calcium oxalate monohydrate/40% calcium phosphate) of uniform mass and diameter (4 to 5 mm) were laser ablated with fibers through a flexible video-ureteroscope under saline irrigation with flow rates of 22.7 and 13.7 ml/ min for the TFL and holmium laser, respectively. The temperature 3 mm from the tube's center and 1 mm above the mesh sieve was measured by a thermocouple and recorded throughout each experiment for both lasers. Total laser and operation times were recorded once all stone fragments passed through a 1.5-mm sieve. The holmium laser time measured 167±41 s (n=12). TFL times measured 111±49, 39±11, and 23±4 s, for pulse rates of 150, 300, and 500 Hz, respectively (n=12 each). Mean peak saline irrigation temperatures reached 24±1°C for holmium, and 33±3°C, 33±7°C, and 39±6°C, for TFL at pulse rates of 150, 300, and 500 Hz, respectively. To avoid thermal buildup and provide a sufficient safety margin, TFL lithotripsy should be performed with pulse rates below 500 Hz and/or increased saline irrigation rates. The TFL rapidly fragmented kidney stones due in part to its high pulse rate, high power density, high average power, and observation of reduced stone retropulsion and may provide a clinical alternative to the conventional holmium laser for lithotripsy.

  1. [Extracorporeal shockwave lithotripsy for upper urinary tract stone].

    PubMed

    Lechevallier, E; Traxer, O; Saussine, C

    2008-12-01

    Extracorporeal shockwave lithotripsy (ESWL) is the fragmentation of stone by means of acoustic shockwaves created by an extracorporeal source. ESWL brakes the stone by spallation and squeezing. The optimal frequency for fragmentation is 1Hz. The initial power must be low, then progressively increased during the session. The contra-indications for ESWL are pregnancy, major deformities, severe obesity, aortic aneurism, uncontrolled coagulation disorders, untreated urinary infection, cardiac pacemaker. A stone density of 1000UH is a risk factor for fragmentation failure. The success rate for the kidney and the ureter is 60-80% and 80%, respectively. Stone clearance may be facilitated by alpha blockers. Asymptomatic and non-infected residual fragments less than 4mm must be followed-up annually.

  2. Extracorporeal shockwave lithotripsy and litholytic therapy in cholelithiasis.

    PubMed

    Erdamar, I; Avci, G; Füzün, M; Harmancioğlu, O

    1992-03-01

    Extracorporeal shockwave lithotripsy (ESWL) and litholytic therapy were used in 100 patients over a period of 16 months. ESWL was carried out with a Lithostar Plus and chenodeoxycholic acid was used as the lytic agent, given until 3 months after complete disappearance of stones. Within a period of 8-12 months, stones disappeared completely in 82 per cent of the patients who had a single stone less than or equal to 20 mm in diameter and in 50 per cent of those with a single stone greater than 20 mm in size or with multiple stones. Complications requiring surgery developed in five patients: three had acute cholecystitis and two developed acute pancreatitis. Of the patients in whom complete stone clearance was achieved, two of 11 followed up developed recurrence of stones 4 months after cessation of lytic therapy.

  3. [The prediction of the results of extracorporeal shockwave lithotripsy].

    PubMed

    Stepanov, V N; Perel'man, V M; Kadyrov, Z A

    1997-01-01

    The disease history, objective, x-ray and aggregatometry evidence has been analyzed for 188 nephroureterolithiasis patients to make the prognosis of extracorporeal impulse lithotripsy (EIL). If the concrements presented at x-ray picture as structurally homogeneous, medium-contrast, with even margins, fragmentation occurred after 3-4 sessions in 81% of the cases. Low or high contrast calculi with heterogeneous margins disintegrated after 1-2 EIL sessions. Flat calculi were easier to crush than round ones. A decline or absence of changes on the aggregatometry curves prompted the decision on efficacy of further EIL. The calculi which existed for 6 months maximum were the easiest to crush. The outcome of the previous EIL is also essential for prognosis. Inflammation and obesity worsen EIL results. Variant of EIL regimen and the number of impulses are also prognostically significant.

  4. Is extracorporeal shockwave lithotripsy suitable treatment for lower ureteric stones?

    PubMed

    Cole, R S; Shuttleworth, K E

    1988-12-01

    Forty patients with lower ureteric calculi for which intervention was considered desirable have been treated by in situ extracorporeal shockwave lithotripsy (ESWL) on the Dornier HM3 Lithotripter using a modified technique. Stone localisation was satisfactory in all patients. Adequate disintegration was achieved in 90% of patients following one treatment; 34 patients have been followed up for at least 3 months and 27 of these are stone-free (79%). Treatment failed in 4 patients and 2 of these had dense lower ureteric stone streets as a result of previous ESWL. The retreatment rate, post-treatment auxiliary procedure rate and complication rate were minimal. It was concluded that in situ ESWL is an effective and safe method for treating certain selected lower ureteric stones and should be considered as a feasible alternative to the more conventional methods of treatment.

  5. Extracorporeal shockwave lithotripsy of gallstones. Possibilities and limitations.

    PubMed

    Vergunst, H; Terpstra, O T; Brakel, K; Laméris, J S; van Blankenstein, M; Schröder, F H

    1989-11-01

    Recently extracorporeal shockwave lithotripsy (ESWL) has been introduced as a nonoperative treatment for gallstone disease. Except for lung damage, no significant adverse effects of ESWL of gallbladder stones have been observed in animals. In clinical use ESWL of gallbladder stones is now confined to 15% to 30% of symptomatic patients. To achieve complete stone clearance, ESWL of gallbladder stones must be supplemented by an adjuvant therapy. ESWL of bile duct stones is highly effective and can be considered in patients in whom primary endoscopic or surgical stone removal fails. Second generation lithotriptors allow anesthesia-free (outpatient) treatments, but the clinical experience with most of these ESWL devices is still limited. The likelihood of gallbladder stone recurrence is a major disadvantage of ESWL treatment, which raises the issue of cost-effectiveness. ESWL for cholelithiasis is a promising treatment modality with good short-term and unknown long-term results.

  6. [Biliary extracorporeal shockwave lithotripsy in the surgical treatment concept of cholelithiasis].

    PubMed

    Meiser, G; Heinerman, M; Boeckl, O

    1990-05-01

    Extracorporeal shock-wave lithotripsy (BESWL) using the "Obertisch" module Lithostar Plus (Siemens AG) was carried out in 100 patients, comprising a total of 189 gallbladder stones with a size range from 8 to 35 mm. Chenodeoxycholic and ursodeoxycholic acid was given as adjuvant litholytic therapy, beginning 14 days before treatment. 53% of the patients suffered from radiolucent solitary stones with an average size of 21 +/- 6 mm. 14% had more than 3 stones, another 12% had solitary stones with a small rim calcification. In 99 patients all stones could be disintegrated. In 90% we achieved a fragment size smaller than 5 mm, in 10% smaller than 8 mm. 68 patients were treated in a single session, in 32% a 2nd or 3rd treatment was necessary. In the average 4100 +/- 2200 shock-waves with energy level 9 (650 bar) were applied. During treatment 15 patients suffered from slight right kidney pain. In the following 48 hours after BESWL we observed a transitory significant elevation of transaminases (32%), urinary amylases without clinical symptoms (31%), bilirubin (31%) and white blood cells (71%). A microhematuria was seen in 33%, a macrohematuria in 2%. Post-BESWL sonographically we found a transitory edema of the gallbladder wall in 18%, in 15% a hydrops, in 10% a dilatation of the common bile duct and in 4% free fluid surrounding the gallbladder. After dismission 31% of the patients suffered from slight colicky pain. In 3 patients acute biliary pancreatitis was observed 4 and 8 weeks after BESWL which could be treated by EPT and endoscopic stone removal.

  7. Can aspirin prevent gallstone recurrence after successful extracorporeal shockwave lithotripsy?

    PubMed

    Adamek, H E; Buttmann, A; Weber, J; Riemann, J F

    1994-04-01

    Extracorporeal shockwave lithotripsy (ESWL) is a feasible procedure for the treatment of gallbladder stones in humans. Well-selected patients can achieve stone-free rates in a high percentage. With the gallbladder in situ, these patients are at risk of stone recurrence. There is considerable evidence that aspirin prevents cholesterol gallstone formation in animal models and may prevent gallstone recurrence in man. We attempted to clarify the risk of gallstone recurrence after successful piezoelectric lithotripsy in patients taking either low-dose aspirin or no medication. The first 45 patients shown to be completely free from stones after ESWL were randomized into two groups. One group received 100 mg aspirin daily; the other group did not receive any further medical therapy. Patients were further examined on an average of 19.6 months and 21.9 months, respectively. In the aspirin group the recurrence rate was 18.2%, whereas 21.7% of the patients in the control group developed recurrent stones. Seventy-eight per cent of these patients also had a recurrence of biliary pain. By life-table analysis we had, after a follow-up period of 24 months, a stone recurrence rate of 25% (+/- 11) in the aspirin group and 34% (+/- 14) in the control group. Our results indicate that recurrence prophylaxis remains one of the central questions in ESWL. In this preliminary study, 100 mg of aspirin daily was not able to reduce the recurrence rate after successful ESWL. Further studies will have to show whether higher doses of aspirin or other ways of preventing gallstone after ESWL are possible.

  8. Pre-Emptive Tramadol Could Reduce Pain after Ureteroscopic Lithotripsy

    PubMed Central

    Denčić, Nataša; Jovičić, Jelena; Mirković, Jelena; Durutović, Otaš; Milenković-Petronić, Dragica; Lađević, Nebojša

    2014-01-01

    Purpose Optimal analgesia in ambulatory urology patients still remains a challenge. The aim of this study was to examine if the pre-emptive use of intravenous tramadol can reduce pain after ureteroscopic lithotripsy in patients diagnosed with unilateral ureteral stones. Materials and Methods This prospective pilot cohort study included 74 patients diagnosed with unilateral ureteral stones who underwent ureteroscopic lithotripsy under general anesthesia in the Urology Clinic at the Clinical Center of Serbia from March to June 2012. All patients were randomly allocated to two groups: one group (38 patients) received intravenous infusion of tramadol 100 mg in 500 mL 0.9%NaCl one hour before the procedure, while the other group (36 patients) received 500 mL 0.9%NaCl at the same time. Visual analogue scale (VAS) scores were recorded once prior to surgery and two times after the surgery (1 h and 6 h, respectively). The patients were prescribed additional postoperative analgesia (diclofenac 75 mg i.m.) when required. Pre-emptive effects of tramadol were assessed measuring pain scores, VAS1 and VAS2, intraoperative fentanyl consumption, and postoperative analgesic requirement. Results The average VAS1 score in the tramadol group was significantly lower than that in the non-tramadol group. The difference in average VAS2 score values between the two groups was not statistically significant; however, there were more patients who experienced severe pain in the non-tramadol group (p<0.01). The number of patients that required postoperative analgesia was not statistically different between the groups. Conclusion Pre-emptive tramadol did reduce early postoperative pain. The patients who received pre-emptive tramadol were less likely to experience severe post-operative pain. PMID:25048508

  9. Effects of extracorporeal shockwave lithotripsy at different stages of pregnancy in the rabbit.

    PubMed

    Gümüş, B; Lekili, M; Kandiloğlu, A R; Işisağ, A; Temeltaş, G; Nazli, O; Büyüksu, C

    1997-10-01

    Although SWL is now the most common treatment modality for urinary tract stone disease, it is not regarded as a safe method for pregnant patients because of its potential harmful effects on fetus. Using a rabbit model, we investigated whether SWL might cause fetal injury when administered at various developmental stages. Two groups of pregnant rabbits were given 1000 shockwaves either early or late in the gestational period. Time-matched controls did not receive shockwaves. After spontaneous labor, all newborn rabbits were counted, weighted, and measured, and specimens were taken from organs and examined histopathologically. The numbers, weights, and diameters of the newborns in each group were similar. There was no notable histopathologic finding in the heart and brain specimens of any of the newborns, whereas noticeable congestion and multiple focal intraparanchymal microhemorrhages were found in lungs, livers, and kidneys of the animals that had been exposed to shockwaves early in gestation. In conclusion, this study shows that SWL is not a safe treatment in early pregnancy.

  10. [Extracorporeal shockwave lithotripsy in the treatment of common bile duct calculi].

    PubMed

    Amstrup, J H; Eldrup, J; Wille-Jørgensen, P A

    1995-04-10

    Fifteen patients with stones in the common bile duct, in whom treatment with endoscopic papillotomy and stone-extraction had been unsuccessful were treated with extracorporeal shockwave lithotripsy. Nine patients were stone-free after one or two sessions, and two patients after further endoscopic treatment. One patient achieved partial clearance and palliation. One patient had a choledochoduodenostomy performed due to ineffectiveness of the shockwave lithotripsy. Two patients, who were thought to have a stone, turned out to have neoplasma in the common bile duct. Complications were frequent but temporary and needed no treatment. We conclude that extracorporeal shockwave lithotripsy is a valuable and safe alternative in those cases where conventional endoscopic treatment has failed, and should be considered before operation, especially to old for high-risk patients.

  11. [Value of extracorporeal shockwave lithotripsy in the treatment of urinary lithiasis in children].

    PubMed

    Charbit, L; Terdjman, S; Gendreau, M C; Guérin, D; Quentel, P; Cukier, J

    1989-01-01

    We report our experience with extracorporeal lithotripsy (Dornier HM3) in a series of 26 children with a mean age of 11.6 years, treated for 3 1/2 years. 12 children (46%) had a previous history of calculi and 7 (27%) had already undergone surgery on the same side. Treatment requires two transducer investigations before lithotripsy. With the exception of minor modifications the technique is the same as in the adult. Three (9.7%) postlithotripsy complications were noted, requiring 2 drainage procedures to be carried out on the urinary tract. At 3 months, the success rate (no residual calculi on the plain abdominal film) was 60.7%. This study confirms the efficacy of lithotripsy in the treatment of urinary lithiasis in children.

  12. Application of holographic interferometric studies of underwater shock-wave focusing to medicine

    NASA Astrophysics Data System (ADS)

    Takayama, Kazuyoshi; Nagoya, H.; Obara, Tetsuro; Kuwahara, M.

    1993-01-01

    Holographic interferometric flow visualization was successfully applied to underwater shock wave focusing and its application to extracorporeal shock wave lithotripsy (ESWL). Real time diffuse holograms revealed the shock wave focusing process in an ellipsoidal reflector made from PMMA and double exposure holographic interferometry also clarified quantitatively the shock focusing process. Disintegration of urinary tract stones and gallbladder stones was observed by high speed photogrammetry. Tissue damage associated with the ESWL treatment is discussed in some detail.

  13. Review on Lithotripsy and Cavitation in Urinary Stone Therapy.

    PubMed

    Ghorbani, Morteza; Oral, Ozlem; Ekici, Sinan; Gozuacik, Devrim; Kosar, Ali

    2016-01-01

    Cavitation is the sudden formation of vapor bubbles or voids in liquid media and occurs after rapid changes in pressure as a consequence of mechanical forces. It is mostly an undesirable phenomenon. Although the elimination of cavitation is a major topic in the study of fluid dynamics, its destructive nature could be exploited for therapeutic applications. Ultrasonic and hydrodynamic sources are two main origins for generating cavitation. The purpose of this review is to give the reader a general idea about the formation of cavitation phenomenon and existing biomedical applications of ultrasonic and hydrodynamic cavitation. Because of the high number of the studies on ultrasound cavitation in the literature, the main focus of this review is placed on the lithotripsy techniques, which have been widely used for the treatment of urinary stones. Accordingly, cavitation phenomenon and its basic concepts are presented in Section II. The significance of the ultrasound cavitation in the urinary stone treatment is discussed in Section III in detail and hydrodynamic cavitation as an important alternative for the ultrasound cavitation is included in Section IV. Finally, side effects of using both ultrasound and hydrodynamic cavitation in biomedical applications are presented in Section V. PMID:27249837

  14. Extracorporeal shockwave lithotripsy of gallstones: clinical experience with 170 patients.

    PubMed

    Dion, Y M; Morin, J; Fraser, W

    1992-04-01

    Between Jan. 19, 1989 and Nov. 23, 1990, 170 patients with symptomatic cholelithiasis were evaluated for possible treatment by extracorporeal shockwave lithotripsy (ESWL). Thirty-one patients were not eligible for treatment, 28 (16%) because of nonvisualization of gallstones by ultrasonography and 3 (2%) because polyps were erroneously diagnosed on ultrasonography. Thirteen (8%) patients failed to comply with the protocol, leaving 126 patients for assessment. At the time of writing, the treatment success rate is 57% at 6 months and 69% at 9 months. Treatment failed in 21 (17%) patients because of unsatisfactory fragmentation in 16 (13%) patients, frequent biliary colic in 3 (2%) patients, acute pancreatitis in 1 (0.8%) patient and severe bile-salt-induced diarrhea in 1 (0.8%) patient. Complications included biliary colic (40 patients), mild diarrhea on bile salts (24 patients), severe diarrhea (1 patient), macroscopic hematuria (4 patients), acute pancreatitis (2 patients) and vagal shock (1 patient). This study demonstrates the effectiveness (87%) of the lithotripter in reducing gallstones to fragments 5 mm in diameter or smaller. However, complete disappearance of these fragments with adjuvant bile-salt therapy may take many months.

  15. Cavitation bubble dynamics during thulium fiber laser lithotripsy

    NASA Astrophysics Data System (ADS)

    Hardy, Luke A.; Kennedy, Joshua D.; Wilson, Christopher R.; Irby, Pierce B.; Fried, Nathaniel M.

    2016-02-01

    The Thulium fiber laser (TFL) is being explored for lithotripsy. TFL parameters differ from standard Holmium:YAG laser in several ways, including smaller fiber delivery, more strongly absorbed wavelength, low pulse energy/high pulse rate operation, and more uniform temporal pulse structure. High speed imaging of cavitation bubbles was performed at 105,000 fps and 10 μm spatial resolution to determine influence of these laser parameters on bubble formation. TFL was operated at 1908 nm with pulse energies of 5-75 mJ, and pulse durations of 200-1000 μs, delivered through 100-μm-core fiber. Cavitation bubble dynamics using Holmium laser at 2100 nm with pulse energies of 200-1000 mJ and pulse duration of 350 μs was studied, for comparison. A single, 500 μs TFL pulse produced a bubble stream extending 1090 +/- 110 μm from fiber tip, and maximum bubble diameters averaged 590 +/- 20 μm (n=4). These observations are consistent with previous studies which reported TFL ablation stallout at working distances < 1.0 mm. TFL bubble dimensions were five times smaller than for Holmium laser due to lower pulse energy, higher water absorption coefficient, and smaller fiber diameter used.

  16. [Electrohydraulic shockwave lithotripsy with ventral shockwave exposure--technic, indications and initial clinical results].

    PubMed

    Miller, K; Bachor, R; Hautmann, R

    1988-05-01

    Shockwave lithotripsy of ureteral or calyceal calculi covered by the bony pelvis and of anteriorly located stones, such as calculi in horseshoe kidneys or the common bile duct, requires ventral introduction of the shockwave into the body. Eleven patients underwent ESWL in the prone position for the aforementioned indications. All treatments were performed with the Dornier HM3 lithotripter, which allows prone positioning of the patient without technical modification of the stretcher. ESWL was successful in all patients, one requiring a second session for complete stone disintegration. Thus, the possibility of shockwave lithotripsy with the patient in the prone position allows further extension of the indications for noninvasive treatment of calculi.

  17. Evaluation of adrenomedullin levels in renal parenchyma subjected to extracorporeal shockwave lithotripsy.

    PubMed

    Sarica, Kemal; Sari, Ibrahim; Balat, Ayşe; Erbağci, Ahmet; Yurtseven, Cihanser; Yağci, Faruk; Karakök, Metin

    2003-08-01

    Despite its safety and efficacy, the traumatic effects of high-energy shock waves (HESW) on renal morphology and function during long-term follow-up have yet to be elucidated. Although the main target of shock waves is the stone located in the kidney, the surrounding tissue and other organs are also subjected to trauma during this procedure. In contrast to renal blood flow evaluation after shock wave treatment, ischemic development, causing varying degrees of damage at the tissue level, has not been well evaluated. The renoprotective peptide adrenomedullin (AM) is a potent vasorelaxing, natriuretic and cell growth modulating peptide, which is thought to act as an autocrine/paracrine regulator in renal glomeruli and tubules. In this experimental study, renal parenchymal AM levels were assessed in an attempt to evaluate the effect of HESW on the tissue levels of this peptide, which may be responsible for the regulation of ischemia induced by extracorporeal shock wave lithotripsy(ESWL), in a rabbit model. Thirty white New Zealand rabbits, each weighing 3-5 kg were used. The animals were divided into three main groups, and varying numbers of shock waves (1000, 1500, 2000) were applied under fluoroscopic localization to the same kidney of all animals. Ketamine HCl anesthesia was administered (15-20 mg/kg) and all of the procedures were performed with a Multimed 2000 lithotriptor. Untreated contralateral kidneys were evaluated as controls. Following HESW application, the treated and untreated kidneys of each animal were removed through bilateral flank incisions under ketamine HCl anesthesia after 24 h and 7 days, respectively. Tissue AM levels were assessed with immunohistochemistry. During the early follow-up period (24 h), both treated and untreated kidneys showed a moderate to high degree of AM positivity. The number of tubules stained with AM increased as the number of shock waves increased and the expression of this protein became evident, possibly due to a higher

  18. [99m-Technetium-mercaptoacetyltriglycine (MAG3) for the demonstration of the kidney changes following extracorporeal shockwave lithotripsy. A prospective study of 117 patients].

    PubMed

    Schaub, T; Witsch, U; el-Damanhoury, H; Nägele-Wöhrle, B; Hahn, K

    1992-10-01

    Extracorporeal shock wave lithotripsy (ESWL) has become the treatment of choice for urinary calculi. 117 patients were studied prospectively with 99mTc mercaptoacetyltriglycine (MAG3) before and after ESWL. 79 (66%) of the 119 kidneys treated had abnormal findings. Of these 63/119 (53%) had abnormal scans. 41 (65%) had focal lesions with a delayed intrarenal transport. The remaining 22 had a diffuse delay of intrarenal transport. A loss of relative renal function of 3% and more compared to the pretreatment values was observed in 50/119 (42%) patients. 99mTc MAG3 should be done routinely together with radiologic tests (CT or MRI) before and after ESWL to select the patients at risk for post ESWL hypertension.

  19. [Extracorporeal shockwave lithotripsy in the treatment of urolithiasis--experiences from a center with the Piezolith 2200 and HM3 lithotriptors].

    PubMed

    Zwergel, T; Neisius, D; Zwergel, U; Ziegler, M

    1988-03-01

    The Piezolith 2200 allows not only a qualitatively identical treatment of urolithiasis like the HM-Dornier systems or the Siemens Lithostar, but the application of lithotriptable urinary calculi could be extended to cardiac risk patients, to patients with skeletal deformities and to those with unusual body height and weight. As the piezolithotripsy does not cause pain, treatment is possible without anaesthesia or analgesia. Combined with internal ureteral stenting by self-retaining double-J-ureteral catheter also calculi with larger stone masses can be treated advantageously by exclusive piezolithotripsy as monotherapy. Multiple treatments by the piezolithotriptor are possible because of good focussing of the shock waves and the smaller parenchymal alteration. Lithotripsy of ureteral calculi is performed in the upper and lower part of the ureter. In small calculi the retrograde introduction of an ureteral catheter armed with an "ultrasound mirror" is necessary.

  20. Thulium fiber laser lithotripsy using small spherical distal fiber tips

    NASA Astrophysics Data System (ADS)

    Wilson, Christopher R.; Hardy, Luke A.; Kennedy, Joshua D.; Irby, Pierce B.; Fried, Nathaniel M.

    2016-02-01

    This study tests a 100-μm-core fiber with 300-μm-diameter ball tip during Thulium fiber laser (TFL) lithotripsy. The TFL was operated at 1908 nm wavelength with 35-mJ pulse energy, 500-μs pulse duration, and 300-Hz pulse rate. Calcium oxalate/phosphate stone samples were weighed, laser procedure times measured, and ablation rates calculated for ball tip fibers, with comparison to bare tip fibers. Photographs of ball tips were taken before and after each procedure to observe ball tip degradation and determine number of procedures completed before need to replace fiber. Saline irrigation rates and ureteroscope deflection were measured with and without TFL fiber present. There was no statistical difference (P > 0.05) between stone ablation rates for single-use ball tip fiber (1.3 +/- 0.4 mg/s) (n=10), multiple-use ball tip fiber (1.3 +/- 0.5 mg/s) (n=44), and conventional single-use bare tip fibers (1.3 +/- 0.2 mg/s) (n=10). Ball tip durability varied widely, but fibers averaged > 4 stone procedures before decline in stone ablation rates due to mechanical damage at front surface of ball tip. The small fiber diameter did not impact ureteroscope deflection or saline flow rates. The miniature ball tip fiber may provide a cost-effective design for safe fiber insertion through the ureteroscope working channel and the ureter without risk of scope damage or tissue perforation, and without compromising stone ablation efficiency during TFL ablation of kidney stones.

  1. Endoscopic gallbladder catheterisation and extracorporeal shockwave lithotripsy in the management of Mirizzi's syndrome.

    PubMed

    Martin, D F; Tweedle, D E; Rao, P N

    1988-11-01

    A novel approach to the management of Mirizzi's syndrome due to a mucocele of the gallbladder is reported. Endoscopic retrograde catheterisation of the gallbladder permitted decompression, and was followed by extracorporeal shockwave lithotripsy of gallbladder calculi in an 80-year-old man considered unfit for operation.

  2. Hypercalciuria and renal stones in a sarcoidosis patient treated by extracorporeal shockwave lithotripsy.

    PubMed

    Sharma, O P; Alfaro, C

    1986-03-01

    A case of chronic pulmonary sarcoidosis and hypercalciuria complicated by bilateral renal stones is reported. Urinary stones were pulverized by extracorporeal shockwave lithotripsy (ESWL) as the patient had declined any surgical procedure. The use of ESWL in conjunction with corticosteroids appears to be the treatment of choice in the management of renal stones secondary to abnormalities of calcium metabolism in sarcoidosis.

  3. Effectiveness and Safety of Ureteroscopic Holmium Laser Lithotripsy for Upper Urinary Tract Calculi in Elderly Patients.

    PubMed

    Yoshioka, Takashi; Otsuki, Hideo; Uehara, Shinya; Shimizu, Toshihiro; Murao, Wataru; Fujio, Koji; Fujio, Kei; Wada, Koichiro; Araki, Motoo; Nasu, Yasutomo

    2016-06-01

    Upper urinary tract calculi are common; however, there is no recommended treatment selection for elderly patients. Ureteroscopic holmium laser lithotripsy (URS lithotripsy) is minimally invasive, and it provides a high stone-free rate (SFR) treatment for upper urinary tract calculi. Here, we retrospectively evaluated the surgical outcomes of URS lithotripsy after dividing the 189 cases into 3 groups by patient age: the '<65 group' (<65 years old, n=108), the '65-74 group' (65-74 years old, n=42), and the ' 75 group' ( 75 years old, n=39). The patients' characteristics, stone status, and perioperative outcomes were assessed. The 65-74 group and the 75 group had a significantly higher prevalence of hypertension compared to the<65 group. Compared to the<65 group, the 65-74 group had a significantly higher prevalence of hyperlipidemia, and the 75 group had significantly higher the American Society of Anesthesiologists (ASA) scores. Despite these preoperative risk factors, SFR and postoperative pyelonephritis in the 65-74 group and the 75 group were similar to those of the<65 group. In conclusion, URS lithotripsy is the preferred treatment for upper urinary tract calculi, even for elderly patients who have multiple preoperative risk factors. PMID:27339204

  4. Ureteropyeloscopy and homium: YAG laser lithotripsy for treatment of ureteral calculi (report of 356 cases)

    NASA Astrophysics Data System (ADS)

    Wu, Zhong; Din, Qiang; Jiang, Hao-wen; Zen, Jing-cun; Yu, Jiang; Zhang, Yuanfang

    2005-07-01

    Objective: To evaluate the efficacy and safety of holmium YAG laser lithotripsy for the treatment of ureteral calculi. Methods: A total of 356 patients underwent ureteropyeloscopic lithotripsy using holmium YAG laser with a semirigid uretesopyeloscope, 93 upper, 135 middle, and 128 lower ureteral stones were treated. Results: The overall successful fragmentation rate for all ureteral stones in a single session achieved 98% (349/356). The successful fragmentation rate stratified by stone location was 95% 88/93 in the upper ureter, 99% (134/135) in the mid ureter , and 99%(127/128) in the distal ureter. 12 cases with bilateral ureteral stones which caused acute renal failure and anuria were treated rapidly and effectively by the holmium YAG laser lithotripsy. No complications such as perforation and severe trauma were encountered during the operations. 2 weeks 17months (with an average of 6.8 month ) follow up postoperatively revealed that the overall stone-free rate was 98%(343/349) and no ureteral stenosis was found. Conclusions Holmium YAG laser lithotripsy is a highly effective, minimally invasive and safe therapy for ureteral calculi. It is indicated as a first choice of treatment for patients with ureteral calculi, especially for the ones with mid- lower levels of ureteral calculi.

  5. Efficacy and safety of endoscopic laser lithotripsy for urinary stone treatment in children.

    PubMed

    Uygun, Ibrahim; Okur, Mehmet Hanifi; Aydogdu, Bahattin; Arayici, Yilmaz; Isler, Burak; Otcu, Selcuk

    2012-12-01

    We reviewed our 6 years of experience with endoscopic holmium: yttrium aluminum garnet (YAG) laser lithotripsy for treatment of urinary stones in different locations in 111 children. A retrospective review was performed on endoscopic holmium: YAG laser lithotripsy procedures performed to treat stones in children between March 2006 and March 2012. In total, 120 laser lithotripsy procedures were performed to treat 131 stones in 111 children (80 males and 31 females; age range, 11 months to 16 years; median age, 6 years). Stones were located in the kidney in 48 cases (36.7 %), ureter in 52 (39.7 %), bladder in 21 (16.0 %), and urethra in 10 (7.6 %). Stone size ranged from 4 to 30 mm (mean, 12.8 mm), and anesthesia duration was 10-170 min (mean, 56 min). Forty-four ureters required balloon dilation, and 61 double J stents were inserted. Follow-up ranged from 3 to 75 months (mean, 35 months). Complete stone clearance was achieved at the end of the procedure in 102 (91.9 %) patients (age < 7 years, 93.3 % vs. age ≥ 7 years, 90.2 %; p > 0.05). The success rate was 81.3 % for kidney stones (<10 mm, 90.9 % vs. ≥ 10 mm, 78.4 %; p > 0.05) and 100 % for the ureter, bladder, and urethral stones. Overall success rate with extracorporeal shockwave lithotripsy was 100 %. No major complications were encountered during or after the procedures. These results confirm the effectiveness and safety of holmium laser lithotripsy for treating all urinary stone locations in children of all ages.

  6. [Five-years' experience in the use of extracorporeal shockwave lithotripsy at the Central Kiev Clinic Hospital].

    PubMed

    Bidnyĭ, V H; Popov, V O; Bidnyĭ, V V; Revunets', R H

    2001-01-01

    The article focuses on the main aspects of treatment of urolithiasis with the aid of extracorporeal lithotripsy at the Central Kiev City Clinical Hospital with particular regard to the therapeutic policy of in-patient managing of patients. An analysis has been performed together with substantiation of connection between physical parameters of the focal zone and efficiency of lithotripsy, which attempts will, we believe, promote the accuracy of prognostication of the course of treatment.

  7. Prevention of shockwave induced functional and morphological alterations: an overview.

    PubMed

    Sarica, Kemal; Yencilek, Faruk

    2008-03-01

    Experimental as well as clinical findings reported in the literature suggest that treatment with shock wave lithotripsy (SWL) causes renal parenchymal damage mainly by generating free radicals through ischaemia/reperfusion injury mechanism. Although SWL-induced renal damage is well tolerated in the majority of healthy cases with no permanent functional and/or morphologic side effects, a subset of patients with certain risk factors requires close attention on this aspect among which the ones with pre-existing renal disorders, urinary tract infection, previous lithotripsy history and solitary kidneys could be mentioned. It is clear that in such patients lowering the number of shock waves (per session) could be beneficial and has been applied by the physicians as the first practical step of diminishing SWL induced parenchymal damage. On the other hand, taking the injurious effects of high energy shock wave (HESW) induced free radical formation on renal parenchyma and subsequent histopathologic alterations into account, physicians searched for some protective agents in an attempt to prevent or at least to limit the extent of the functional as well as the morphologic alterations. Among these agents calcium channel blocking agents (verapamil and nifedipine), antioxidant agents (allopurinol, vitamin E and selenium) and potassium citrate have been used to minimize these adverse effects. Additionally, therapeutic application of these agents on reducing stone recurrence particularly after SWL will gain more importance in the future in order to limit new stone formation in these cases. Lastly, as experimental and clinical studies have demonstrated, combination of anti-oxidants with free radical scavengers may provide superior renal protection against shock wave induced trauma. However, we believe that further investigations are certainly needed to determine the dose-response relationship between the damaging effects of SWL application and the protective role of these agents.

  8. Randomised controlled trial of cost-effectiveness of lithotripsy and open cholecystectomy as treatments for gallbladder stones.

    PubMed

    Nicholl, J P; Brazier, J E; Milner, P C; Westlake, L; Kohler, B; Williams, B T; Ross, B; Frost, E; Johnson, A G

    1992-10-01

    Inpatient extracorporeal shockwave lithotripsy for treatment of gallbladder stones has not previously been compared with open cholecystectomy in terms of cost-effectiveness. In a randomised controlled trial, 163 patients, stratified by gallstone bulk (over 4 cm3 or not), were randomised to lithotripsy or cholecystectomy (38 large-bulk and 27 small-bulk cholecystectomy; 37 large-bulk and 61 small-bulk lithotripsy) and followed up for 1 year. Both treatments gave significant health gains in terms of a reduction in episodes of biliary pain, improved perceived health status, and symptom relief, but few differences between treatments were found. There was some evidence that biliary-pain episodes were less severe after cholecystectomy. Cholecystectomy patients also had greater improvements in mean health gain for three related symptoms: vomiting, feeling sick, and fatty-food upset. However, there were no differences between groups in perceived health status. Among lithotripsy patients, health gain was not related to stone clearance. Lithotripsy was more expensive than cholecystectomy, principally because of the costs of the inpatient stay and adjuvant bile-salt therapy. Conventional lithotripsy appears at least as cost-effective as cholecystectomy for patients with small-bulk stones but less cost-effective for those with large-bulk stones. To some extent treatment choice can be guided by patient preference.

  9. History of Ureteral Stenting Negatively Affects the Outcomes of Extracorporeal Shockwave Lithotripsy. Results of a Matched-pair Analysis.

    PubMed

    Sfoungaristos, Stavros; Gofrit, Ofer N; Pode, Dov; Landau, Ezekiel H; Yutkin, Vladimir; Latke, Arie; Duvdevani, Mordechai

    2015-01-01

    To evaluate the impact of ureteral stenting history to the outcomes of extracorporeal shockwave lithotripsy, we retrospectively analysed patients who underwent shockwave lithotripsy with Dornier Gemini lithotripter between September 2010 and August 2012. Forty seven patients (group A) who had a double J stent which was removed just before the procedure were matched-paired with another 47 patients (group B) who underwent shockwave lithotripsy having no stent history. The correlation between ureteral stenting history and stone-free rates was assessed. Stone-free rates were 68.1% and 87.2% for patients of group A and B, respectively (p=0.026). Postoperative complications were not different between groups. Multivariate analysis revealed that stone size (p=0.007), stone location (p=0.044) and history of ureteral stenting (p=0.046) were independent predictors for stone clearance after shockwave lithotripsy. Ureteral stents adversely affect shockwave lithotripsy outcome, even if they are removed before the procedure. Stenting history should divert treatment plan towards intracorporeal lithotripsy.

  10. History of Ureteral Stenting Negatively Affects the Outcomes of Extracorporeal Shockwave Lithotripsy. Results of a Matched-pair Analysis.

    PubMed

    Sfoungaristos, Stavros; Gofrit, Ofer N; Pode, Dov; Landau, Ezekiel H; Yutkin, Vladimir; Latke, Arie; Duvdevani, Mordechai

    2015-01-01

    To evaluate the impact of ureteral stenting history to the outcomes of extracorporeal shockwave lithotripsy, we retrospectively analysed patients who underwent shockwave lithotripsy with Dornier Gemini lithotripter between September 2010 and August 2012. Forty seven patients (group A) who had a double J stent which was removed just before the procedure were matched-paired with another 47 patients (group B) who underwent shockwave lithotripsy having no stent history. The correlation between ureteral stenting history and stone-free rates was assessed. Stone-free rates were 68.1% and 87.2% for patients of group A and B, respectively (p=0.026). Postoperative complications were not different between groups. Multivariate analysis revealed that stone size (p=0.007), stone location (p=0.044) and history of ureteral stenting (p=0.046) were independent predictors for stone clearance after shockwave lithotripsy. Ureteral stents adversely affect shockwave lithotripsy outcome, even if they are removed before the procedure. Stenting history should divert treatment plan towards intracorporeal lithotripsy. PMID:26445394

  11. The influence of fluid properties and pulse amplitude on bubble dynamics in the field of a shock wave lithotripter.

    PubMed

    Choi, M J; Coleman, A J; Saunders, J E

    1993-11-01

    This study concerns the radial dynamics of a bubble driven by pulsed ultrasound of the type generated during extracorporeal shock wave lithotripsy. In particular, a numerical model has been used to examine the sensitivity of the bubble oscillations to changes in both the amplitude of the driving field and the physical conditions of the fluid surrounding the bubble: viscosity, surface tension, temperature and gas content. It is shown that, at high negative pressures (p- = 10 MPa) as in lithotripsy, the timing and amplitude of bubble collapses have a considerably reduced sensitivity to the initial bubble size and all fluid parameters, except gas content, compared with those expected in lower-amplitude fields (p- = 0.2 MPa). This study indicates that, in the lithotripsy fields, the differences in the viscosity, surface tension and temperature of body fluids and the initial bubble size will have little effect on bubble dynamics compared with those expected in water.

  12. [Extracorporeal shockwave lithotripsy of stones in lower calices of kidney].

    PubMed

    Martov, A G; Peniukova, I V; Moskalenko, S A; Peniukov, V G; Peniukov, D V; Balykov, I S

    2013-01-01

    The article presents the results of the study aimed to evaluation of possible relationship between anatomical structure of the renal pelvis of the kidney, the size of the stone and the effectiveness of extracorporeal shockwave lithotripsy (ESWL) of stones in lower calices of kidney, defined as "stone-free state". ESWL was performed in 285 patients. Sizes of stones varied from 5 to 25 mm. With interval distribution of stone sizes, the greatest number of cases was detected with size of 5 to 12 mm. The destruction of stone required one ESWL session in 196 cases, and three sessions only in 12 cases. The total number of pulses per one stone did not exceed 9500, and more than 70% of the stones have been effectively destroyed with less than 3000 pulses. The result of treatment was assessed 3-4 months after the last ESWL session on the basis of ultrasound and X-ray examination using nominal (dichotomous) scale. In addition, for verification of significant (expected and unexpected) correlations, exploratory analysis of the correlation matrices of factors possibly affecting the discharge of stone fragments was performed. Positive treatment outcome was recorded in 212 (74.4%) patients. Residual stone fragments (> or = 5 mm) were identified in 73 (25.6%) patients; in 69 patients fragments corresponded to the initial localization and 4 fragments were located in the pelvis and calices of middle and lower segments of the kidney. Statistical processing found no association between the size of the stone and the number of ESWL sessions required for its destruction (P = 0,4056). The analysis of relationship between the nature of the complications and size of stone revealed differences, but there were no significant differences in median test (p = 0.1067). Based on exploratory analysis and correlations identified, in-depth evaluation was carried out on three factors: the size of the stone, length of lower calices neck, and pyelocaliceal corner. Width of lower calices neck as a

  13. Sonographically-guided extracorporeal shockwave lithotripsy for pancreatic stones in patients with chronic pancreatitis.

    PubMed

    Schreiber, F; Gurakuqi, G C; Pristautz, H; Trauner, M; Schnedl, W

    1996-03-01

    Over a 2 year period, 10 patients with pancreatic stones due to alcohol induced chronic pancreatitis (proven by endoscopic retrograde pancreatography) underwent extracorporeal shockwave lithotripsy. Prior to shockwave therapy, all patients underwent endoscopic sphincterotomy. Targeting of shockwave lithotripsy was exclusively performed under sonographic control. All patients were treated with a second generation electrohydraulic spark gap lithotriptor and fragmentation of concrements could be achieved in all cases. Complete duct clearance was confirmed in seven patients by endoscopic retrograde pancreatography in one session, with endoscopic fragment extraction by basket and/or balloon catheter. In three patients, balloon dilation of concomitant strictures located in the head of the pancreas was performed prior to fragment extraction. All stone-free patients showed no further symptoms over the follow-up period of 12 months. Three patients in whom complete extraction of fragments was not successful experienced minor symptoms over the 12 month follow-up period.

  14. Donor-gifted allograft lithiasis: extracorporeal shockwave lithotripsy with over table module using the Lithostar Plus.

    PubMed

    Bhadauria, R P; Ahlawat, R; Kumar, R V; Srinadh, E S; Banerjee, G K; Bhandari, M

    1995-01-01

    Allograft lithiasis is usually secondary. Donor-graft lithiasis is a rare cause and only 5 cases have been reported. We report 2 such cases which are the first in the live-related transplantation programme. The pressing need to increase the donor pool in developing countries, safety of therapy in graft lithiasis coupled with minimal estimated risk of lithiasis recurrence in the donor are the main justifications for accepting calculi bearing kidney for transplantation. The 2 cases underwent extracorporeal shockwave lithotripsy using the overhead table module of the Lithostar Plus. The technical ease of lithotripsy using an on-line ultrasound module in these 'ectopically' placed kidneys is discussed. The effect of shockwaves on allograft function was studied by a pre- and post-renal scan (99Tc-DTPA) and serum creatinine. No adverse effect of shockwave on allograft function was noted both on short- and long-term follow-up.

  15. Interspersion of fragmented fiber's splinters into tissue during pulsed alexandrite laser lithotripsy.

    PubMed

    Strunge, C; Brinkmann, R; Flemming, G; Engelhardt, R

    1991-01-01

    Laser induced shockwave lithotripsy (LISL) on artificially inserted human renal calculi was realized in explanted pig ureters. A pulse stretched Alexandrite solid state laser was used at 750nm. Pulses of 350ns and 1 microseconds duration were transmitted through a 250 microns all silica fiber onto a stone surface, keeping the fiber tip in contact with a stone close to the ureter wall. The high power density of the 350 ns pulses lead to an optical breakdown inside the distal fiber tip causing fiber fragmentation of about 28 mm/100 pulses. Deep penetration of the fiber fragments into the ureter wall was proven histologically. Fiber fragmentation was avoided by increasing the pulse duration up to 1 microseconds. Riks for patient treatment caused by short pulse lithotripsy are discussed.

  16. Failure of piezoelectric lithotripsy of a gallstone impacted in the gallbladder neck.

    PubMed

    Brooks, D C; Connors, P J; Apstein, M D; Carr-Locke, D L

    1993-05-01

    Failure of extracorporeal shockwave lithotripsy is most frequently related to total stone mass, the size of individual stones, or unrecognized stone calcification which interferes with the dissolution effects of orally administered bile salts. We report a case of piezoelectric extracorporeal shockwave lithotripsy failure in a young woman with a 2-cm stone impacted in the neck of the gallbladder. Despite adequate positioning of the shockwave focal point on two separate occasions, no fragmentation was achieved. The stone was subsequently retrieved after the woman underwent laparoscopic cholecystectomy. When treated ex vivo, the stone rapidly fragmented. We hypothesize that the impacted stone, lacking a uniform liquid interface, failed to fragment because of the inability of cavitational forces to achieve a surface effect.

  17. Electrohydraulic Lithotripsy of an Impacted Enterolith Causing Acute Afferent Loop Syndrome

    PubMed Central

    Cho, Young Sin; Hwang, Soon Oh; Lee, Sunhyo; Jung, Yunho; Chung, Il-Kwun; Park, Sang-Heum; Kim, Sun-Joo

    2014-01-01

    Afferent loop syndrome caused by an impacted enterolith is very rare, and endoscopic removal of the enterolith may be difficult if a stricture is present or the normal anatomy has been altered. Electrohydraulic lithotripsy is commonly used for endoscopic fragmentation of biliary and pancreatic duct stones. A 64-year-old man who had undergone subtotal gastrectomy and gastrojejunostomy presented with acute, severe abdominal pain for a duration of 2 hours. Initially, he was diagnosed with acute pancreatitis because of an elevated amylase level and pain, but was finally diagnosed with acute afferent loop syndrome when an impacted enterolith was identified by computed tomography. We successfully removed the enterolith using direct electrohydraulic lithotripsy conducted using a transparent cap-fitted endoscope without complications. We found that this procedure was therapeutically beneficial. PMID:25133128

  18. Extracorporeal shockwave lithotripsy for a giant calcified gallbladder stone. Case report.

    PubMed

    Herbetko, J; Burhenne, H J

    1992-03-01

    Extracorporeal shockwave lithotripsy to gallstones is an alternative treatment to surgery in the high-risk patient with acute cholecystitis. We describe the successful fragmentation of a giant gallbladder stone and the subsequent removal of fragments through a cholecystostomy tract. Even though the treatment required 22 days in hospital and multiple procedures, these were all considered low risk in this patient with severe chronic obstructive airway disease.

  19. Modification of Dornier HM-4 lithotriptor for pediatric extracorporeal shockwave lithotripsy.

    PubMed

    Mathews, R; Makhuli, Z; Rahrle, R; Patil, U

    1995-06-01

    Extracorporeal shockwave lithotripsy has enjoyed increasing acceptance and utility in pediatric urology. The Dornier HM-4 lithotriptor has had good results in adults, but the gantry design does not allow smaller children to be treated. We have employed a specially designed yet simple 'spacer' to allow smaller children to be treated safely. The device may also have application in other patients with deformities who could not be treated in the past.

  20. Experience with electrohydraulic shockwave lithotripsy in the treatment of vesical calculi.

    PubMed

    Zhaowu, Z; Xiwen, W; Fenling, Z

    1988-06-01

    Five hundred and two patients with bladder stones have been treated by electrohydraulic shockwave lithotripsy (EHSWL) with the Wolf RIWOLTH-2135 disintegrator. The patients were aged between 18 and 80 years. The largest stone measured 3.6 x 4.8 cm but most were less than 3 cm; 533 stones were disintegrated in the 502 patients. The indications and complications of the treatment are discussed.

  1. Extracorporeal piezoelectric shockwave lithotripsy of multiple pancreatic duct stones under ultrasonographic control.

    PubMed

    Kerzel, W; Ell, C; Schneider, T; Matek, W; Heyder, N; Hahn, E G

    1989-09-01

    The first ultrasonographically controlled fragmentation of multiple pancreatic duct stones of up to 14 mm size by means of extracorporeal, piezoelectric shockwave lithotripsy is reported. On account of the ultrasound localization and continuous control during therapy a nasopancreatic tube for instillation of contrast medium and frequent x-ray checks were not necessary. The 48-year-old patient did not experience any pain during the four treatment sessions and during the follow-up period. No complications were noted.

  2. Transurethral holmium-YAG laser lithotripsy for large symptomatic prostatic calculi: initial experience.

    PubMed

    Goyal, Neeraj Kumar; Goel, Apul; Sankhwar, Satyanarayan

    2013-08-01

    Symptomatic prostatic calculi are a rare clinical entity with wide range of management options, however, there is no agreement about the preferred method for treating these symptomatic calculi. In this study we describe our experience of transurethral management of symptomatic prostatic calculi using holmium-YAG laser lithotripsy. Patients with large, symptomatic prostatic stones managed by transurethral lithotripsy using holmium-YAG laser over 3-year duration were included in this retrospective study. Patients were evaluated for any underlying pathological condition and calculus load was determined by preoperative X-ray KUB film/CT scan. Urethrocystoscopy was performed using 30° cystoscope in lithotomy position under spinal anesthesia, followed by transurethral lithotripsy of prostatic calculi using a 550 μm laser fiber. Stone fragments were disintegrated using 100 W laser generators (VersaPulse PowerSuite 100 W, LUMENIS Surgical, CA). Larger stone fragments were retreived using Ellik's evacuator while smaller fragments got flushed under continuous irrigation. Five patients (median age 42 years) with large symptomatic prostatic calculi were operated using the described technique. Three patients had idiopathic stones while rest two had bulbar urethral stricture and neurogenic bladder, respectively. Median operative time was 62 min. All the patients were stone free at the end of procedure. Median duration of catheterization was 2 days. Significant improvement was observed in symptoms score and peak urinary flow and none of the patient had any complication. Transurethral management using holmium-YAG laser lithotripsy is a safe and highly effective, minimally invasive technique for managing symptomatic prostatic calculi of all sizes with no associated morbidity.

  3. Laser lithotripsy with the Ho:YAG laser: fragmentation process revealed by time-resolved imaging

    NASA Astrophysics Data System (ADS)

    Schmidlin, Franz R.; Beghuin, Didier; Delacretaz, Guy P.; Venzi, Giordano; Jichlinski, Patrice; Rink, Klaus; Leisinger, Hans-Juerg; Graber, Peter

    1998-07-01

    Improvements of endoscopic techniques have renewed the interest of urologists in laser lithotripsy in recent years. Laser energy can be easily transmitted through flexible fibers thereby enabling different surgical procedures such as cutting, coagulating and lithotripsy. The Ho:YAG laser offers multiple medical applications in Urology, among them stone fragmentation. However, the present knowledge of its fragmentation mechanism is incomplete. The objective was therefore to analyze the fragmentation process and to discuss the clinical implications related to the underlying fragmentation mechanism. The stone fragmentation process during Ho:YAG laser lithotripsy was observed by time resolved flash video imaging. Possible acoustic transient occurrence was simultaneously monitored with a PVDF-needle hydrophone. Fragmentation was performed on artificial and cystine kidney stones in water. We observed that though the fragmentation process is accompanied with the formation of a cavitation bubble, cavitation has only a minimal effect on stone fragmentation. Fragment ejection is mainly due to direct laser stone heating leading to vaporization of organic stone constituents and interstitial water. The minimal effect of the cavitation bubble is confirmed by acoustic transients measurements, which reveal weak pressure transients. Stone fragmentation with the Holmium laser is the result of vaporization of interstitial (stone) water and organic stone constituents. It is not due to the acoustic effects of a cavitation bubble or plasma formation. The fragmentation process is strongly related with heat production thereby harboring the risk of undesired thermal damage. Therefore, a solid comprehension of the fragmentation process is needed when using the different clinically available laser types of lithotripsy.

  4. [The characteristics or urolithiasis in flight personnel and the treatment results using a method of extracorporeal shockwave lithotripsy on the Russian lithotripter Urat-P2].

    PubMed

    Garilevich, B A; Avdeĭchuk, Iu I

    1995-01-01

    Urolithiasis occurs more frequently in the pilots than in the ground-service personnel. To decrease a damaging effect of the focused shock waves on the renal tissue while using remote lithotripsy technique, a new domestic-certified lithotriptor "URAT-P2" which shows a significantly low energy of shock wave with sufficient effectiveness of crushing the renal stones, is devised. Urolithiasis in the pilots is apparent at the early stages of its development and its complicated forms are less common than in the subjects of other professions. The stones are predominantly located in the renal calyces (73,3% of cases), in the left kidney and urethra in 63,3% of cases and there were urate stones in 40% of cases. The clinical use of the URAT-P2 complex in 30 pilots indicated that it holds advantages over the production domestic-certified lithotriptor. The stones are crushed in all the patients but the complications associated with a negative effect of the focused shock waves on the renal tissue are absent. The use of the new lithotriptor for treating urolithiasis in the pilots will allow one to improve the treatment response and to maintain professional worthiness of the pilots for a long time.

  5. Effectiveness of transcutaneous electrical nerve stimulation (TENS) for analgesia during biliary lithotripsy.

    PubMed

    Rawat, B; Genz, A; Fache, J S; Ong, M; Coldman, A J; Burhenne, H J

    1991-10-01

    The effectiveness of transcutaneous electrical nerve stimulation (TENS) in controlling pain during biliary extracorporeal shockwave lithotripsy (BESWL) was assessed in 100 patients with symptomatic gallbladder calculi. Patients were divided into four groups: TENS electrodes were placed on the back at cutaneous anesthesia sites and on the right leg and the gallbladder acupuncture site in groups A and B. Electrodes were "turned on" only in group A. In groups C and D, electrodes were placed only on the back at cutaneous dermatomes. Electrodes were "turned on" in group C only. The TENS unit was stimulated at the pulse rate of 60 to 100 microseconds and frequency of 80 to 125 Hz. Lithotripsy was performed with the Lithostar Plus overhead module. The differences in the amount of analgesic used and the pain experiences by the patients in all groups were not statistically significant. The proportion of patients requiring intravenous analgesia in each group was also not significantly different (72%, 80%, 68%, 76% in groups A to D, respectively). Thus, TENS did not help in reducing the amount of intravenous analgesia required or the average pain perceived by the patient during lithotripsy treatment.

  6. Bolus injection v drip infusion contrast administration for ureteral stone targeting during shockwave lithotripsy.

    PubMed

    Pearle, M S; McClennan, B L; Roehrborn, C G; Clayman, R V

    1997-06-01

    Intraoperative excretory urography may be used to facilitate stone targeting during in situ SWL for ureteral stones, precluding the need for ureteral catheter placement. We compared bolus injection with drip infusion urography for efficacy in stone localization. Twenty-seven patients with normal renal function and a solitary, difficult to visualize, radiopaque ureteral calculus were randomized to receive intravenous contrast by either bolus injection (N = 13) or drip infusion (N = 14). The bolus injection patients received an average of 74 mL of Conray 400 contrast over 1 minute; the drip infusion patients received an average of 92 mL of contrast over 15 minutes. After bolus injection, it took an average of 12 minutes to opacify the ureter compared with 14 minutes after drip infusion (P = 0.62). It took longer to initiate (5 minutes) and complete (6 minutes) treatment after drip infusion than after bolus injection (P = 0.28 and P = 0.16, respectively). Imaging time was significantly longer in the infusion group than in the bolus group (12 v 7 minutes; P = 0.04). Stone-free rates were similar in the two groups: 100% for the bolus group and 91% for the infusion group. No patient in either group experienced an adverse reaction to the contrast. Overall, the two methods of contrast administration were equally efficacious for stone targeting during SWL. However, bolus injection required lesser amounts of contrast, provided more rapid opacification of the ureter, and resulted in an overall shorter procedural time, although the only statistically significant differences were in imaging time and contrast volume.

  7. [Tissue reactions with administration of piezoelectric shock waves in lithotripsy of salivary calculi].

    PubMed

    Iro, H; Wessel, B; Benzel, W; Zenk, J; Meier, J; Nitsche, N; Wirtz, P M; Ell, C

    1990-02-01

    Before clinical application of an extracorporeal piezoelectric lithotripter to treat sialolithiasis, tissue reaction during shockwave application was examined in vitro and in experiments with animals. Application of shockwaves to human tissue in vitro showed neither macroscopic nor microscopic effects. In animal experiments, the acute experiment (16 rabbits, Chinchilla-Bastard) revealed minor bleeding in the parenchyma of the parotid gland, while the chronic experiment (14 rabbits, Chinichilla-Bastard) revealed no morphologic tissue damage to the parotid region of the rabbit, as a result of piezoelectric shockwaves. However, when the eye was placed in the shockwave focal area and the shockwaves were transmitted via the fissura orbitalis to the endocranium, brain damage could be detected morphologically. In conclusion, the authors feel that the clinical application of extracorporeal piezoelectric fragmentation of salivary stones is justified, provided that a reliable positioning of the patient and exact sonographic location of the concrement are possible.

  8. Evaluation of Extracorporeal Shock Wave Lithotripsy (ESWL): Efficacy in Treatment of Urinary System Stones

    PubMed Central

    Junuzovic, Dzelaludin; Prstojevic, Jelena Kovacevic; Hasanbegovic, Munira; Lepara, Zahid

    2014-01-01

    ABSTRACT Introduction: Elimination of stone is determined by size and its localization. Stone from the ureter in 80% of cases can be eliminated spontaneously. If the stone by its characteristics is not spontaneously eliminated, taken are further steps and therapeutic protocols to solve this problem. Material and methods: The study was prospective, open and comparative. It was conducted at the Urology Clinic Clinical Center of Sarajevo University in the period from 2007 to 2013. The study included 404 patients with urinary tract lithiasis treated by ESWL. ESWL treatment is performed on the machine Siemens Model Lithostar Multiline, which has a combined ultrasonographic and fluoroscopic display, large energy density in order to obtain optimum focus (without damaging surrounding tissue) and minimal pain that on rare occasions requires for mild sedation-sedation. Results: From a total of 404 patients included in the study there were 234 (57.92%) male and 170 (42.08%) female patients. The most common type of stone both in female and male patients was calcium type. From a total of 262 calcium stones, 105 of them (40.07%) was present in female patients and 157 (59.92%) in male. Share of infectious type of stone in female patients was 63 (49.60%) and 64 among males (50.39%). Other stones were less abundant in both the gender groups and their total number was only 17. In women their frequency was 2 (13.33%) and 13 among males (86.67%). There was a significant difference in the frequency of different types of stones by gender (x2 = 11.47, p = 0.009). Conclusion: There was no statistically significant correlation between the number of treatments and localization of stones in the ureter, as well as a statistically significant correlation between the size of the stone and the localization of calculus in the ureter. PMID:25568579

  9. Extracorporeal shock wave lithotripsy for urinary stone disease: clinical experience with the electromagnetic lithotriptor 'Lithostar'.

    PubMed

    Simon, J; Corbusier, A; Mendes Leal, A; Van den Bossche, M; Wespes, E; Van Regemorter, G; Schulman, C C

    1989-01-01

    400 urinary stone patients were treated with the electromagnetic lithotriptor Siemens 'Lithostar': 66.3% had renal stones and 33.7% had ureteral stones. Ninety percent of the treatments were performed under intravenous sedation only: 14.5% of the patients had more than one session. After 3 months more than 80% of the patients with a single stone smaller than 1.5 cm and 46% of the patients with stones larger than 2.5 cm were 'stone-free'.

  10. Gallbladder stone inspection and identification for laser lithotripsy

    NASA Astrophysics Data System (ADS)

    Makdisi, Yacob; Kokaj, Jahja O.

    1999-03-01

    Using high speed imaging techniques, the gall bladder stone immersed in liquid is detected and identified. The detection of the shock waves induced by laser power is reached by using interferometry technique. Using gall bladder and tissue images obtained by ultra-fast photography and time resolved laser fluorescence the correlation of correlation is performed. The tissue image is used to perform the correlation filter. Hence lower correlation output is used for firing of the laser power.

  11. Nonstented versus routine stented ureteroscopic holmium laser lithotripsy: a prospective randomized trial.

    PubMed

    Shao, Yi; Zhuo, Jian; Sun, Xiao-Wen; Wen, Wei; Liu, Hai-Tao; Xia, Shu-Jie

    2008-10-01

    We conducted a prospective, randomized study to evaluate whether postoperative ureteral stenting is necessary after ureteroscopic holmium laser lithotripsy. A total of 115 consecutive patients with distal or middle ureteral calculi amenable to ureteroscopic holmium laser lithotripsy were prospectively randomized into stented group (n = 58) and nonstented group (n = 57). The stent was routinely placed in the treated ureter for 2 weeks. The outcomes were measured with postoperative patient symptoms, stone-free rates, early and late postoperative complications, and cost-effectiveness. The postoperative symptoms were measured with Ureteral Stent Symptom Questionnaire (USSQ). All patients completed a 12-week follow-up. There was no significant difference between two groups with respect to the patient age, stone size, stone location and mean operative time. According to the USSQ, the symptoms of the stented group were significantly worse compared to the nonstented group (P = 0.0001). In the stented group, two patients had high fever for 1 week after the operation, stent migration was found in two patients, and the stents had to be removed earlier in five patients because of severe pain or hematuria. The cost of the stented group was significantly higher than the nonstented group. The stone-free rate was 100% in both groups. No hydronephrosis or ureteral stricture was detected by intravenous pyelogram in the 12th week postoperative follow-up. In conclusion, we believe that routine stenting after ureteroscopic intracorporeal lithotripsy with the holmium laser is not necessary as long as the procedure is uncomplicated for distal or middle ureteral calculis less than 2 cm.

  12. Efficacy of retrograde ureteropyeloscopic holmium laser lithotripsy for intrarenal calculi >2 cm.

    PubMed

    Bader, M J; Gratzke, C; Walther, S; Weidlich, P; Staehler, M; Seitz, M; Sroka, R; Reich, O; Stief, C G; Schlenker, B

    2010-10-01

    The objectives of this study are to assess the efficacy and safety of retrograde ureteroscopic holmium laser lithotripsy for intrarenal calculi greater than 2 cm in diameter. A total of 24 patients with a stone burden >2 cm were treated with retrograde ureteroscopic laser lithotripsy. Primary study endpoints were number of treatments until the patient was stone free and perioperative complications with a follow-up of at least 3 months after intervention. In 24 patients (11 women and 13 men, 20-78 years of age), a total of 40 intrarenal calculi were treated with retrograde endoscopic procedures. At the time of the initial procedure, calculi had an average total linear diameter of 29.75 ± 1.57 mm and an average stone volume of 739.52 ± 82.12 mm(3). The mean number of procedures per patient was 1.7 ± 0.8 (range 1-3 procedures). The overall stone-free rate was 92%. After 1, 2 and 3 procedures 54, 79 and 92% of patients were stone free, respectively. There were no major complications. Minor postoperative complications included pyelonephritis in three cases (7.5%), of whom all responded immediately to parenteral antibiotics. In one patient the development of steinstrasse in the distal ureter required ureteroscopic fragment disruption and basketing. Ureteroscopy with holmium laser lithotripsy represents an efficient treatment option and allows the treatment of large intrarenal calculi of all compositions and throughout the whole collecting system even for patients with a stone burden of more than 2 cm size. PMID:20204341

  13. Percutaneous Endoscopic Holmium Laser Lithotripsy for Management of Complicated Biliary Calculi

    PubMed Central

    Healy, Kelly; Chamsuddin, Abbas; Spivey, James; Martin, Louis; Nieh, Peter

    2009-01-01

    Background and Objectives: Advances in endoscopic techniques have transformed the management of urolithiasis. We sought to evaluate the role of such urological interventions for the treatment of complex biliary calculi. Methods: We conducted a retrospective review of all patients (n=9) undergoing percutaneous holmium laser lithotripsy for complicated biliary calculi over a 4-year period (12/2003 to 12/2007). All previously failed standard techniques include ERCP with sphincterotomy (n=6), PTHC (n=7), or both of these. Access to the biliary system was obtained via an existing percutaneous transhepatic catheter or T-tube tracts. Endoscopic holmium laser lithotripsy was performed via a flexible cystoscope or ureteroscope. Stone clearance was confirmed intra- and postoperatively. A percutaneous transhepatic drain was left indwelling for follow-up imaging. Results: Mean patient age was 65.6 years (range, 38 to 92). Total stone burden ranged from 1.7 cm to 5 cm. All 9 patients had stones located in the CBD, with 2 patients also having additional stones within the hepatic ducts. All 9 patients (100%) were visually stone-free after one endoscopic procedure. No major perioperative complications occurred. Mean length of stay was 2.4 days. At a mean radiological follow-up of 5.4 months (range, 0.5 to 21), no stone recurrence was noted. Conclusions: Percutaneous endoscopic holmium laser lithotripsy is a minimally invasive alternative to open salvage surgery for complex biliary calculi refractory to standard approaches. This treatment is both safe and efficacious. Success depends on a multidisciplinary approach. PMID:19660213

  14. Disintegration of a pancreatic duct stone with extracorporeal shock waves in a patient with chronic pancreatitis.

    PubMed

    Sauerbruch, T; Holl, J; Sackmann, M; Werner, R; Wotzka, R; Paumgartner, G

    1987-09-01

    We report the case of a 33-year-old woman with chronic calcifying pancreatitis in whom an intraductal pancreatic stone with a diameter of 8 mm was successfully disintegrated with extracorporeal shock waves, permitting subsequent endoscopic extraction of the fragments. The patient had a mild attack of pancreatitis after the treatment. We conclude that shockwave lithotripsy of a pancreatic duct stone in patients with chronic pancreatitis is possible. It should, however, be viewed with reservation until further experience has been gained.

  15. Extracorporeal shockwave lithotripsy and percutaneous renal surgery. Comparisons, combinations and conclusions.

    PubMed

    Webb, D R; Payne, S R; Wickham, J E

    1986-02-01

    Although percutaneous nephrolithotomy (PCNL) and extracorporeal shockwave lithotripsy (ESWL) were introduced clinically at approximately the same time (1980-1981), their clinical progress appeared to progress along separate paths and to compete with each other. After 5 years it has become apparent that for optimal removal of nearly all renal stones by minimal or noninvasive techniques, PCNL and ESWL are required either separately or as combined procedures. This review traces the development, introduction and progress of these procedures and defines the current indications for extracorporeal, percutaneous and open renal stone surgery.

  16. Post-extracorporeal shockwave lithotripsy residual stone fragments: clinical significance and management.

    PubMed

    Porfyris, O; Delakas, D

    2012-06-01

    Although extracorporeal shockwave lithotripsy (ESWL) is one of the primary treatments for urolithiasis, very often residual fragments of the calculi are still present for a long time after the ESWL session. These fragments are usually asymptomatic and can be managed expectantly, but sometimes they can cause symptoms and require intervention. Secondary procedures are not routinely applied to all patients with residual fragments, but only to those with significant symptoms. Medical therapy may play an important role in the management of residual fragments, by correcting an underlying metabolic disorder and by preventing the growth of residual calculi and the formation of new ones.

  17. Combination of percutaneous surgery and extracorporeal shockwave lithotripsy for the treatment of large renal calculi.

    PubMed

    Dickinson, I K; Fletcher, M S; Bailey, M J; Coptcoat, M J; McNicholas, T A; Kellett, M J; Whitfield, H N; Wickham, J E

    1986-12-01

    Open surgery for large or complex renal calculi may be difficult, particularly in patients with recurrent stones, and may require special operative techniques to preserve renal function. With the advent of percutaneous nephrolithotripsy (PCNL) and extracorporeal shockwave lithotripsy (ESWL) new approaches are now available for the treatment of these difficult cases. A review of 67 patients who presented between November 1984 and May 1986 has shown that it was possible to clear large stones in 71% of patients using a combination of PCNL and ESWL. There was no mortality; the morbidity for both procedures was low and was less than when either procedure was used alone for the treatment of complex stones.

  18. Management of staghorn stones using a combination of lithotripsy, percutaneous nephrolithotomy and Solution R irrigation.

    PubMed

    Holden, D; Rao, P N

    1991-01-01

    The treatment of staghorn and partial staghorn calculi remains complex despite modern methods of stone removal. We describe the results following treatment of 112 stones. Three methods were used: percutaneous nephrolithotomy, extracorporeal shockwave lithotripsy and Solution R irrigation, either alone or in combination; 57 stones (55.8%) were completely cleared, with Solution R irrigation helping to achieve complete clearance in 6 of these. A further 24 stones were not completely cleared (small asymptomatic fragments less than 3 mm remained). A satisfactory outcome (stone-free or asymptomatic fragments less than 3 mm) was achieved in 81 stones (79%).

  19. A case of portal venous gas after extracorporeal shockwave lithotripsy and obstructive pyelonephritis.

    PubMed

    Rana, Abbas A; Sylla, Patricia; Woodland, David C; Feingold, Daniel L

    2008-03-01

    The presence of gas in the portal venous system is considered an ominous sign often mandating immediate exploratory laparotomy; however, there are numerous reports of benign incidences of this finding. This report describes a case of portal venous gas after extracorporeal shockwave lithotripsy. The patient had the rare complication of obstructive pyleonephritis that progressed to sepsis and subsequently underwent a negative exploratory laparotomy. It is suggested that the radiographic finding of portal venous gas should be correlated with the likely cause and overall clinical picture.

  20. [The scintigraphic effect of extracorporeal lithotripsy: prospective series of 25 cases].

    PubMed

    Saussine, C; Ansieau, J P; Helwig, J J; Jacqmin, D; Cuvelier, G; Delepaul, B; Bollack, C

    1993-12-01

    25 patients with non complicated renal stones were treated by extracorporeal shockwave lithotripsy (ESWL) using Sonolith 3000 an electrohydraulic generator type. They were evaluated before, 15 days and 3 months after ESWL by renal scintigraphy, using for 15 of them technetium -99m dimer captosuccinic acid and technetium -99m-diethylene-triamine acetate for the last 10. This follow up scintigraphic study shows no reduction of glomerular filtration rate after ESWL but some focal parenchymal lesions. Very few of these lesions persist at 3 months. These parenchymal damages seem to be less frequent and less persistent than with piezo-electric lithotripter.

  1. [Treatment of a subcapsular renal bleeding after extracorporeal shockwave lithotripsy with recombinant, activated factor VII].

    PubMed

    Langer, H; Strohmaier, W L; Probst, S

    2002-11-01

    We report on a patient who suffered a large subcapsular and perirenal haematoma after extracorporeal shockwave lithotripsy. Despite surgical intervention the bleeding did not stop for 6 days and 10 units of packed red blood cells were transfused. With the treatment of recombinant, activated factor VIII (NovoSeven((R))) an immediate haemostasis could be reached, so that impending nephrectomy could be avoided. This is the first case where FVIIa has been successfully used to stop a trauma-related bleeding in a patient without any obvious accompanying coagulation disorder.

  2. [The conditions for performing extracorporeal lithotripsy with different physicochemical compositions of the urinary stones].

    PubMed

    Dzeranov, N K; Grishkova, N V; Boĭko, T A; Golovanov, S A

    1994-01-01

    Remote impulse lithotripsy (RIL) parameters were assessed when crushing uroliths with the use of URAT-II lithotriptor. The results were referred to the concrement size, location and physicochemical properties. A total of 365 examinations were made. Disintegration of large concrements, including coral calculi occurred in response to less number of impulses than it was necessary for destruction of concrements up to 1.5 cm in size. The hardest were vitlokite and cystine stones. The lowest traumaticity was observed in disintegration of the concrements composed of struvite and carbonatapatite.

  3. [Extracorporeal shockwave lithotripsy in patients with a single kidney].

    PubMed

    Mompó Sanchís, J A; Fernández Rodríguez, A; Tormos Pérez, E

    1989-01-01

    Seventy-eight patients with calculi in solitary kidney were submitted to treatment with shock waves. The epidemiologic data presented herein include stone volume, localization, and type (29 caliceal, 10 pyelic, and 5 multiple calculi; 13 pseudostaghorn, 11 staghorn, and 10 ureteral calculi). Patient evaluation 3 months after treatment revealed overall good results were achieved: 46 renal units were stone-free and 20 had small stone fragments that could be spontaneously passed. Thirteen patients had persistent residual lithiasis. Different types of complementary endoscopic treatments had been utilized in 65% of the cases. With regard to complications, there were 5 cases with obstructive anuria and 4 with fever. The foregoing results show that ESWL is a safe and effective method of treatment of lithiasis in patients with solitary kidney. It is currently the procedure of choice for this patient group.

  4. [Extracorporeal shockwave lithotripsy in patients with urinary diversion].

    PubMed

    Martínez Jabaloyas, J M; Broseta Rico, E; Ruiz Cerdá, J L; Sánz Chinesta, S; Osca García, J M; Jiménez Cruz, J F

    1995-02-01

    Presentation of a review on nine patients (10 renal units) with urinary by-pass and renoureteral lithiasis who underwent shock wave extracorporeal lithotrity in our hospital. The justification for the by-pass was an infiltrant vesical tumour in 6 patients, myelomeningocele in 2, and vesicourethral trauma in the remaining one. All cases were being treated for a Bricker-type by-pass except the last one (bilateral ureterosigmoidostomy). Outcome of treatment was: absence of residual lithiasis in 6, minimal residues in 1 (2 renal units), failure in 1. The remaining patient suffered anaphylactic shock induced by the latex in the ureteral catheter placed prior to lithotrity which caused the patient's death.

  5. A review of the physical properties and biological effects of the high amplitude acoustic field used in extracorporeal lithotripsy.

    PubMed

    Coleman, A J; Saunders, J E

    1993-01-01

    Extracorporeal shockwave lithotripsy (ESWL) has now been used for more than a decade in the treatment of urinary stone disease. During this period there has been a wide range of studies on the physical properties of the high-amplitude focussed fields used in ESWL and the biological effects of exposure to such fields, including their ability to fragment hard concretions. These studies form a distinct body of knowledge whose relevance to the broader literature on biological effects from lower amplitude exposures has yet to be fully evaluated. This review attempts to present the main results of biological-effects studies in ESWL along with what is known of the physical properties of lithotripsy fields with the aim of assisting this evaluation. In general, the reported biological effects of lithotripsy fields are compatible with those that have been observed at those lower amplitudes of focussed pulsed ultrasound in which transient cavitation is the dominant mechanism of interaction. The relatively large amplitudes and low frequencies in ESWL, however, make it a more potent generator of transient cavitation than most other forms of medical ultrasound. Biological-effects studies with lithotripsy fields may, therefore, be expected to extend our understanding of the nature of transient cavitation and, in particular, its effects in mammalian tissue.

  6. The acceleration of gallstone destruction with synchronous biliary lithotripsy and contact dissolution in vitro using three cholesterol-solubilizing solvent.

    PubMed

    Kannegieter, L S; Brandon, J C; Teplick, S K; Norris, J A; Baker, M L; Deutsch, L S; Friedenberg, R M

    1992-02-01

    In the first-known application of its kind, shockwave lithotripsy and contact-solvent dissolution of large, calcified gallstone burdens were performed simultaneously with three chemical solvents, each tested separately in an in vitro model, with the combined effects on gallstone eradication examined. Two solvents, ethyl propionate and isopropyl acetate, were chosen for their solubilizing ability and potentially high level of patient safety. The third solvent, a 70%:30% mixture of methyl tert-butyl ether (MTBE) and dimethyl sulfoxide (DMSO), was chosen for its known ability to accelerate the dissolution of calcium-containing gallstones. All stones were matched for size, weight, and number. Gallstone lithotripsy performed in ethyl propionate was significantly more effective (P less than .02) in the production of fragments less than 2 mm when compared with bile; lithotripsy with isopropyl acetate and the MTBE/DMSO mixture showed no statistically significant effect. Biliary lithotripsy performed in an ethyl propionate medium may enhance gallstone dissolution and the production of small fragments (diameter less than 2 mm).

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

    NASA Astrophysics Data System (ADS)

    Watterson, James D.; Girvan, Andrew R.; Beiko, Darren T.; Nott, Linda; Wollin, Timothy A.; Razvi, Hassan A.; Denstedt, John D.

    2003-06-01

    Objectives: Symptomatic urolithiasis in pregnancy that does not respond to conservative measures has traditionally been managed with ureteral stent insertion or percutaneous nephrostomy (PCN). Holmium:yttrium-aluminum-garnet (YAG) laser lithotripsy using state-of-the-art ureteroscopes represents an emerging strategy for definitive stone management in pregnancy. The purpose of this study was to review the results of holmium laser lithotripsy in a cohort of patients who presented with symptomatic urolithiasis in pregnancy. Methods: A retrospective analysis was conducted at 2 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 2 encrusted ureteral stents were treated. Mean gestational age at presentation was 22 weeks. Mean stone size was 8.1 mm. Stones were located in the proximal ureter/ureteropelvic junction (UPJ) (3), mid ureter (1), and distal ureter (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 obstetrical or urological 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.

  8. Holmium:YAG laser lithotripsy for the management of urolithiasis in small ruminants and pot-bellied pigs

    NASA Astrophysics Data System (ADS)

    Halland, Spring K.; House, John K.; George, Lisle

    2001-05-01

    Obstructive urolithiasis is a common problem in small ruminants and pot-bellied pigs. The most common site of urinary tract obstruction in these species is the urethra. Surgical procedures developed to relieve obstructions, in our experience have been effective in approximately 75% of cases. Urethral stricture is a common complication if the mucosa of the urethra is disrupted. The objective of this project was to evaluate endoscopy guided laser lithotripsy as a therapeutic modality to relieve urethral obstructions in small ruminants and pot-bellied pigs. The study population consisted of patients presented to the Veterinary Medical Teaching Hospital at the University of California Davis with obstructive urolithiasis. Lithotripsy was performed using a Holmium:YAG laser via a 200-micron low water quartz fiber passed through a flexible mini-endoscope. Two types of urinary calculi were managed with this technique, calcium carbonate and calcium hydroxyphosphate. Laser lithotripsy was effective at relieving obstructions caused by both types of calculi when conventional methods had failed. Laser lithotripsy performed via urethral endoscopy is a safe and effective therapeutic modality for management of obstructive urolithiasis in small ruminants and pot-bellied pigs and reduces the risk of post procedural urethral stricture.

  9. Soft-tissue effects of biliary extracorporeal shockwave lithotripsy in swine.

    PubMed

    Malone, D E; Becker, C D; Reich, D; Quenville, N F; Burhenne, H J

    1989-09-01

    This study investigates the soft-tissue effects of biliary extracorporeal shockwave lithotripsy (BESWL) using a recently developed lithotripter, which consists of an electromagnetic shockwave generator and an integrated ultrasonic targeting system. Sixteen swine, evenly divided into four groups, underwent BESWL. One group had one BESWL session targeted on the gallbladder and another group had two BESWL sessions targeted on the gallbladder. The third group had one BESWL session targeted on implanted gallbladder stones and the fourth group had one BESWL session targeted on the region of the common bile duct (CBD). Half of each group were sacrificed on the day of lithotripsy and half 1 week later. Post-mortem examinations were performed. Each implanted gallstone had fragmented. There were no findings attributable to BESWL in 11 animals. Three animals had pulmonary haemorrhagic spots (the largest was 10 mm in diameter) and one had a submucosal CBD petechia; these findings were attributable to BESWL. In two animals, microscopic haemorrhage associated with bronchopneumonia (usually present in our pig population) was more prominent than usual. This was possibly attributable to BESWL. The swine's deep posterior costophrenic sulcus makes it difficult to avoid the lung base during BESWL in swine. We conclude that this BESWL device can fragment gallstones without causing clinically significant soft-tissue damage.

  10. Comparison of urinary calculus fragmentation during Ho:YAG and Er:YAG lithotripsy

    NASA Astrophysics Data System (ADS)

    Kang, Hyun Wook; Lee, Ho; Teichman, Joel H.; Welch, A. J.

    2005-04-01

    We compared urinary calculus fragmentation with long pulsed Ho:YAG (λ= 2.12 μm) versus Er:YAG (λ = 2.94 μm) lasers. We measured the ablation width, depth, volume and efficiency as a function of pulse energy from calculus threshold energy to clinical energy typically used for Ho:YAG laser lithotripsy. Ablation effects were evaluated for three types of urinary calculi (calcium oxalate monohydrate, cystine, and uric acid), for single and multiple pulses applied at various optical energy levels. By means of comparing laser-induced crater topography and ablation volume for each stone type, the feasibility of Er:YAG laser lithotripsy was appraised. The Er:YAG laser pulse energy generated deeper and narrower crater shapes with relatively smooth contours whereas the Ho:YAG laser produced shallower and wider craters with irregular shapes. In terms of multiple pulses ablation, the Er:YAG produced larger ablation volume than Ho:YAG. The deeper crater induced by the Er:YAG was attributed to the higher absorption coefficient of stones at the 2.94 μm wavelength, and widening of crater by Ho:YAG was perhaps caused by lateral expansion of ablated material. Comparing the ablation efficiency, Er:YAG was superior to Ho:YAG for both single and five-pulses.

  11. Percutaneous yttrium aluminum garnet-laser lithotripsy of intrahepatic stones and casts after liver transplantation.

    PubMed

    Schlesinger, Nis Hallundbaek; Svenningsen, Peter; Frevert, Susanne; Wettergren, André; Hillingsø, Jens

    2015-06-01

    Bile duct stones and casts (BDSs) contribute importantly to morbidity after liver transplantation (LT). The purpose of this study was to estimate the clinical efficacy, safety, and long-term results of percutaneous transhepatic cholangioscopic lithotripsy (PTCSL) in transplant recipients and to discuss underlying factors affecting the outcome. A retrospective chart review revealed 18 recipients with BDSs treated by PTCSL laser lithotripsy with a holmium-yttrium aluminum garnet laser probe at 365 to 550 µm. They were analyzed in a median follow-up time of 55 months. In all but 1 patient (17/18 or 94%), it was technically feasible to clear all BDSs with a mean of 1.3 sessions. PTCSL was unsuccessful in 1 patient because of multiple stones impacting the bile ducts bilaterally; 17% had early complications (Clavien II). All biliary casts were successfully cleared; 39% had total remission; 61% needed additional interventions in the form of percutaneous transhepatic cholangiography and dilation (17%), re-PTCSL (11%), self-expandable metallic stents (22%), or hepaticojejunostomy (6%); and 22% eventually underwent retransplantation. The overall liver graft survival rate was 78%. Two patients died during follow-up for reasons not related to their BDS. Nonanastomotic strictures (NASs) were significantly associated with treatment failure. We conclude that PTCSL in LT patients is safe and feasible. NASs significantly increased the risk of relapse. Repeated minimally invasive treatments, however, prevented graft failure in 78% of the cases. PMID:25821134

  12. Detachable fiber optic tips for use in thulium fiber laser lithotripsy

    NASA Astrophysics Data System (ADS)

    Hutchens, Thomas C.; Blackmon, Richard L.; Irby, Pierce B.; Fried, Nathaniel M.

    2013-03-01

    The thulium fiber laser (TFL) has recently been proposed as an alternative to the Holmium:YAG (Ho:YAG) laser for lithotripsy. The TFL's Gaussian spatial beam profile provides higher power transmission through smaller optical fibers with reduced proximal fiber tip damage, and improved saline irrigation and flexibility through the ureteroscope. However, distal fiber tip damage may still occur during stone fragmentation, resulting in disposal of the entire fiber after the procedure. A novel design for a short, detachable, distal fiber tip that can fit into an ureteroscope's working channel is proposed. A prototype, twist-lock, spring-loaded mechanism was constructed using micromachining methods, mating a 150-μm-core trunk fiber to 300-μm-core fiber tip. Optical transmission measuring 80% was observed using a 30-mJ pulse energy and 500-μs pulse duration. Ex vivo human calcium oxalate monohydrate urinary stones were vaporized at an average rate of 187 μg/s using 20-Hz modulated, 50% duty cycle 5 pulse packets. The highest stone ablation rates corresponded to the highest fiber tip degradation, thus providing motivation for use of detachable and disposable distal fiber tips during lithotripsy. The 1-mm outer-diameter prototype also functioned comparable to previously tested tapered fiber tips.

  13. Detachable fiber optic tips for use in thulium fiber laser lithotripsy.

    PubMed

    Hutchens, Thomas C; Blackmon, Richard L; Irby, Pierce B; Fried, Nathaniel M

    2013-03-01

    The thulium fiber laser (TFL) has recently been proposed as an alternative to the Holmium:YAG (Ho:YAG) laser for lithotripsy. The TFL's Gaussian spatial beam profile provides higher power transmission through smaller optical fibers with reduced proximal fiber tip damage, and improved saline irrigation and flexibility through the ureteroscope. However, distal fiber tip damage may still occur during stone fragmentation, resulting in disposal of the entire fiber after the procedure. A novel design for a short, detachable, distal fiber tip that can fit into an ureteroscope's working channel is proposed. A prototype, twist-lock, spring-loaded mechanism was constructed using micromachining methods, mating a 150-μm-core trunk fiber to 300-μm-core fiber tip. Optical transmission measuring 80% was observed using a 30-mJ pulse energy and 500-μs pulse duration. Ex vivo human calcium oxalate monohydrate urinary stones were vaporized at an average rate of 187  μg/s using 20-Hz modulated, 50% duty cycle 5 pulse packets. The highest stone ablation rates corresponded to the highest fiber tip degradation, thus providing motivation for use of detachable and disposable distal fiber tips during lithotripsy. The 1-mm outer-diameter prototype also functioned comparable to previously tested tapered fiber tips.

  14. [Extracorporeal shockwave lithotripsy in single kidneys. Our experience].

    PubMed

    Martínez Sarmiento, M; Morera Martínez, J; Sanz Chinesta, S; Vera Donoso, C D; Oliver Amoros, F; Boronat Tormo, F; Jiménez Cruz, J F

    1995-03-01

    Forty patients with renal lithiasis in single kidney were treated with extracorporeal shock wave lithotrity in our unit. Nine patients required emergency urinary by-pass, because of original picture of obstructive anuria, and in another 21 cases a double-J catheterism was conducted as prophylaxis prior to lithotrity. Treatment was carried out with analgesia and ambulatory, except for 10 patients with calculi of less than 10 mm where by-pass was not performed, and who were kept in preventive hospitalization for 24 hours. Average of sessions per patients was 1.59 (range 1-7). After 6 months follow-up there are 24 free renal units (60%), 12 (30%) with debris that can be expelled, failure in 4 (10%): 2 with debris that can be expelled and 2 which were not fragmented. Renal function has not deteriorated during follow-up, except for 2 patients with obstructive uropathy, that subsequently normalized following resolution of the condition. No significant differences were found in the treatment of calculi of less than 10 mm with or without double-J. ESWL is considered to be the choice approach for lithiasis in patients with one single kidney, due to is efficacy and low morbidity, safety in the ambulatory environment, even for calculi of less than 10 mm with no urinary by-pass.

  15. Stone recurrence after shockwave lithotripsy: possible enhanced crystal deposition in traumatized tissue in rabbit model.

    PubMed

    Sarica, K; Soygür, T; Yaman, O; Ozer, G; Sayin, N; Akbay, C; Küpeli, S; Yaman, L S

    1996-12-01

    To evaluate the possible traumatizing effect of high-energy shockwaves (HESW) on new stone formation as indicated by crystal deposition in the renal parenchyma, we performed an experimental study in 50 rabbits. During severe oxaluria induced by continuous ethylene glycol (0.75%) administration, animals in the first group (N = 15) received 500 to 1500 shockwaves. Animals in the second group (N = 15) underwent no specific therapy apart from ethylene glycol administration. In a third group of animals (N = 15), only shockwave administration was applied. Sham group animals constituted the last group in our study (N = 5). Three months after shockwave application, tissue sections obtained from treated and untreated kidneys were evaluated histopathologically under light and transmission electron microscopy (TEM) for the presence and degree of crystal deposition in the cortical parenchymal region subjected to HESW. Crystal deposition was evident in the intercellular region and intratubular parts of the parenchyma in animals subjected to HESW application, especially in those receiving relatively high (1000 or 1500) numbers of shockwaves. On the other hand, no crystal formation and deposition was detectable in animals undergoing only ethylene glycol therapy or shockwave administration alone. Sham group animals demonstrated no significant renal histopathology. The traumatic effects of HESW should be evaluated as a factor in new stone formation after SWL.

  16. Comparison of treatment of renal calculi by open surgery, percutaneous nephrolithotomy, and extracorporeal shockwave lithotripsy.

    PubMed Central

    Charig, C R; Webb, D R; Payne, S R; Wickham, J E

    1986-01-01

    This study was designed to compare different methods of treating renal calculi in order to establish which was the most cost effective and successful. Of 1052 patients with renal calculi, 350 underwent open surgery, 350 percutaneous nephrolithotomy, 328 extracorporeal shockwave lithotripsy (ESWL), and 24 both percutaneous nephrolithotomy and ESWL. Treatment was defined as successful if stones were eliminated or reduced to less than 2 mm after three months. Success was achieved in 273 (78%) patients after open surgery, 289 (83%) after percutaneous nephrolithotomy, 301 (92%) after ESWL, and 15 (62%) after percutaneous nephrolithotomy and ESWL. Comparative total costs to the NHS were estimated as 3500 pounds for open surgery, 1861 pounds for percutaneous nephrolithotomy, 1789 pounds for ESWL, and 3210 pounds for both ESWL and nephrolithotomy. ESWL caused no blood loss and little morbidity and is the cheapest and quickest way of returning patients to normal life. PMID:3083922

  17. [Ultrasound controlled extracorporeal shockwave lithotripsy of pancreatic calculi in patients with chronic recurrent pancreatitis].

    PubMed

    Schreiber, F; Gurakuqi, G C; Trauner, M; Krejs, G J

    1994-09-01

    A consecutive series of 10 patients with pancreatic stones due to chronic pancreatitis was treated by extracorporeal shockwave lithotripsy during an investigation period of 2 years. The first step of the therapeutic regime included an endoscopic sphincterotomy prior to shockwave treatment. The targeting procedure was performed strictly under sonographic control. All patients were treated with a second-generation electrohydraulic lithotriptor, fragmentation could be achieved in all 10 cases. In 7 patients stonefreeness could be reached by endoscopic stone extraction, all these patients were symptom-free over a follow-up period of 12 months. In 3 patients complete duct clearance could not be achieved, these patients presented with minor symptoms over the follow-up period.

  18. Aspects on how extracorporeal shockwave lithotripsy should be carried out in order to be maximally effective.

    PubMed

    Tiselius, Hans-Göran; Chaussy, Christian G

    2012-10-01

    The present review summarizes the most important considerations and steps for an optimal result of extracorporeal shockwave lithotripsy. The relationship between shockwave path, geometry and anatomical conditions is of utmost importance. Selection of appropriate treatment variables in terms of shockwave number, power and frequency, is an important prerequisite for proper disintegration and prevention of complications. Several supportive measures such as inversion therapy, citrate therapy, high diuresis, α-receptor antagonists, chemolysis and recurrence preventive measures are important parts of the management of this group of patients in order to avoid problems with residual fragments and new stone formation. Proper understanding of these factors as well as of the physics of shockwaves is necessary for a successful application of this non-invasive technology treatment concept.

  19. Percutaneous debulking of staghorn stones combined with extracorporeal shockwave lithotripsy: results and complications.

    PubMed

    Puppo, P; Bottino, P; Germinale, F; Caviglia, C; Ricciotti, G; Giuliani, L

    1988-01-01

    The results and complications of 122 percutaneous debulking of staghorn stones are carefully reviewed, discriminating between dilated and not dilated kidneys. Percutaneous debulking can be defined as satisfactory in about 70% of the cases. In the remaining 30% of the cases (mostly not dilated kidneys) it has got little or no results. The overall complication rate is quite low and most of the common complications can be prevented. Percutaneous procedures in nondilated kidneys have an overall complication rate highly superior to that in dilated kidneys. It should be preferable to treat as many staghorn stones as possible in nondilated kidneys with staged extracorporeal shockwave lithotripsy (ESWL) monotherapy, stenting the ureter and monitoring the urinary infection. Struvite stones are best suitable for stented ESWL because of their fragility. In case of cystine or oxalate monohydrate staghorn stone open surgery might be preferable in virgin patients, but it is often refused by the patients.

  20. Comparison of treatment of renal calculi by open surgery, percutaneous nephrolithotomy, and extracorporeal shockwave lithotripsy.

    PubMed

    Charig, C R; Webb, D R; Payne, S R; Wickham, J E

    1986-03-29

    This study was designed to compare different methods of treating renal calculi in order to establish which was the most cost effective and successful. Of 1052 patients with renal calculi, 350 underwent open surgery, 350 percutaneous nephrolithotomy, 328 extracorporeal shockwave lithotripsy (ESWL), and 24 both percutaneous nephrolithotomy and ESWL. Treatment was defined as successful if stones were eliminated or reduced to less than 2 mm after three months. Success was achieved in 273 (78%) patients after open surgery, 289 (83%) after percutaneous nephrolithotomy, 301 (92%) after ESWL, and 15 (62%) after percutaneous nephrolithotomy and ESWL. Comparative total costs to the NHS were estimated as 3500 pounds for open surgery, 1861 pounds for percutaneous nephrolithotomy, 1789 pounds for ESWL, and 3210 pounds for both ESWL and nephrolithotomy. ESWL caused no blood loss and little morbidity and is the cheapest and quickest way of returning patients to normal life.