Tratamiento de la litiasis piélica con el litotritor Mododulith slx-mx (storz) / Treatment of the pyelic lithiasis using the Mododulith slx-mx (storz)lithotriptor

La litiasis urinaria es una enfermedad de alta prevalencia y recurrencia, a la que los hospitales no pueden dar solución quirúrgica con la celeridad necesaria. La litotricia extracorpórea por ondas de choque (LEC) es la primera opción de tratamiento y las tasas de resolución fluctúan del 33 al 90 por ciento. El objetivo de este estudio fue analizar nuestros resultados con la utilización del litotritor Mododulith slx-mx (storz) para el tratamiento monoterápico de la litiasis de la pelvis renal. Se incluyeron pacientes con litiasis piélica que no hubieran recibido otro tratamiento. Se conformaron 4 grupos según la superficie litiásica y se relacionaron con la terapéutica (sesiones, ondas de choque, energía, complicaciones, aplicación de procedimientos auxiliares, maniobras complementarias y evolución). El mayor número de pacientes tenía cálculos de hasta 2 cm², y más del 92 por ciento fueron resueltos con una sola sesión. Más del 94 por ciento no presentó complicaciones y no se necesitaron procedimientos auxiliares en más del 97 por ciento de los casos. . Se lograron buenos resultados en más del 97 por ciento de los casos mediante LEC monoterápica de la litiasis piélica de hasta 4 cm² utilizando el litotritor Mododulith slx-mx (storz). Los mejores resultados se obtuvieron en los cálculos de hasta 3 cm² y más del 99 por ciento de éstos correspondieron a los cálculos de hasta 2 cm². Las ventajas de este equipo se deben, sobre todo, a su alta eficacia y al hecho de que logra una fragmentación fina que facilita la eliminación total de los cálculos. Por esta razón, se consigue una alta tasa de resolución, sin restos de la litiasis en más del 97 por ciento de los casos y con un mínimo de maniobras complementarias(AU)

The urinary lithiasis is a disease with a high prevalence and recurrence and the hospitals can not give a surgical solution as quickly as possible. The shock waves extracorporeal lithotripsy (SWEL) is the first choice of treatment and the resolution rates fluctuate from 33 to 90 percent. The objective of present study was to analyze our results using the Mododulith slx-mx (storz) lithotriptor for the monotherapy of renal pelvis lithiasis. The patients presenting with pyelic lithiasis and any other treatment were included in study that were divided into four groups according the lithiasis surface and were related to therapeutics (sessions, chock waves, energy, complications and application of auxiliary procedures, complementary manoeuvres and course). RESULTS. Most of patients had 2 cm² calculi and more than the 92 percent were solved with only one session. More than 94 percent had not complications without auxiliary procedures in more than 97 percent of the cases. It was possible to obtain good results in more than 97 percent of the cases using monotherapy-SWEL of pyelic lithiasis of 4 cm² using the Mododulith slx-mx (storz) lithotriptor. The better results were obtained in calculi of 3 cm² and more than the 99 percent belongs to calculi of 2 cm². The advantages of this device were mainly due to its high effectiveness level and to fact that it achieves a fine fragmentation allowing the total removal of calculi. Thus, it is possible to obtain a high rate resolution without rests of lithiasis in more than 97 percent of the cases and with a minimum of complementary manoeuvres(AU)

Resultados de la litotricia extracorpórea utilizando el litotritor MODULITH SLX-MX (STORZ) para el tratamiento de la litiasis ureteral / Results of the shock waves extracorporeal lithotripsy using the MODULITH SLX-MX (STORZ) lithotriptor for treatment or ureteral lithiasis

INTRODUCCIÓN. La litiasis del uréter constituye una gran preocupación para los médicos debido a que frecuentemente ocasiona una uropatía obstructiva y el deterioro progresivo de la función renal ipsolateral, estado patológico de alta prevalencia, por lo que los hospitales con frecuencia no pueden dar solución quirúrgica con la celeridad necesaria. El objetivo de esta investigación fue conocer los resultados de la litotricia extracorpórea por ondas de choque (LEC) con el litotritor MODULITH SLX-MX (STORZ) para el tratamiento de la litiasis ureteral. MÉTODOS. Se incluyeron 598 pacientes con litiasis radiopaca del uréter, atendidos en el Hospital Hermanos Ameijeiras entre enero de 2007 y diciembre de 2008. Se conformaron 4 grupos según la localización del cálculo: en la unión pieloureteral (UPU) (96), uréter lumbar (UL) (263), iliaco (UI) (40), pelviano (UP) (199) y se analizó su relación con la superficie litiásica, sesiones de tratamiento, maniobras complementarias previas a la litotricia, aplicación de procedimientos auxiliares posteriores, resolución definitiva por otra técnica quirúrgica y eficacia terapéutica. La colimación se realizó por fluoroscopia. RESULTADOS. El mayor número de cálculos se localizó en el uréter lumbar, y en segundo lugar, en el uréter pelviano. El tamaño medio de la litiasis fue de 0,8 ± 0,5233 cm2, en rango de 0,09-4 cm2. La media de sesiones utilizadas fue de 1,24 ± 0,531, rango de 1-4. Se realizaron maniobras complementarias previas en 72 pacientes (12,04 por ciento) y la más utilizada fue la nefrostomía percutánea (40; 6,6 por ciento). Después de la LEC fue necesaria la conversión a otro procedimiento para la solución del 4,68 por ciento de los casos. La LEC fue eficaz en el 95,32 por ciento, con mejores resultados en el UP (96,99 por ciento) y peores en el UI (92,50 por ciento). CONCLUSIONES. Los resultados fueron buenos utilizando el litotritor MODULITH SLX-MX (STORZ). Los mejores resultados se obtuvieron en el uréter pelviano y en general es posible considerar la LEC como la primera opción terapéutica de la litiasis ureteral(AU)

INTRODUCTION. Ureter lithiasis is a concern for physicians because frequently provokes an obstructive uropathy and a progressive deterioration of ipsilateral renal function and a high prevalence of pathological state that is why the hospitals can not give a surgical solution as quickly as possible. The objective of present research was to know the results of the shock waves extracorporeal lithotripsy (SWEL) using the MODULITH SLX-MX (STORZ) lithotriptor for treatment or ureteral lithiasis. METHODS. In present research 598 patients presenting with ureter radiopaque lithiasis, seen in the Hermanos Ameijeiras Clinical Surgical Hospital from January, 2007 to December, 2008, divided into four groups according to the calculus localization: in pyeloureteral joint (PUJ) (96), lumbar ureter (LU) (263), iliac joint (IJ) (40), pelvic joint (PJ) (199) analyzing its relationship with lithiasis surface, treatment sessions, complementary manoeuvres previous to lithotripsy, application of subsequent auxiliary procedures, definite resolution using other surgical technique and therapeutical effectiveness. Collimation was carried out by fluoroscopy. RESULTS. Most of calculi were located in the lumbar ureter and in the second place in pelvic ureter. The mean size of lithiasis was of 0,8 ± 0,5233 cm2 in the rank of 0,09-4 cm2. The mean of sessions used was of 1,24 ± 0,531, in the rank of 0,09-4 cm2. The mean of sessions used was of 1,24 ± 0,531, rank of 1-4. In 72 patients 12,04 percent) previous complementary manoeuvres were carried out and the more used one was the percutaneous nephrostomy (40; 6,6 percent). After SWEL it was necessary the conversion to other procedure for solution of 4,68 percent of the cases. The SWEL was effective in the 95,32 percent with better results in the UP (96,99 percent) and with worse results in the IJ (92,50 percent). CONCLUSIONS. The results were good using the MODULITH SLX-MX (STORZ) lithotriptor. The better results were obtained in the pelvic ureter and in general, it is possible to consider the SWEL as the first therapeutical choice of ureteral lithiasis(AU)

Comparison of the Results after Lithotripsy of EDAP LT-01+ and Modulith SLX for Urinary Stones / 대한비뇨기과학회지

We attempted to compare the result of EDAP LT-01+ lithotripsy with Modulith SLX lithotripsy for management of urinary stones. We evaluated 1,544 patients (1,731 renal units) treated with EDAP LT-01+ ESWL (Group A) and 668 patients (707 renal units) treated with Modulith SLX ESWL (Group B). The results were obtained as follows; 1. Between the group A and B, stones were located in kidney (except staghorn calculi) in 666 cases (38.5%) and 160 cases (22.6%), in staghorn calculi in 31 cases (1.8%) and 13 cases (1.8%), in ureteropelvic junction (UPJ) in 65 cases (3.8%) and 19 cases (2.7%), in upper ureter in 469 cases (27.0%) and 200 cases (28.3%), in lower ureter in 491 cases (28.4%) and 271 cases (38.3%) and in bladder in 9 cases (0.5%) and 10 cases (1.4%), respectively. 2. Success rates according to stone size were 99.4% and 99.6% in less than 1 cm:, 97.5% and 97.2% in 1 cm2 to 2 cm2, 92.4% and 91.3% in 2 cm2 to 3 cm2 and 82.2% and 78.1% more than 3 cm2 respectively in the group A and B. There. was no statistically significant difference between two groups (,p>0.05). 3. Success rates ccording to stone location were 98.8% and 100% in renal stone (except staghorn calculi) , 83.9% and 84.6% in staghorn calculi,92.3% and 94.7% in UPJ stone, 97.7% and 98.5% in upper ureteral stone, 98.4% and 98.6% in lower ureteral stone and 66.7% and 30% in bladder respectively in the group A and B. There was no statistically significant difference between two groups (p>0.05). 4. Average shock wave sessions and time (min.) were 4.0 and 1.8 and 42.1 and 28.6 respectively in the group A and B. These differences were statistically significant (p=3 days) in 1.6% and 10.7%, steinstrasse in 5.1% and 12.5%, fever (>=38 degree C) in 2.1% and 2.3% and perirenal hematoma in 0% and 0.7% respectively in the group A and B. We concluded that success rates according to location and size of urinary stone were similar between two groups. But, treatment time of the group B was significantly shorter than that of the group A. Treatment sessions of the group B were decreased compared with the group A. Gross hematuria and steinstrasse were occurred significantly more in the group B compared to the group A (p<0.05).

Extracorporeal Shock Wave Lithotripsy: Experience of the Year with Modulith SLX / 대한비뇨기과학회지

Storz Modulith SLX represents a newly developed third generation lithotriptor with an electromagnetic cylinder as shock wave source and a dual localization system consisting of inline ultrasound and an integrated fluoroscope C-arm. We report our initial experience with in situ ESWL treatment of renal and ureteral stones with Modulith SLX. 282 patients with urinary stones were treated. Stones were located in calices or the renal pelvis in 21.4%, in the upper ureter in 50.5%. in the midureter in 6.1% and in the lower ureter in 22.0%. The age range of the patients was 18 to 73 years (mean of 43.8 years). The male to female ratio was 1.6: 1. The size of the stones ranged from 3 to 48mm (mean of 11.6mm). No general or regional anesthesia was required. The average number of shock waves was 3,250 shock/session and the total number of treatment session was 535 (mean of 1.9/person). The success rate was 84.1% in kidney, 92.6% in upper ureter. 83.3% in midureter and 95.4% in lower ureter respectively (overall 90.8%). The success rate was decreased in accordance with increment of stones size : 93.996 for stones of 1- 10mm, 86.2% for 11-20mm, 44.4% for stones larger than 20mm. There was no significant complications. In conclusion, ESWL with Storz Modulith SLX is the first choice of management for urinary stones less than 20mm in diameter regardless of the stone location. And it is an efficient and safe lithotriptor which allows anesthesia-free lithotripsy and treatment for outpatient basis.