Extracorporeal shock wave lithotripsy

To determine the outcome of patients undergoing extracorporeal shock wave lithotripsy [ESWL] for treatment of upper urinary tract calculi [renal and ureteric], and to note role of double-J [DJ] stents in these patients. A cross-sectional analytical study. Department of Urology, Rawalpindi General Hospital, Rawalpindi, from February 1999 to July 2001. Record of patients who underwent ESWL for renal and ureteric stones was retrieved and analyzed using statistical program, SPSS version-10 and Epi-Info 2000. In some patients pre-ESWL DJ stents were placed because of various reasons like solitary kidney, large stone volume etc. Patients were divided in two groups, Group I, in whom DJ stents were not placed, and Group II, in whom DJ stents were placed. ESWL was performed in each subject in standard way employing piezoelectric lithotripter E.D.A.P. LT 02X. Patients were evaluated for stone clearance fortnightly with X-ray or ultrasound. Four hundred and thirty-two patients, 68.8% male and 31.2% female, underwent ESWL. Mean age of patients was 37.7 ' 13.1 years. Majority of patients [78.47%, n=339] had renal, while rest had ureteric stones. Group I and II included 408 [94.4%] and 24 [5.6%] patients respectively. Renal stones were present in 78% [n=318] of Group I and 87.5% [n=21] of Group II patients. Mean size of stones in Group I and II patients was 10.91 ' 4.6, and 10.4 ' 4.7mm. Stone clearance was 96.3% and 100% in Group I and Group II patients respectively. Significantly more ESWL sessions were required for stone clearance in Group II [p-value 0.03]; in addition Group II patients had significantly more complications [p-value 0.01]. ESWL is an effective procedure. Pre-ESWL stenting is associated with increased numbers of ESWL sessions and more complications

Bladder calculi: clearance rates and early complications after shock wave lithotripsy versus those after transurethral endoscopic manipulations

Extracorporeal shock wave lithotripsy [ESWL] and transurethral endoscopic extraction with or without pneumatic fragmentation have been the most commonly applied procedures at our institution for the treatment of bladder stones. Through this work we aimed to evaluate and compare the results of both procedures during the past 5 years as regards the stone-clearing capabilities and the incidence of peri-operative complications. The peri-operative data and imaging studies of 88 patients who underwent ESWL for their bladder stones as well as 74 patients who had transurethral extraction with or without pneumatic fragmentation were revised [groups A and B, respectively]. Children in either groups were analyzed separately while adults were sub-classified according to their stone sizes [small, medium or large]. A stone-free status was judged if there were no residual fragments larger than 5 mm in adults and larger than 3 mm in children. Each of the subgroups in one treatment arm was compared statistically to its counterpart in the other treatment arm as regards stone clearance rate and complications. Student-t and chi-square tests were applied. ESWL rendered 76.9% of 26 children stone-free while all 4 children who were treated endoscopically were cleared of their stones. Stone clearance rates in adults who underwent ESWL were 83.3, 88.9 and 50% for small, medium and large stones, respectively. The equivalent figures in group B were 96.2, 89.5 and 68%. Although transurethral therapy appeared more successful particularly in small stones, yet there has been no statistical significance between either treatment modalities. On the other hand, the incidence of complications was significantly higher in group B adults. These included for instance, 2 patients with bladder injuries, 8 with moderate to severe haematuria and 5 with urethral injuries. These results indicate that transurethral endoscopic extraction [with or without pneumatic fragmentation] of small bladder stones yielded better clearance rates than ESWL although this was not statistically significant. Both modalities were almost equivalent at clearing medium sized stones but ESWL fared better as regards safety. The results in large stones were not only fair, but they also carried a high rate of complications particularly with the endoscopic access