Comparing the effect of topical eutectic mixture of local anesthesia and lidocaine infiltration on pain response and analgesia requirement during extra corporeal lithotripsy procedure [using the storz modulith SL20]

Fifty adult male patients [mean age 35 +/- 15 ys.] with renal pelvic stones were selected for this study, all patients required 3 ESWL sessions. First session was performed without any form of preoperative analgesia or anaesthesia. Second session, patients received 25mg of EMLA cream applied locally to cover a skin area overlying the treated kidney, 90 minuets before ESWL session. Third session was started 10 minuets after subcutaneous infiltration to the area overlying the treated kidney with 20 ml, 1% lidocaine. Using EMLA cream and lidocaine subcutaneous infiltration lead to decrease the pain score perception when compared to without anaesthesia session. During the first 500 shock waves of ESWL, pain score of 2 or more was reported by 6%, 10% and 35% of patients using EMLA cream, lidocaine infiltration and without anaesthesia respectively, and 38%, 32% and 70% during the following 2500 shock waves. This decrease in pain score lead to less need for I.V. alfentanil analgesia to 38% in case of using EMLA cream, 32% in case of using lidocaine infiltration, while it was 70% when nothing was used. Local anesthesia is an effective means to reduce the pain score and analgesia requirement during extra corporeal lithotripsy procedure. Both EMLA and local infiltration are effective. However EMLA cream is easy to apply and has no complications. It is only drawback is its price

Ureteroscopy vs in situ extracorporeal shock wave lithotripsy for the treatment of distal ureteral calculi

One hundred patients with distal ureteral stones were treated by ESWL [50 patients] using Modulith SL20 Storz Lithotriptor and [50 patients] ureteroscopic extraction. The stone free rate [SFR] with ESWL line was 72% with an average of two sessions of treatment and 28% needed other line of treatment, no complications occurred except mild renal pain [30%] and microscopic haematuria [30%], all cases were done as out patient procedure. The stone free rate with ureteroscopy group was 90% and failed ureteroscopic extraction occurred in 5 cases [10%] which were treated by ESWL, ureteral catheter inserted in all cases post operatively, stricture ureter occurred in 2 patients [4%] with average hospital stay of 1.5 days. Ureteroscopy is more efficicious than ESWL for the treatment of distal ureteral colculi and less expensive