Clinical Experience of Extracorporeal Shock Wave Lithotripsy with EDAP LT-02 in Urinary Calculi / 대한비뇨기과학회지

PURPOSE: To evaluate the efficacy of the EDAP LT-02 (LT-02) lithotriptor in the treatment of urinary stones. MATERIALS AND METHODS: We analysed 2,176 cases with urinary calculi, primarily treated by LT-02, between January 1995 and December 2001. There were 591 cases with renal, and 1,585 with ureteral, calculi. The distribution of stones, success rate in relation to the location and size of stones, comparisons of success rate in relation to radio-opacity, causes of failure and complications of extracorporeal shock wave lithotripsy (SWL), were reviewed. Renal and upper ureteral calculi were treated with the patients in the supine position, and mid and lower ureteral calculi were treated with the patients in the prone position. RESULTS: The success rates (stone free or residual fragments with a diameter <4mm) in relation to the stone location, size and radio-opacity were as follows: 1. The success rates of the renal and ureteral stones were 90.9 and 98.4%, respectively. 2. With renal stones, the success rates were 96.4, 92.2, 74.5, 73.5 and 28.6% for stone sizes of less than 10, 11-20, 21-30, 31-40 and above 41mm, respectively (p<0.001). With ureteral stones, the success rates were 100, 98.4, 83.3 and 0% for stone sizes of less than 10, 11-20, 21-30 and 31-40mm, respectively (p<0.001) 3. In relation to the radio-opacities, for the renal and ureteral stones, there were no significantly differences in the success rates. The retreatment rate for stones was 64.1% and that for auxiliary treatment was 2.4%. Thus, the efficiency quotient was 43.5% with SWL using LT-02. CONCLUSIONS: We suggest that SWL using LT-02 is a safe and effective method, which should be considered as an acceptable option for the primary management of urinary calculi in selected patients.

Experience of Percutaneous Nephrolithotomy in Patients with Older Age / 대한비뇨기과학회지

PURPOSE: The aim of this study was to evaluate the safety and efficacy of percutaneous nephrolithotomy (PCNL) preformed in patients aged 65 years or older. MATERIALS AND METHODS: We retrospectively evaluated the data of 26 PCNL, performed on 25 patients aged 65 years or older (mean 68.7), and compared the data with those of another 127 PCNL procedures on 123 patients, aged under 65 years, performed at our clinic. RESULTS: The presence of staghorn calculi (6 of 26 renal units [23.1%] versus 41 of 127 renal units [30.7%], p=0.44) and the average stone size (29mm versus 26mm, p=0.19) were similar for the 2 groups. The success rates (stone-free patients and patients with residual stones <4mm) were similar, being 80.8% for the elderly group and 84.2% for the younger patients (p=0.66). The transfusion rates for the 2 groups were similar, 15.4% in the elderly group versus 11.8% in the younger group (p=0.61). No serious complications or deaths were observed. CONCLUSIONS: PCNL is a safe, effective and less invasive therapy for the treatment of elderly patients with complex stone diseases.

The Effects of Nifedipine and Allopurinol on Shock Wave Induced Acute changes of Rabbit Ureter / 대한비뇨기과학회지

PURPOSE: Introduction of shock wave lithotripsy has provided an avenue for dealing with many urinary stones noninvasively. Although shock wave is known to cause pathologic changes in various organ, little is k nown about its effect on the ureter and recovery after shock wave, the target organ in SWL of injury induced by shock wave and the potential protective effect of allopurinol and nifedipine against shock wave. MATERIALS AND METHODS: A total 24 rabbits were assigned to 2 groups. 12 rabbits received allopurinol(10mg.each) and nifedipine (1mg.each) that were given orally 3 times a day for 5 days starting the night before SWL. The other 12 rabbits reseived no medication. The left lower Ureter segments of 24 rabbits were removed ureter. Groups of 8 rabbits(4were medication group and 4, no medication group) were sacrificed 1, 3 and 5 days after shock wave exposure. The histomorphological alterations were examined under light and transmission electron microscopy. RESULTS: The epithelial cells disclosed no change after shock wave application. Histologically the muscular layer was the most affected part of ureter. There was interstitial and intracellular edema on light microscopy and made chromatin and mitochondrial changes at the subcellular level. The adventitial layer wes also edematous. This chanfes were prominent on day 1and 3 and returned to normal on day 5. The medication group showed less severe features of injury, compared with the no medication group. CONCLUSIONS: Electromagnetic shock waves produce reversible morphological changes in rabbit ureteric muscle and allopurinol and nifedipine may have its role in protecting the tissue injury produced by high energy shock waves.

In situ Shock Wave Lithotripsy of Upper Ureteral Calculi: Affecting Factors of Retreatment / 대한비뇨기과학회지

PURPOSE: In situ SWL has become the preferred treatment modality for proximal ureteral calculi. However, reported rate of retreatment and need for stone manipulation such as stenting or push back were considerably high. We tried to determine the clinical factors affecting retreatment rate for effective in situ SWL. MATERIALS AND METHODS: One hundred seven patients with upper ureteral calculi underwent in situ SWL by using the Dornier MPL 9000 with ultrasound locating system. We evaluated the factors such as size and texture of the stone, degree of obstruction, distance from ureteropelvic junction and duration of symptom by comparing success rate of 1st session SWL. RESULTS: The overall stone free rate was 93.9% at 3 months. Average number of session of SWL was 1.35. Sucess rate of 1st session was 71%(76/107). Retreatment rate after 1st session was 29%(31/107). The significant clinical factors affecting retreatment rate of SWL were size of stones( 1.2cm), texture(rough shape) and complete ureteral obstruction. CONCLUSIONS: From these results we conclude that upper ureteral calculi with these factors should be performed primary in situ SWL more carefully to improved the therapeutic result.

Extracorporeal Shock Wave Lithotripsy Experience with Domestic SDS-5000 in 173 Patients with 195 Urinary Calculi / 대한비뇨기과학회지

PURPOSE: This study was performed to evaluate the success rate, failure causes, complications, safety and effectiveness of extracorporeal shock wave lithotripsy(SWL) with domestic SDS-5000 lithotriptor for the treatment of urinary calculi. MATERIALS AND METHODS: SWL monotherapy using the Domestic SDS-5000 lithotripter was performed in 195 urinary stones from 173 patients between 9 years and 74 years old from March 1998 to February 1999. Distribution of stones, location and size of stones, session, success rate, causes of failure and complications of SWL were reviewed. RESULTS: Of 195 cases, 88(45.1%) had renal, and 107(54.9%) ureteral stones. Of these cases 44.6% had stones smaller than 0.9cm, 33.3% from 1 to 1.9cm, 15.9% from 2 to 2.9cm, and 4% larger than 3cm. The overall success rate of complete SWL was 91.3% with 90.1% in 5-9mm, 96.9% in 10-19mm, 90.3% in 20-29mm and 62.5% over 30mm stone size. There were no significant complications. The cases of transient gross hematuria were developed in 11.3%, renal colic in 8.7%, steinstrasse in 2.0% and fever in 1.0%. These complications were controlled with conservative treatment or repeated session of shock wave lithotripsy, Double - J stent insertion. CONCLUSIONS: SWL with Domestic SDS-5000 lithotriptor is considered to be a safe and efficient outpatient procedure for the initial treatment of urinary stone.

Analysis of Factors Affecting Stone Recurrence after Extracorporeal Shock Wave Lithotripsy / 대한비뇨기과학회지

PURPOSE: A retrospective analysis was performed to investigate the factors that affect stone recurrence in patients who were stone-free after extracorporeal shock wave lithotripsy(SWL). MATERIALS AND METHODS: From February 1990 to December 1992, 1039 patients were treated by SWL with EDAP LT-01+ lithotriptor. Among them 200 patients were followed up at 60 months. Fifty eight(29.0%) of 200 patients had recurrent stone after SWL. We analysed the patients according to patient age, sex, location, multiplicity and size of the original stones, serum calcium and uric acid level, urinary calcium and uric acid level at presentation, anatomical abnormality and pyuria after SWL as possible factors affecting stone recurrence. RESULTS: Mean age of the patients was 43.6 years(range 7 to 81) and there were 115 male and 85 female patients with sex ratio 1.35:1. Age and sex did not affect stone recurrence. The recurrence rates according to the stone location were 100%(1/1) for staghorn calculi, 28.6%(2/7) for pelvic stones, 26.2%(16/61) for single calyceal stone, 47.8%(11/23) for multiple calyceal stones and 29.7%(41/138) for ureteral stones. Stone location did not affect stone recurrence. 16(47.0%) of 34 renal units with multiple stones had recurrent stones, whereas 55(28.1%) of 196 renal units with single stone recurred. Multiplicity of the stone was the risk factor for stone recurrence(p<0.05). The stone size(renal unit) of less than 20mm were identified in 213 and 64(30.0%) of them had recurrent stones, whereas stone size(renal unit) of more than 20mm were identified in 17 and 7(41.2%) of them had recurrent stones. More than 20mm of the stone size was the risk factor for stone recurrence(p<0.05). Hypercalcemia, hyperuricemia, hypercalciuria, and hyperuricosuria did not affect stone recurrence. 14(28.6%) of 49 patients who had pyuria after SWL had recurrent stones, whereas sterile urine after SWL were noted in 151 and 44(29.1%) of them had recurrent stones. Pyuria after SWL did not affect stone recurrence. Anatomical abnormality was noted in 5 patients and 4(80%) of them showed recurrence, but there was no statistical significance due to small populations. CONCLUSIONS: Multiplicity and size of the stones were the risk factor for stone recurrence. But patient age, sex, location of the original stones, serum calcium and uric acid level, urinary calcium and uric acid level at presentation and pyuria after SWL did not affect stone recurrence.

Lower Caliceal Stone Clearance after Shock Wave Lithotripsy: Impact of Lower Pole Radiographic Anatomy / 대한비뇨기과학회지

PURPOSE: We analyzed our experience to determine the influence of infundibulo-pelvoureteral angle, lower calyceal width and length in predicting the clearance of fragments after extracorporal shock wave lithotripsy(ESWL) for lower calyceal stone. MATERIALS AND METHODS: From October 1995 to April 1998, a retrospective analysis of 51 patients with a solitary radiopaque lower pole calyceal stone who underwent excretory urography(IVP) preoperatively were treated ESWL with a Storz Modulith SLX third generation. RESULTS: The overall stone-free rate was 54.9%. Stone-free status after ESWL was significantly related to each anatomical measurement. Of the stone-free and not stone-free groups, with the infundibulo-pelvoureteral angle 40 degree or greater 21 patients were found in stone-free groups(75%) and 5 patients in not stone-free groups(21.7%), with the infundibular width >5mm 22 patients were found in stone-free groups(78.6%) and 11 patients in not stone-free groups(47.8%) and with the infundibular length < or =30mm 16 patients were found in stone-free groups(57.1%) and 5 patients in not stone-free groups(21.7%), respectively. CONCLUSIONS: We recommend that the 3 major radiographic features of the lower pole calix should be assessed during intravenous urography to facilitate the planning of treatment for lower calyceal stones.

Extracorporeal Shock Wave Lithotripsy Monotherapy for Staghorn Stones / 대한비뇨기과학회지

PURPOSE: The clinical effectiveness of extracorporeal shock wave lithotripsy(SWL) monotherapy for staghorn stone was evaluated. MATERIALS AND METHODS: A total of 26 patients with staghorn stone treated by SWL monotherapy with Dornier MPL 9000 between April 1990 and December 1997 was reviewed. Dornier MPL 9000 lithotriptor was characterized by ultrasonic localization, automatic target system, water cushion and under water spark gap generation of shock wave. The number of treatment sessions for complete clearance, complications and ancillary procedures were compared regarding type and volume of the stone. RESULTS: All stones were completely fragmented and cleared without serious complications. The mean number of treatment sessions was 5.2 in incomplete type(16 cases) and 6.6 in complete type(10 cases). It was 5.5 in stones under 20ml(12 cases) and 5.9 in stones over 20ml(14 cases). The ureteral stent was indwelled before SWL in 22 cases. The complication after SWL included steinstrasse in 14 cases and high fever in 4 cases. SWL to steinstrasse was performed in 6 cases and push-up was needed in 8 cases. CONCLUSIONS: We conclude that, in spite of the high number of treatment sessions, SWL monotherapy for staghorn offers good results without serious complications.

Extracorporeal Shock Wave Lithotripsy in 37 Patients with Calyceal Diverticular Stone / 대한비뇨기과학회지

PURPOSE: Extracorporeal shock wave lithotripsy(SWL) is considered to be a safe and efficient treatment for urinary stones, but controversies still remain for the treatment of stones in caliceal diverticula, because the anatomical factor of the stone formation persists, even when the stone itself has been resolved. For this reason, we reviewed 37 patients with calyceal diverticular stone to determine whether they could be treated successfully by SWL as the initial treatment. MATERIALS AND METHODS: A total of 37 patients with caliceal diverticular calculi underwent SWL with EDAP-LT01, LT02 and LT02-Plus between February 1990 and June 1998. Among the 37 patients, 26 were asymptomatic and 11 were symptomatic. RESULTS: The location of the diverticulum was right upper calyx in 12 kidneys, right middle calyx in 5, right lower calyx in 7, left upper calyx in 7, left middle calyx in 4 and left lower calyx in 2. The average stone size was 1.1cm, with a range of 0.2 to 2.5cm. A stone-free state was initially achieved in 17(45.9%) patients for 1 to 26 months (mean 5.1 months). The average number of treatments was 3.5. Additionally, a success rate of 68.8% can be achieved in the patients with radiographical patency of diverticular neck. Extended follow-up in 17 patients for 8 to 100 months (mean 47.1 months) after SWL revealed recurrent stones in only 1(5.9%). Of the 11 patients with flank pain or urinary tract infection before SWL, 8(72.7%) were relieved or markedly improved in 1 to 2 months(mean 1.3 months) after average session of 2.1. Side effects of SWL developed in 10(27%); Colic in 8(21.6%), mild fever in 1(2.7%), and severe gross hematuria in 1(2.7%). CONCLUSIONS: We confirmed that SWL is a safe and effective method and should be considered an acceptable form of primary management for patients with calyceal diverticular stone.