In situ ultrasonic guided extracorporeal shock wave lithotripsy of ureteric stones

ABSTRACT

From July 1989 to December 1993 182 patients with symptomatic ureteric calculi were treated, 160 in the upper ureter and 22 in the lower ureter, by using in situ extracorporeal shock wave lithotripsy [ESWL]. The lithotriptor used is "Sonolith 3000", it is ultrasound guided spark gap unit. Transverse diameter of the stones ranged from 5 to 16 mm. A total of 139 patients underwent a single treatment and 43 needed multiple treatment sessions. Successful fragmentation was obtained in 148 and in 19 patients with upper and lower ureteric stones, respectively. Stone fragmentation failed in 15 patients, 12 with upper ureteric stones and 3 with lower ureteric stones. 9 of the 12 non-fragmented upper ureteric stones has a large transverse diameter [>10 mm]. Local anesthesia and IV sedation were used in 145 patients, while general anesthesia was needed for 37 patients. There were no major complications. Steinstrasse and severe renal colic occurred in 20 and 42 patients, respectively. Ureteroscopy was the only ancillary procedure needed, it was successful in 13 of 15 patients. After 3 months 58 patients were lost to follow up, 118 patients of the remaining 124 evaluable patients were stone-free. In view of these results, it is suggested that ESWL in situ is the primary treatment of upper ureteric stones and selected subgroup of lower ureteric stones