Extra corporeal shockwave lithotripsy for the management of urinary calculi: experience with 453 patients

ABSTRACT

Extracorporeal shock wave lithotripsy [ESWL] has revolutionized the treatment of urinary calculi. In this study, we analyze our experience of using ESWL as a monotherapy in the treatment of urinary calculi of different sizes and at different sites. Patients presenting to our urology unit with urolithiasis were subjected to ESWL monotherapy with or without preliminary insertion of 'J' ureteric stents. Preliminary investigations included routine hematological and biochemical assessment, urine culture, coagulation profile and intravenous urography [I.V.U.]. The outcome of treating calculi in the kidneys, ureters, and bladder using ESWL was analyzed. Success was defined as either becoming completely stone-free or by the presence of residual, but insignificant, calculi. ESWL was performed on 453 patients using a Storz Modulith SL-20 lithotriptor. Pre-ESWL procedures included insertion of 'J' stents in 84 patients [18.5%], "push" and 'J' stenting in six patients [1.3%], and ureteral catheterization in six patients [1.3%]. A total of 225 patients had renal calculi [49.7%], 225 patients had ureteral calculi [49.7%], and three patients had bladder calculi [0.6%]. Out of the 453 patients, 417 patients completed ESWL. The success rate was 92.5%. The number of treatment sessions for 417 patients increased in accordance with the stone size and averaged 2.4 sessions. Post-ESWL ancillary procedures included ureteroscopy and Dormia basket extraction in 21 patients, and 'J' stent fixation in 12 patients. Complications encountered included steinstrasse in 33 [7.3%] patients, septicemia in six [1.3%] patients, acute pyelonephritis in three [0.66%] patients and three [0.66%] patients had subcapsular hematoma. ESWL, as a monotherapy is a safe and efficient outpatient procedure for the initial treatment of urinary calculi