Twenty years of single center experience in ESWL 1987-2007: an evaluation of 3079 patients.

INTRODUCTION: Since 1987 we have consecutively operated five different Dornier lithotriptors in the management of lithiasis at all levels of the urinary tract. At the time of usage of each machine we periodically evaluated the treatment results in order to eventually adapt treatment strategies to improve results. None of these evaluations comprised the totality of patients treated on a certain machine during the entire period it was in use. This overview retrospectively compares the results over the entire period in order to gauge the impact of the different machines and SW-sources on clinical results. MATERIAL AND METHODS: A total of 3079 patients, treated from september 1987 till september 2006 with two electrohydraulic machines, HM4 (1987-1988) and MPL9000 (1988-1994), and three electromagnetic machines, Compact (1991-1999), DoLi U/50 (1996-1999) and DoLi S (1999-2006) were thus evaluated. Parameters reviewed were stone location and size, retreatment rate, auxiliary procedures, stone free rate and Effectiveness Quotient (EQ). RESULTS: There is no significant difference in stone size or stone free rate (p=0.4715) for the different groups. There is a significant difference for auxiliary procedure rate and retreatment rate for the different machines. The DoLiS with EMSE 220F-XXP scores significantly better than any of the other systems for auxiliary procedure rate pre-ESWL (p<0.05) and total auxiliary procedure rate (p<0.05), and retreatment rate (p=0.0024). There is a gradual increase in EQ with the consecutive machines. CONCLUSION: Although stone free rates (85%-88.8%) remained constant, Effectiveness Quotients improved. This is largely due to reduced auxiliary procedure rates and reduced retreatment rates. The first effect is a consequence of improvement in treatment strategies and experience, the latter no doubt also of improvement in SW-sources.

Mountainbiker's hematuria: a case report.

Although exercise-induced hematuria is a well known finding in long distance running, it is extremely rare in cycling. We describe a case of gross atraumatic hematuria after mountainbiking. The only pathologic finding in our patient was a small hyperemic zone in the bladder mucosa suggesting a local traumatic origin due to repeated contact of the flaccid bladder wall against the bladder base. This in contrast with the renal origin commonly seen in marathon runners. It is a benign hematuria that usually resolves within a day without specific treatment. The best treatment is prevention by means of good bladder filling. Neoplasm of the urothelium should be ruled out in differential diagnosis.

Use of tramadol drip in controlling renal colic pain.

BACKGROUND AND PURPOSE: Although the continuous perfusion of antispasmodic drugs has been the traditional mainstay in the treatment of renal colic, the results more often than not are unsatisfactory. Our hypothesis was that a continuous intravenous (IV) drip of tramadol would be an effective and safe alternative. PATIENTS AND METHODS: In this prospective study, 300 patients with renal colic were randomized into four treatment groups, single blind for the patients. At the start, all received an anti-inflammatory drug intramuscularly and an antiemetic and antispasmodic IV. Group A was given the classical IV antispasmodic perfusion combined with a sham drip. Group B received the classical antispasmodic perfusion in combination with a tramadol drip. Group C had a sham perfusion and drip. Group D received a sham perfusion and tramadol drip. There was no significant difference in the degree of pain between the groups on a visual analog scale (VAS) at the start. The pain was scored again on the VAS at 30 minutes, 1 hour, and 4 hours after the start of the treatment and at IV urography. Side effects, as well as the need for rescue medication, were registered. RESULTS: Both tramadol groups scored significantly better after 60 and 240 minutes and during IV urography (P < 0.005). There was a significant decrease in VAS in group B after 30 minutes. The tramadol groups needed significantly less rescue medication (P = 0.001). There was no significant difference in the reported side effects. The combination spasmolytic-tramadol drip scored the best, although the difference was not statistically significant. CONCLUSION: We consider our hypothesis proved that a continuous tramadol drip is a safe and valuable analgesic regimen in renal colic.