[Shock wave lithotripsy in Germany: Results of a nationwide survey]. / Stoßwellenlithotripsie in Deutschland: Ergebnisse einer deutschlandweiten Umfrage.

BACKGROUND: Following its introduction in the 1980s extracorporeal shock wave lithotripsy (SWL) became the gold standard for therapy of ureteral and renal calculi. The research data published during the last decade suggest a paradigm shift to endourological techniques. OBJECTIVES: The purpose of this study was to compare whether the suggested loss of status for SWL corresponds with actual real-life treatment in Germany. A further aim was to assess the quality of SWL therapy in German hospitals. MATERIALS AND METHODS: The board of the German Society for Shock Wave Lithotripsy (DGSWL) sent a questionnaire to 306 urological departments in Germany, which encompassed medical, technical and organizational topics in the therapy of ureteral and renal calculi. A total of 99 (33%) questionnaires were returned. CONCLUSION: With the exception of a few departments, non-invasive SWL still plays a major role in the treatment of urolithiasis and a loss of the gold standard status is not in sight. The performance of SWL in German hospitals is carried out at a high level of quality. To maintain and optimize this status a structured SWL training and adherence to clinical practice guidelines are needed.

Incidence and risk factors of renal hematoma: a prospective study of 1,300 SWL treatments.

Shock wave lithotripsy (SWL) is the gold standard for the treatment of upper urinary tract stones. Despite being relatively non-invasive, SWL can cause renal hematoma (RHT). The aim of this study was to determine incidence and risk factors for RHT following SWL. 857 patients were included in a prospectively maintained database. The observation period spans from 2007 to 2012. 1,324 procedures were performed due to kidney stones. Treatment protocol included power ramping and shock wave frequency of 60-90 per minute as well as an ultrasound check within 3 days of SWL for all patients. Patients with RHT were analyzed, and treatment characteristics were compared with the complete population in a non-statistical manner due to the low event count. RHTs after SWL, sized between 2.6 × 0.6 cm and 17 × 15 cm, were verified in seven patients (0.53%). In four patients, the RHT was asymptomatic. Three patients developed pain after SWL treatment due to a RHT. In one patient surgical intervention was necessary due to a symptomatic RHT, the kidney was preserved. The risk of RHT following SWL treatment of kidney stones is about 0.5%. Clinically relevant or symptomatic RHTs occur in 0.23%, RHTs requiring surgical intervention are extremely rare. Older age and vascular comorbidities appear to be risk factors for the development of RHT. The technical characteristics of SWL treatment and intake of low-dose acetylsalicylic acid due to an imperative cardiologic indication do not appear to influence the risk. Prospective studies are warranted.

[Transrectal high-intensity focused ultrasound for local treatment of prostate cancer. 2009 Update]. / Hoch intensiver fokussierter transrektaler Ultraschall (rHIFU) zur lokalen Therapie des Prostatakarzinoms. Update 2009.

Pulsed robotic high-intensity focused ultrasound (rHIFU) is an interesting therapeutic option mainly due to its noninvasive character. In urologic oncology, rHIFU is used for the transrectal therapy of prostate cancer. While percutaneous therapy of renal cancer using rHIFU is still being tested in experimental studies, transrectal therapy with rHIFU for prostate cancer is already established in more than 230 urologic departments worldwide. The results of prostate cancer therapy with rHIFU are mainly based on different clinical studies. In 2007 a clinical study comparing rHIFU and cryotherapy for the treatment of prostate cancer was initiated in the USA in order to gain clinical approval by the FDA. The most recent publications concluded that the use of rHIFU is an effective standard treatment for prostate cancer with a broad range of indications in all tumor stages: (1) in the primary treatment of local prostate cancer, (2) in patients with local recurrence after failure of any primary treatment, and (3) as an adjuvant therapy in the palliation of systemic prostate cancer.

High-intensive focused ultrasound in localized prostate cancer.

BACKGROUND AND PURPOSE: The results of the standard treatment for prostate cancer-radical prostatectomy-are not entirely satisfactory. A new local therapy, transrectal high-intensive focused ultrasound (HIFU), has been developed. We reviewed our experience with HIFU for palliation of localized prostate cancer. PATIENTS AND METHODS: Our series included 65 men with confirmed prostate cancer without detectable metastases who were not suitable candidates for radical prostatectomy. After prophylactic suprapubic cystostomy, the patients were treated using the Ablatherm version 2.32 under spinal anesthesia. The effects were monitored by serum prostate specific antigen assays, digital rectal examination, and biopsy. The mean follow-up is 10 months (range 1-18 months). RESULTS: There were no intraoperative or postoperative deaths, and there have been no deaths from prostate cancer. Residual cancer was detected in 35% of the patients in whom only biopsy-positive portions of the prostate were treated and 17% of those in whom the entire gland was treated. Retreatment was performed 1 month after the first session in these patients. The prostate volume increased an average of 30% after treatment, but by 3 months, the gland was 10% to 20% smaller than its original size. Three patients suffered complications secondary to overheating of the rectal wall or treatment too close to the external urethral sphincter. CONCLUSION: The low morbidity, minimal invasiveness, avoidance of systemic side effects, and potentially curative effect make HIFU a potentially useful option for the treatment of localized prostate cancer.

First clinical experience and in situ treatment of ureteric stones using Lithostar Multiline lithotripter.

This article reviews the first experience using the Siemens Lithostar Multiline lithotripter in 372 consecutive treatments of ureteric and kidney stones. The disintegration rate was 97.7%, and a stone-free rate of 87% was achieved at the end of 3 months. Auxillary procedures were required in only 11% of the patients. No medication was required for pain management in 60.4% of the patients. The results were especially impressive in the management of ureteric stones, with a success rate of 91%, these patients being stone free after 1 week using the new booster technique. Analysis of the data indicates that the Siemens Lithostar Multiline is a safe, effective, and economically sound device to treat patients with ureteric and renal stones.

Current state and future developments of noninvasive treatment of human urinary stones with extracorporeal shock wave lithotripsy.

Extracorporeal shock wave lithotripsy has now been in clinical use for 8 years and it has replaced other treatment techniques for the majority of surgical calculi in the upper urinary tract. For the first time it provides a completely noninvasive method for the treatment of renal and ureteral stones. The current range of its indications includes approximately 70 per cent of nonselected urinary stone patients. An additional 25 per cent of the patients with more complex stones in the upper urinary tract can receive treatment with the lithotriptor combined with endourological procedures. More recent additions to the range of clinical routine applications with the original lithotriptor have been its use on common bile duct stones combined with endosurgical or radiological manipulations. With a modified kidney lithotriptor gallstones have been treated successfully, which has led to the development of a multipurpose device for biliary and urinary stones.

Treatment of ureteral calculi by extracorporeal shock-wave lithotripsy. UCLA experience.

One hundred sixteen patients underwent extracorporeal shock-wave lithotripsy (ESWL) for ureteral stones. In 108 patients, the stones were manipulated pre-ESWL whereas 8 patients underwent ESWL without prior stone manipulation. Ureteral lubrication using a 2% Xylocaine jelly solution greatly facilitated the retrograde advancement of the calculus or the passage of ureteral catheters alongside the stone. ESWL disintegrated all but 4 stones for an overall success rate of 96.6 per cent. It is considered that the combination of retrograde ureteral stone repositioning and ESWL is a highly successful alternative in the management of ureteral calculi.

The in vitro and in vivo effects of extracorporeal shock waves on malignant cells.

The in vitro cytotoxic effect of extracorporeal shock waves (ESW) on renal cell carcinoma (RCC) cells was compared to the effect on normal human embryonic kidney (NHEK) cells. In the in vitro studies cell samples were brought into the second focal point and exposed to different numbers of shock wave impulses. The four parameters of RCC tumor cell injury which were measured, i.e., cell viability, cell growth, cell attachment and electron microscopic evidence of damage, were augmented with increasing SW levels. At 2,000 shock waves (SW) a significant decrease in RCC viability, cell growth and cell attachment was seen compared to the NHEK cells. In the in vivo experiment a FANFT induced bladder tumor was transplanted into the right hind legs of C3H/He mice and the tumors were exposed to 1,400 SW. Preliminary data showed that 1,400 SW at day 12 post transplant significantly inhibited tumor growth. Combining 1,400 SW with cis-diamminedichloroplatinum (4 mg/kg) did not enhance the tumor inhibitory effect of each individually. Doxorubicin (5 mg/kg) and 1,400 SW produced a significant synergistic tumor inhibitory effect.

The treatment of uric acid calculi with extracorporeal shock wave lithotripsy.

A review of the first 1000 patients treated with extracorporeal shock wave lithotripsy (ESWL) at UCLA revealed 21 patients with uric acid renal or ureteric calculi. Using the combination of ESWL and oral urinary alkalinisation, 16/21 patients (76%) were stone-free at follow-up 3 months later and 19 patients were stone-free at 5 months. ESWL and urinary alkalinisation are complementary methods for the non-invasive treatment of uric acid renal calculi.

Calcification of ureteral stent treated by extracorporeal shock wave lithotripsy.

A patient with stones presented with large calcifications of the J ends of a Double-J stent that had been placed in the ureter for an obstructing ureteral stone 1 month previously. The J end located in the renal pelvis was treated with extracorporeal shock wave lithotripsy and the calcification was disintegrated completely. This noninvasive procedure appears to be the method of choice in the treatment of such complications.