Major Factors Influencing on the Success of Extracorporeal Shock Wave Lithotripsy

Yang, Seung Chul; Park, Dong Soo; Lee, Jin Moo

Abstract

This study is performed to extend the indication of Extracorporeal Shock Wave Lithotripsy (ESWL) and to help the improvement of treatment results. We analysed the results of urinary stone disintegration for the 345 urinary stones of 271 patients to whom the ESWL had been undergone by Siemens Lithostar from March, 1992 to September, l993, of which the complete data for stone volume, shape, location, catheterization, and intravenous urographic findings were obtained. Also, using the specially devised instrument, we dipped stones of several components that our department have in the solution differentiated by pH, shot a little shock wave and observed the differences of urinary stone destruction. The results of study are as follows. l. The results of stone destruction according to the volume of stone showed the significant differences. 2. Destruction results according to the location of renal stone or ureteral stone did not show the differences. 3. In the destruction of ureteral stone, there are no differences according to the existence of ureteral catheter. 4. It showed a tendency to resist disintegrating in the case of accompanying severe hydronephrosis with stone, however, the destruction results according to the degree of hydronephrosis did not show the differences. 5. The destruction effect in the differentiated pH solution, there is an effect in the uric acid stone and in the struvite stone a little effect but there is no effect in the calcium oxalate and calcium phosphate stone. As the result above, in the view of destruction itself of stone, we can say that the stone destruction is the most influenced by the volume of stone and we cannot expect to be succeeded by one time ESWL in case of the greater than 1,016.691mm3 in stone volume, therefore, it is necessary for us to operate the volume-reductive procedure such as percutaneous nephrolithotripsy, to plan the retreatment of ESWL prior to the first operation. Neither the location of stone nor the ureteral catheterization have particular effects the stone destruction. Effect of hydronephrosis is necessary to make more study. Even though we use the irrigating solution in order to increase the treatment effect of stone, regulating pH, There seems no much help to the treatment except uric acid stone.