Clinical Results of Piezoelectric Shock Wave Lithotripsy for Treatment of Patients with Urolithiasis

Chang, Sung Goo; Chae, Soo Eung

Abstract

Extracorporeal shock wave lithotripsy(ESWL) is becoming treatment of choice for most upper tract calculi, and especially EDAP made piezoelectric E. S. W. L. can treat kidney, upper ureter and lower ureter stones. We present the results of 245 consecutive treatments performed between May, 1987 and February, 1988 with piezoeletric shock wave lithotriptor. 1. The oldest patient was age of 78 and the youngest patient was age of 15 and there was no contraindication due to other systemic disease. 2. No anesthesia were required and only narcotics were given for pain that induced from shock wave, but one, 18 years old female with renal stone was treated with ketamine. 3. Response rate revealed that complete response was 174 cases (71%), partial response was 63 cases (25.7%) and non-response was 8 cases (3.3%). 4. In complete response cases, average requirement of shock wave storages were noted that renal stone was 323, upper ureter stone was 562 and lower ureter stone was 377 and then the shock wave storage was increase depend upon the location of the stone, such as kidney, lower ureter stone and upper ureter stone in priority. 5. Staghorn calculi, multiple renal stones, caliceal diverticular stones, renal stones with migration into the ureter while treatment, impact ureter stones, ureter stones with larger than 2.5 cm and obesity were poor response factors. 6. We adopted push up (9 cases), double J stent (6 cases), stone basket (6 cases), URS.(2 cases) and nephrostomy (1 cases) as auxiliary procedure. 7. Chemical composition of treated stones were that calcium oxalate and phosphate mixed stone8 were 50.6%, calcium oxalates 33.5%, struvites 10.5%, uric acid 3.9% and calcium phosphate 1.3%. 8. We experienced 11 cases (4.4%) of complications: 5 cases of stone street, 3 cases of post ESWL flank pain, 1 case of high fever, 1 case of sepsis and 1 case of perirencal hematoma. 9. As a result, we suggest that we should consider stone size, location, situation of patient and history of stone surgery for good effectiveness from treatment with E.S.W.L.