Study on the Effectiveness of Extracorporeal Shock Wave Lithotripsy for the Lower Ureteral Stones and Large Volume Renal Stones

Joo, Kwan Joong; Kim, Dong Sun; Cho, Jae Heung

Abstract

Since the advent of extracorporeal shock wave lithotripsy(ESWL) provided an opportunity for a non-invasive method of treating urinary stones, it has been widely accepted that the ESWL is highly effective modality as the first line treatment method for the most urinary stones. However, there are still some controversies in establishing therapeutic strategy for the cases of large volume renal stones and lower ureteral stones. To evaluate the effectiveness of ESWL for these stones, comparative study about ESWL was performed with percutaneous nephrolithotomy(PNL) for the large volume renal stones and with ureteroscopic stone removal(URS) for the lower ureteral stones. For renal stone larger than 2.5 cm in long axis and lower ureteral stone, a total of 538 patients (542 organs) underwent treatment with ESWU using EDAP LT-01 machine) as outpatientbasis, PNL and URS under general anesthesia with admission from February in 1988to July in 1995. The patients were 318 in male and 220 in female. The average age of patient was 44.4 years, with the range of 10 to 81 years. The selection of treatment modality were decided largely by patients with their preference among the given options and with their economic status. They were analysed with respect to stone free rate, auxiliary procedure, complication, treatment duration and cost. The results were as follows ; 1. For renal stone larger than 2.5 cm in long axis, ESWL was undergone in 77 cases. The stone free rate was 63.6%(47.4% for the staghorn stones, 69.0% for the large renal stones excluding staghorn calculi). Mean time lost from work was 15.9+/-9.7 days(19.4+/-10.8 days for the staghorn stones, 14.8+/-9.1 days for the large renal stones excluding staghorn calculi). Mean treatment expense was 1,065,320 won. Complications that need additional treatment were occurred in 20.8%(21.2% for the staghorn stones, 20.7% for the large renal stones excluding staghorn calculi). PNL was performed in 42 cases. The stone free rate was 78.6%(55.6% for the staghorn stones, 84.8% for the large renal stones excluding staghorn calculi). Mean time lost from work was 19.8+/-3.7 days(20.4+/-4.7 days for the staghorn stones, 17.1+/-3.2 days for the large renal stones excluding staghorn calculi). Mean treatment expense was 911,390 won. Complications that need additional treatment were occurred in 28.6%(33.3% for the staghorn stones, 27.3% for the large renal stones excluding staghorn calculi) (Table 1). 2. For lower ureteral stone, ESWL was undergone in 214 cases. The stone free rate was 97.2%. Mean time lost from work was 3.2+/-2.1 days. Mean treatment expense was 645,680 won. Complications that need additional treatment were occurred in 4.7%. URS was performed in 209 cases. The stone free rate was 96.7%. Mean time lost from work was 10.8+/-3.2 days. Mean treatment expense was 701,850 won. Complications that need additional treatment were occurred in 7.2% (Table 2). For large volume renal stones excluding staghorn calculi, ESWL monotherapy resulted 15.8% less stone free rate than PNL monotherapy. For lower ureteral stone, ESWL was as effective as URS with respect to stone free rate and treatment expense. Moreover, time lost from work of ESWL cases was shorter than that of URS cases. Conclusively, it could be suggested that ESWL monotherapy is effective and preferentially applicable method for the lower ureteral stones and large volume renal stones excluding staghorn calculi. Whereas, it is not effective for the staghorn calculi.