In-situ Extracorporeal Shock Wave Lithotripsy (ESWL) Using an Ultrasonographic Localization System for Mid-Ureteral Stones

Jung, Il Hyung; Yang, Dae Yul; Kim, Hayoung

Abstract

PURPOSE: In situ ESWL is the most attractive treatment for mid-ureteral stones as it is non-invasive and effective. X-ray fluoroscopy is usually used to localize the mid-ureteral stones for in-situ ESWL, since it is easy to manipulate, although a radiation hazard and high maintenance costs are involved. We report our experience of in-situ ESWL, using an ultrasonographic localization system, for the treatment of mid-ureteral stones.
MATERIALS AND METHODS
Between June 1992 and June 2001, the mid-ureteral stones overlying the pelvic bone were treated with a Siemens Lithostar Ultra lithotriptor using a Sonoline SL-1 (Siemens, Germany) ultrasonographic localization system, with no anesthesia nor pain control. The mid-ureteral stones, located at the upper half of the pelvic bone, were treated in the prone position, with the shock waves delivered through the back wall using the kidney, renal pelvis and ureter, as landmarks for targeting. The mid-ureteral stones, located at the lower half of the pelvic bone, were treated in supine position, with the shock waves delivered through the abdominal wall using a filled bladder as the landmark for targeting. The localization success, stone free, ESWL success rates, and complications, were evaluated.
RESULTS
Of the 96 patients, with mid-ureteral stones, we failed to localize the stone in only 2 patients. Therefore, the success rate for the stone localization was 97.9% (94/96). The stone free rate at 3 months after completion of the in-situ ESWL was 97.9% (92/94). Therefore, in-situ ESWL success rate was 95.8% (92/96). The mean ESWL sessions needed to be free of stones were 1.3+/-0.8 (126 sessions/92 patients). Some patients had hematuria and colicky pain, but serious complications, such as febrile UTI or severe hematuria requiring a transfusion were not encountered.
CONCLUSIONS
In-situ ESWL, using an ultrasonographic localization system, is a non- invasive and effective treatment for mid-ureteral stones.