Stones can recur as long as 10 years after the first episode, although the rate is lower than previously reported. The metabolic evaluation after a first stone episode needs to be reappraised in terms of its cost-effectiveness, since recurrences do not seem to be predictable from standard laboratory tests.
Extracorporeal shockwave lithotripsy without ECG triggering has been found to be fast and efficient and not correlated with the occurrence of dysrhythmic episodes of any particular clinical significance. No significant correlation was found between the occurrence of dysrhythmia, the side treated, the number and strength of the shockwaves, or the administration of analgesics. It was found, however, that dysrhythmia occurred almost exclusively in treatments involving the kidneys. The ECG-triggering option was indispensable in some patients in order to complete the lithotripsy without complications.
A primary abnormality of bone metabolism could be a reasonable explanation of reduced bone density observed in renal stone formers on a low calcium diet since serum parathyroid hormone levels are in the normal range. From a therapeutic point of view these data confirm that restriction of dairy products in renal stone formers should be avoided.
Extracorporeal shock wave lithotripsy is nowadays first choice treatment of ureteral stones. Shock wave generator technology has greatly advanced since the first electrohydraulic lithotriptor was introduced. Third generation lithotriptors combine all these advantages and integrate them into a multi-functional X-ray system. From January 1996 to June 1996, 63 patients (43 male and 20 female) suffering from ureteral calculosis were treated. Stone localisation was in 35 cases (55%) the lumbar ureter, in 3 (5%) the iliac ureter and in 25 (40%) the pelvic ureter. A Storz Modulith SLX lithotriptor with an electromagnetic cylindrical source was used. Easy positioning of the patient and dry coupling make treatment procedures simple. Furthermore, general anesthesia is not required and analgesic sedation (Fentanest and Diazepam) is often unnecessary, especially in ureteral stones.
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