No abstract

The slow SWL rate is associated with a significantly higher success rate at a lower number of total shock waves compared to the fast SWL rate.

Either transurethral ureteroscopy (URS) or extracorporeal shock wave lithotripsy (ESWL) was the primary method of intervention in two series of patients presenting consecutively with stones located in the ureter distal to the radiological marking of the sacroiliac joint. Of 65 patients treated by URS, successful evacuation of the major part of the stone was achieved in 97% in one or two sessions. Of those subsequently attending for review, 93% proved stone-free but 3% required surgery for serious complications. In the ESWL series of 53 patients, successful stone fragmentation was recorded in 94%, with 2 patients requiring a supplementary endourological or surgical procedure. No significant complications were related to ESWL and 90% of those followed up after successful ESWL proved stone-free at 6 weeks. In uncomplicated cases, the mean procedure time for ESWL was one-third of that required for URS and the hospital stay one-half. It is suggested that ESWL should be the primary method of intervention in patients with distal ureteric stone, with URS reserved for the small number that prove refractory to such treatment.

Large bladder calculi are often outside the range of treatment with conventional endoscopic lithotrites because of either anatomic factors or the mechanical limits of available instruments. Alternative methods of cystolithotripsy: ultrasonic, electrohydraulic, or laser, can prove time-consuming or even hazardous, so that open surgery is often the most expeditious option. We report our experience using Dornier HM3 extracorporeal shockwave lithotripsy (SWL) for initial bladder stone reduction preparatory to transurethral litholapaxy and definitive treatment of any underlying obstructive pathology. Primary cystolitholapaxy was judged impractical in these 24 patients (21 adults and 3 children) presenting 31 large bladder stones (mean size 35.6 mm). In all patients, primary transpelvic SWL was followed immediately by endoscopic evacuation of stone debris or cystolitholapaxy. In addition, 10 of the 24 patients (42%) underwent a definitive endoscopic operation for treatment of an underlying obstructive lesion at either the same or a follow-on session. Morbidity was minimal, and the mean hospital stay after the initial SWL treatment was 3.5 days. In our experience, Dornier SWL has proved invaluable in enabling cystolitholapaxy of very large bladder calculi that would otherwise require protracted and difficult endoscopic manipulation or open surgery.