Evaluation of emergency extracorporeal shock wave lithotripsy for obstructing ureteral stones

Abstract

�BSTR�CTPurpose: To assess the efficacy of extracorporeal shockwave lithotripsy (ESWL) for ureteral calculi during acute renal colic. Materials and Methods: From January 2002 to March 2007, 108 patients were treated by ESWL for obstructing ureteral stones causing acute renal colic. ESWL was performed within 24 hours of the onset of renal colic. Results: The mean age of the patients was 39.5 years (11-72 years). Male/female ratio was 85/23. Mean stone size was 8.45 mm (4-20 mm). They were located in the pelvic (n = 53), iliac (n = 28) or lumbar (n = 27) region. Fragmentation after a single session was complete in 56 patients (52%), incomplete in 28 (26%), and absent in 24 (22%). Patients presenting incomplete fragmentation underwent a second (n = 28) or even a third session (n = 11). Of the 24 patients in whom ESWL had no impact on the stone, 21 underwent ureteroscopy, and in one case open ureterolithotomy for a patient with a hard 17 mm stone, while spontaneous passage occurred in two patients with small stones. Conclusion: Emergency ESWL for obstructing ureteral stones has a satisfactory success rate and very low morbidity. The stone-free rate of retreating ureteral calculi with ESWL decreases significantly after failed initial treatment. Stone size may be the main predictive factor for retreatment. We suggest that no more than 3 treatments should be given for a particular stone due to minimal improvement in the subsequent cumulative treatment success rate.

Mid ureteric stone clearance by Extracorporeal Shock Wave Lithotripsy (ESWL): a clinical study

“…28 in their study of 115 males and 17 females showed the mean age of 47±15 and 53±11 years respectively. Ghalayini et al 29 in their study found the mean age of the patients was 39.5 years (11-72 years). Male to female ratio was 3.7:1.…”

Urinary level of interleukin-1alpha and interleukin-6 in patients underwent extracorporeal shock wave lithotripsy

“…Also, Dundar et al revealed a significant increase in the level of IL-1ɑ in the early phase (24 hours after ESWL) and IL-6 over a 14-day course in patients underwent ESWL (22). There was previously a question whether the levels of IL-6 and IL-1ɑ in stone formers could be utilized as a predictive factor of stone formation; but there were no supportive evidences (23). The difference in the results of various studies may be due to the difference in race, type of equipment used, and skill level of surgeon.…”

“…All of them were included in our study (17,18). The exclusion criteria was essential hypertension, active bleeding disorders, serum creatinine above 3 mg/dL, urinary obstruction distal to the stone, urinary tract abnormalities (horseshoe kidney, displaced kidney, and extra-kidney), the history of colicky or renal lodge pain or taking analgesics or any other antiinflammatory or immunosuppressant in previous week and existence of any infection (21)(22)(23)(24)(25).…”

“…Distal ureter and bladder are placed in the latter positions. Among stones of different types, uric acid and struvite are the most sensitive stones against ESWL (7)(8)(9). Although it is considered as a noninvasive method, ESWL as well as any other treatment has its own complications which causes acute and rarely chronic damages including renal damage, renal colic pain for more than 24 hours, transient hydronephrosis and dermal ecchymosis.…”

The effect of extracorporeal shock wave lithotripsy on distribution of interstitialcells of Cajal in rabbit renal pelvis and proximal ureter

“…Some cases require more than 1 session of ESWL (up to 3 sessions) for a better stone-free rate (1,2,8,9). Each session consists of 1800 to 2000 shock waves (and up to 4000) between 14 and 21 kV (2,3).…”