Combination of Chemolysis and Extracorporeal Shock Wave Lithotripsy in Cystine Urolithiasis

Vandeursen, H.; Baert, Luc

doi:10.1111/j.1464-410x.1991.tb15175.x

Cited by 2 publications

(1 citation statement)

References 6 publications

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“…Wiggins found that this mucoprotein is excreted as a monomer in the ascending loop of Henle but aggrega tion to polymers is influenced by the urinary pH. Al though the exact fragmentation mechanism has not been clarified, a supplementary argument for suspecting the internal cleavage rather than a phenomenon occurring at the stone surface, is the laborious fragmentation when applying shock waves to cystine [9]: these calculi have a dense and smooth surface like COM, but moreover have a homogeneous ultrastructure. Despite all these very inter esting hypotheses which suggest the importance of the pH surrounding the stone, our in vivo experience failed to report an improved degree of comminution.…”

Section: Discussionmentioning

confidence: 99%

Effect of Alkalinization on Calcium Oxalate Monohydrate Calculi during Extracorporeal Shock Wave Lithotripsy: In vivo Experiments

Vandeursen¹,

Ridder²,

Demeulenaere³

et al. 1992

Urol Int

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Previous in vitro experiments demonstrated the reduced microhardness of calcium oxalate monohydrate (COM) calculi, relative to dry values, when saturated with an alkaline solution (pH = 9.5). Nineteen patients with a COM calculus in the distal ureter which had been resistant to prior extracorporeal shock wave lithotripsy in situ, were treated when the stone was surrounded by alkaline urine. The urine of 14 patients was alkalinized orally by administration of acetazolamine and citrate solution; in 5 other patients direct percutaneous irrigation of sodium bicarbonate via a nephrostomy tube was carried out. The urinary pH just before lithotripsy was ≥ 9 in 17/19 patients. 4,000 shock waves, averaging 18.1 kV generated by the Siemens Lithostar, were delivered onto the calculus. No significant increase of comminution rate was apparent at radiographic control immediately after the treatment and only in half of the cases was evacuation obtained within 3 months.

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Section: Discussionmentioning

confidence: 99%