Der hohe Harnleiterstein - Erfahrungen mit der ESWL bei 621 Patienten

Management of Ureteric Stones

“…Growing experience gradually revealed that Chaussy's failures re sulted from selecting patients with stones deeply embed ded in edematous mucosa which prevented fragment dis persion [10]. Wherever the stone could expand while being disintegrated, fragmentation was successful, and the debris was passed, although more energy and higher impulse rates were needed [11][12][13][14][15][16], The main limitations to treating ureteric stones in situ with the first commer cially available lithotriptor (Domier-HM3, FRG) came from the need to treat the patient immersed in a water bath to reduce energy loss. It proved difficult to focus ure cally by piezoelectric lithotriptors, the energy reaching the ovaries is reduced to a negligible extent.…”

ESWL Management of Ureteral Calculi without Anesthesia: An Alternative to Invasive Procedures

“…For these stones, on the whole, three ways of management have actually been established: ( 1 ) Push and Smash: retrograde manipulation of the stone into the renal pelvic immediately before ESWL; (2) ESWL with stenting of the ureter, and (3) ESWL without any preceding treatment. There are arguments and studies on account of each of these proceedings [ 14,15]. As the calculus is often tightly entrapped with no room for spreading fragments, the advice offered by Müller et al [11] is 'to push or flush back all ureteral stones into the renal collection system'.…”