Extracorporeal Lithotripsy of Ureteric Calculi Using the Dornier HM‐3 Lithotriptor

Abstract

Over a 5-year period (November 1984-November 1989), we treated 356 patients with ureteric calculi; 170 were treated by extracorporeal shock wave lithotripsy (ESWL) on a Dornier HM-3 lithotriptor. The calculi (n = 176) were uniformly distributed along the length of the ureter: 44 were just below the pelviureteric junction, 59 were lumbo-iliac, 42 were in the upper bony pelvis and 32 in the lower bony pelvis. The mean diameter of the upper ureteric calculi was 10 mm and for the others it was 8 mm. Thirty-four patients with acute obstructive pyelonephritis required pre-ESWL drainage of the urine. X-ray localisation required intravenous urography during lithotripsy in 52 cases (30%). On plain X-ray the following day 170 stones (96%) were judged to have disintegrated. The 6 patients whose stones were not fragmented received further treatment (ureterotomy (4) and ureteroscopy (2)). Five patients required additional treatment because of pain or fever (catheterisation (3) and ureterotomy (2)) and 2 patients had a second lithotripsy owing to insufficient fragmentation. Four patients were lost to follow-up. In 153 patients (90%) the fragments were eliminated completely, 146 in the first month and the remainder before the sixth month. No serious sequelae were observed. In addition to the 5 patients who required supplementary treatment. 11 patients with pain or fever needed medical treatment. We recommend first intention in situ ESWL for all ureteric calculi.

Ureteroscopic Treatment of Ureteral Stones: Only an Auxiliary Measure of Extracorporeal Shockwave Lithotripsy or a Primary Therapeutic Option?

“…Extracorporeal shockwave lithotripsy (ESWL) using a Dornier HM -3 lithotriptor has been reported to be a safe and effective treatment option for distal ureteral calculi [1][2][3][4][5][6]. At the same time the success rate o f ureteroscopic treatment of stones in the distal part o f the ureter has been shown to be The results represent the number o f patients.…”

“…This concept has been our strategy in the treatment o f patients with ureteral stones over the last 10 years. Recent studies recommend trying in situ ESW L as the initial procedure in patients with ureteral stones irre spective o f their location [1,10], Based on a study o f more than 2,000 patients, Marberger et al [11] propose ESW L for all stones in the proximal and for large stones in the distal ureter but recommend primary ureteroscopy for stones in the middle part of the ureter. In contrast, other authors [ 12] suggest that primary ESW L in the prone posi tion should be considered for patients with calculi in the middle third o f the ureter prior to applying invasive pro cedures.…”

Laparoscopic versus Open Ureterolithotomy

“…Data from the available literature clearly demonstrate the high success rate of SWL and ureteroscopy or in combination of both alternatives [4, 5]. However, additional data show that there is a considerable number of patients (36%) that may require multiple sessions of SWL or ancillary procedures (46%) to be performed in order to render these patients stone free [6].…”