Extracorporeal shock wave lithotripsy in children: Results and short‐term complications
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The introduction of extracorporeal shock wave lithotripsy represented an important evolution in urinary tract lithiasis management. The aim of this study is to describe the results of extracorporeal shock wave lithotripsy for the treatment of urinary tract lithiasis in children, focusing on the index of elimination of the calculi and the complications occurring during the procedure and during the following three months.From September 1991 to July 2002, 135 children between one and 12 years, suffering from urinary tract lithiasis underwent extracorporeal shock wave lithotripsy. A retrospective analysis of these patients was carried out.One hundred and ninety-five calculi ranging in size from 5.0 mm to 20.0 mm were treated, out of which 147 were found in the kidneys and 48 in the ureter. Urinary tract dilation was presented by 30% of the children at the time of the procedure. After extracorporeal shock wave lithotripsy 75.8% of the calculi were eliminated: 64.1% were stone-free and 11.7% had < or = 4 mm stones. Ureteral calculi and 5-10 mm stones responded better than the kidney and 11-20 mm stones (P = 0.027 and P = 0.012, respectively). No differences were detected according to the calculi location, whether in the ureter or kidney (P = 0.637 and P = 0.703, respectively). The shock wave intensity of 14kv was as efficient as the higher voltage. Short-term complications were observed in 23.7%, characterized by fever and pain.In children, extracorporeal shock wave lithotripsy proved to be able to eliminate 75.8% of the treated calculi and 83.7% of the patients presented a complete or partial response. Complications were observed in 23.7% of patients, and pain was the most frequent symptom.Keywords:
Extracorporeal
Extracorporeal shock wave lithotripsy of pancreatic stones was performed in eight patients with chronic pancreatitis and a dilated duct system harbouring stones 5 to 20 mm (means 10 (SD) 5 mm) in diameter. After endoscopic sphincterotomy of the pancreatic orifice the stones were disintegrated by shock waves under fluoroscopic control using a kidney lithotripter (Dornier HM3). The procedure was well tolerated by all but one patient, who had a mild pancreatitic attack immediately after lithotripsy. Clearance of the pancreatic duct systems from the larger stones was achieved in seven of eight patients. Half of the patients showed no improvement in the intensity and frequency of pain. The other patients had a marked amelioration of symptoms, however, both immediately and during a mean follow up interval of 11 (eight) months. A selective combined approach by endoscopy and extracorporeal shock wave lithotripsy for the treatment of pancreatic stones seems promising.
Extracorporeal
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Since the May 1988, when the extracorporeal shock wave lithotripsy was initiated in Hungary, the indication has gradually enlarged. Elaborated methods for making better the radiological perceptibility, focusing and targeting of stones, and auxiliary endoscopic procedures have led to spread of indication. 80-85% of kidney- and ureteral stones needed intervention can be treated successfully by ESWL method.
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A second-generation lithotriptor was used to perform dry extracorporeal shock wave lithotripsy in a dog with ureterolithiasis, nephrolithiasis, and chronic renal failure. Previous studies on the use of lithotripsy in dogs have involved first-generation machines and have primarily concentrated on acute and chronic effects of lithotripsy in experimental models. Treatment in this dog resulted in resolution of ureteral obstruction, ureterolithiasis, and nephrolithiasis, and avoided complications associated with ureteral and renal surgery. The only complication was substantial hematuria of 12 hours' duration immediately after the procedure. Second-generation lithotripsy may offer an effective treatment for ureterolithiasis or nephrolithiasis in selected dogs.
Ureteroscopy
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Objective:To investigate the effects of holmium laser combined with extracorporeal shock wave lithotripsy(ESWL) by percutaneous nephroscope in treatment of complex renal calculi. Methods:Holmium laser combined with ESWL by percutaneous nephroscope were used to treat 46 cases with complex renal calculi. Results:The mean time of operation and hospital stays were 56 minutes(15-221 min) and 15.7 days(10-21 d),and stones clearance was 97.8%.The severe complications of septic shock and surrounding organs injury were not found. Conclusions:The technology of treatment of complex renal calculi with holmium laser combined with ESWL lithotripsy by percutaneous nephroscope is effective and safe way.It is high clearance rate and less complications,and worthy of clinic application.
Shock wave lithotripsy
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Using extracorporeal shock wave lithotripsy (ESWL) pancreatic stones may be disintegrated. Acute adverse effects directly attributably to shock wave lithotripsy are rare. More than half of the patients will exhibit complete clearance of the pancreatic duct system after ESWL, endoscopic sphincterotomy and extraction of fragments. Most of the patients in whom the ducts could be cleared from the stones also showed improvement of chronic pancreatic pain. These findings, however, have to be substantiated by larger clinical studies with longer follow-up periods.
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Abstract Extracorporeal shock wave lithotripsy (ESWL) is a new treatment modality for retained common bile duct stones. Sixty-two patients (mean age 75 years, range 27·95 years) with retained common bile duct stones were treated with two different lithotriptors. One of the lithotriptors operated on the electrohydraulic principle (Dornier HM-3) (n = 13), the other on the electromagnetic principle (Siemens Lithostar®) (n = 49). All HM-3 patients were treated under general anaesthesia, whereas with the Lithostar one patient was treated under general anaesthesia, 43 received analgesia and sedation and five had no analgesia at all. Patients treated with the Lithostar had more sessions (mean 1·9 versus 1·3, P<0·05) and needed more shock waves (mean 8611 versus 2534, P<0·001) than patients treated with the HM-3. Fragmentation was achieved in all patients treated wih the HM-3 and in 42 (86 per cent) patients treated with the Lithostar. In this latter group ten patients underwent common bile duct exploration without complications. Eleven patients had transient haematuria after treatment with the HM-3 and two patients (one in each group) had a subcapsular haematoma of the right kidney, all without clinical sequelae. At follow-up (median: HM-3 43 months, Lithostar 18 months), none of the patients had biliary complaints. We conclude that ESWL of retained common bile duct stones is safe and effective with both lithotriptors and should be considered before surgery in the elderly or high-risk patient.
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We reviewed the records of the 530 patients with urinary stones (renal stones: 243; ureter stones 287) who received extracorporeal shock wave lithotripsy (ESWL) (MFL5000; Dornier), from January 1995 to July 2002, retrospectively and determined whether the ureteral stent affected the incidence rate of stone street (SS). We also assessed the effect of ureteral stent on the subsequent management for SS. Forty patients (7.5%) developed SS. Twenty patients were inserted a ureteral stent prior to ESWL (stent group), and 20 patients were performed ESWL without a ureteral stent (in situ group). In the stent group, the most common (80.0%) location for SS was in the upper third ureter, while in the in situ group, SS mostly developed in the distal third ureter (60.0%). The incidence of SS did not differ significantly between the two groups when the size of renal and ureter stones was below 30 and 20 mm, respectively. When the renal stones were larger than above 30 mm, the incidence of SS in the stent group was significantly higher than that in the in situ group. SS disappeared spontaneously with stone passage in 10 of the patients in in situ group, but in only 1 patient in the stent group. In the stent group, 15 patients were treated for SS by removal of ureteral stent regardless of stone diameter. We conclude that ESWL should be performed without a ureteral stent when the stone diameter is below 20 mm. When the ureteral stent is thought to interfere with the delivery of stone fragments, the decision to remove it should be made as soon as possible.
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Objective To investigate the clinical efficacy of YAG laser lithotripsy and extracorporeal shock wave lithotripsy for ureteral stones. Methods 300 patients with ureteral stones admitted to our hospital were selected and randomly divided into control group and observation group with 150 in each group. Extracorporeal Shock Wave Lithotripsy was used in the control group, while YAG laser lithotripsy was performed in the observation group. The clinical effect and incidence of complications of the two groups were observed. Results The operation time of the observation group was obviously shorter than that of the control group; Clearance rate of the stones(diameter1 cm) of the observation group was higher than that of the control group, and the difference was statistically significant(P0.05); The difference of clearance rate of the stones(diameter ﹤ 1 cm) between the two groups was not obvious and statistically significant(P ﹥ 0.05); The difference of clearance rate of upper ureteral stones between the two groups was not obvious and statistically significant(P﹥0.05); The difference of clearance rate of middle-lower ureteral stones between the two groups was obvious and statistically significant(P0.05).The difference between the incidence of complications of the two groups was not obvious and statistically significant(P﹥0.05).Conclusion For patients with ureteral stones, two therapeutic schemes have their advantages and disadvantages, should be a reasonable choice according to the condition of. If the stone is located in the upper and the diameter below 1cm, can take the extracorporeal shock wave lithotripsy; if the stones located in the lower section and more than 1cm in diameter, recommended ureteroscopic holmium laser lithotripsy.
Laser lithotripsy
Shock wave lithotripsy
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