In a prospective randomized study, the effects of the calcium entry blocker verapamil on shock wave induced tubular impairment were examined. A total of 24 patients with renal pelvis or caliceal stones undergoing anesthesia-free extracorporeal shock wave lithotripsy (ESWL*) without auxiliary measures was randomly assigned to the verapamil group (12) or the control group (12). Four doses of verapamil (80 mg. each) were given orally starting the night before ESWL. Controls received no medication. To assess renal tubular function the urinary excretion of alpha 1-microglobulin, N-acetyl-beta-glucosaminidase and Tamm-Horsfall protein were determined before, immediately, and 12 and 24 hours after ESWL. After ESWL there was an increase in urinary alpha 1-microglobulin and N-acetyl-beta-glucosaminidase, which was significantly higher in the control than in the verapamil group. Tamm-Horsfall protein, a glycoprotein synthesized by the distal tubules, decreased significantly less in the verapamil group compared to the controls. Our results indicate that verapamil exhibits a protective effect on shock wave induced tubular damage. The underlying mechanisms are not elucidated yet, and direct actions on tubular cells and interference with renal hemodynamics are to be discussed.

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In a retrospective study, the data of 102 patients were evaluated for effectiveness of treatment of upper ureteral calculi by extracorporeal shock wave lithotripsy (SWL) alone (in situ) or after repositioning of (push and smash) (53 cases). Whereas no significant differences were seen concerning the duration of stone impaction and obstruction, significant differences were found concerning the number of treatments per patient (1.5 1.2) and the number of shock waves (1500 1240) necessary to destroy the stones. The calculi treated in situ necessitated a considerably higher number of auxiliary measures (ureteral catheterization, double-J stent insertion). The stone-free rates after 6 months were comparable in the two groups. Ureteral catheter mobilization of obstructive upper ureteral calculi prior to SWL provides for short and uneventful passage of fragments.