Änderung des Indikationsbereiches zur Stoßwellentherapie beim Nierensteinleiden

Financial Analysis, Personnel Planning and Organizational Requirements for the Installation of a Kidney Lithotripter in a Urologie Department

“…These methods must be rou tinely established at a clinic using a kidney lithotripter, including the facility for every kind of surgery to remove calculi from the urinary tract. Table IV shows the cost savings due to reduction of dialysis cases, 5 % of which are estimated to be caused by kidney stone disease [8,14,17,19,20,22], It is to be noted that the factor 0.9 in the formula considers the success rate of the method [7,9,14], For patients, who cannot be treated successfully, no cost sav ings can be calculated [19].…”

“…Since 1980 more than 1,000 patients have been treated successfully (Munich group 950, Stuttgart 130). On reex amination, 3-6 months after treatment (Munich group), 90% of the patients were found stone-free, in 9.3% of the cases spontaneously passable fragments remained in the kidney and in 0.7% of cases an operation was necessary because of ureteral obstruction [7,8,15,16], In our department an ESWL unit was inaugurated in October 1983 and in the mean time more than 130 treat ments have been performed with success. Because of the so far short follow-up time, comparable results cannot be obtained yet, but the results of X-ray controls imme diately after treatment are encouraging: in 78% of the cases the stone was disintegrated into particles smaller than 2 mm; in 8% of the cases the fragments were 2-4 mm in size; in 6% of the patients we found residual…”

“…Clinical experience permitted stones larger than 1.0 cm and even partial staghorns to be treated. Ureteral stones, which have a short history, could also be added and a considerable number of patients with multiple stones as well as with infected stones have undergone treatment successfully [9,13,15,16], Also medically unfit persons could be treated without any complications from the procedure [9,16], New estimates indicate that with these indications approximately 60% of the operations for renal stones and 30% for ureteral stones can be substituted by ESWL [9].At the onset in 1980, 30 and 5%, respectively, were supposed to be eligible for contact-free stone destruction [7,12], Extracorporeal shockwave lithotripsy (ESWL), the noninvasive method of treatment of renal calculi [5,6,10,11,14], is now more than 3 years in clinical application. Since 1980 more than 1,000 patients have been treated successfully (Munich group 950, Stuttgart 130).…”

Extracorporeal Shock-Wave Lithotripsy: One-Year Experience with the Dornier Lithotripter

“…When first used clinically, the indications were limited to pelvic stones of less than 1 cm and single calyceal stones [3], Success with these and lack of complications allowed the range of indi cations to be extended to include patients with pelvic stones larger than 1 cm, patients with multiple stones and with stones in the upper ureter [3], Clinical experience has also shown that patients whose medical condition results in an increased risk from open operation greatly benefit from this noninvasive procedure as the opera tional stress is far less than for open operative procedures. When patients with infected stones receive ESWL treat ment under antibiotic cover no adverse side effects are noticed [3]. In infected stones, that is in magnesium ammonium phosphate stones, which have to be taken separately from stones with concomitant urinary infec tion, the rationale is to completely remove all fragments to prevent the hazards of urosepsis secondary to ureteral blockage by stone particles.…”

Treatment of Large Renal Calculi with Extracorporeal Shock Wave Lithotripsy Monotherapy

“…While the original limit for solitary renal stones treated with Domier HM3 litho tripter was 'less than the size of a cherry' [1], further experiences have progressively widened the indications to this technique. Staghorn stones were not initially treated since the vast amount of debris produced was thought to cause obstructive complications; further more, positive urine cultures represented another initial contraindication to ESWL, which was overcome by si multaneous antibiotic treatment [2], Increasing experi ence has demonstrated that the normal ureter usually can negotiate even large amounts of fine stone debris. The number of shock waves delivered during a single treatment has increased in many centers without a rele vant increase of the observed complications.…”