Extracorporeal shockwave lithotripsy monotherapy for treating patients with bladder stones

Abstract

ObjectivesTo describe our experience with extracorporeal shockwave lithotripsy (ESWL) for the treatment of bladder stones of <20 mm.Patients and methodsThis study was prospectively performed in two hospitals (Althawrah Modern General Hospital, and Ibn Sina Specialized Hospital) between November 2012 and November 2015. In all, 44 patients presented with urethral or bladder stones. The location and size of the stones was assessed by abdominal ultrasonography and plain abdominal radiography of the kidneys, ureters and bladder. All patients with radiopaque stones of <20 mm underwent ESWL monotherapy after fixation of a Foley catheter in a supine position under intravenous analgesia.ResultsThe mean size of the stones was 15.8 mm and spontaneous evacuation occurred after removal of the Foley catheter without the need for adjuvant procedures in 40 patients (90.9%). Four patients (9%) developed acute urinary retention due to urethral impaction of large stone fragments. In two of them, the urethral catheter was successfully re-inserted pushing the fragments back to the bladder and a complementary session of ESWL resulted in more fragmentation of the stones, with spontaneous passage after catheter removal. In the other two patients (4.5%), the catheter could not be re-inserted and urgent endoscopic intervention was required.ConclusionsESWL monotherapy is safe and effective method for treatment of bladder stones with no other causes of infra-vesical obstruction. Several indications can be met including patients with high anaesthetic risk, patients fearing anaesthesia or endoscopic procedures, and patients who have difficulty in positioning.

Management of bladder stones: the move towards non-invasive treatment

“…The stonefree rate observed in this study is comparable to the results gathered by El-Halwagy et al 8 and Telha et al 21 with stone-free rate of 96.6% and 95.5%. 8,21 One case series of twenty patients with bladder stone with concurrent paraplegia have demonstrated 100% stone-free rate after ESWL session. 22 The stone free rate of ESWL compared favorably to patients who underwent either intracorporeal lithotripsy or sectio alta (stonefree-rate of 97% and 100% respectively).…”

“…uric acid stones) have been well described. 19 Kostakopoulos et al, 11 Al-ansari et al, 20 and Telha et al 21 have also mentioned ESWL's role as a monotherapy in bladder stones fragmentation. The use of ESWL as a monotherapy in bladder stones, however, still has some controversial issues to address.…”

“…10 Some authors prefered supine position because they assumed that in prone position, the sacrum might hinder stone fragmentation to some extent. 21 In this study, 49 out of 92 patients underwent ESWL with stone-free rate of 93.9%. The stonefree rate observed in this study is comparable to the results gathered by El-Halwagy et al 8 and Telha et al 21 with stone-free rate of 96.6% and 95.5%.…”

“…21 In this study, 49 out of 92 patients underwent ESWL with stone-free rate of 93.9%. The stonefree rate observed in this study is comparable to the results gathered by El-Halwagy et al 8 and Telha et al 21 with stone-free rate of 96.6% and 95.5%. 8,21 One case series of twenty patients with bladder stone with concurrent paraplegia have demonstrated 100% stone-free rate after ESWL session.…”

The use of pneumatic impact lithotripsy and a retrieval pouch to create a closed system for removal of cystic calculi in standing male horses

“…The ability to break up kidney stones, and less commonly urinary bladder stones, with this technique avoids the need for invasive surgery in human patients (Telha et al . ). However, extracorporeal shockwave instrumentation in human subjects uses a generator that encircles the abdomen, so unfortunately, the size of the horse precludes the use of true extracorporeal shockwave lithotripsy in the equine cases.…”