Piezoelectric Extracorporeal Lithotripsy by Ultrashort Waves with the Edap LT 01 Device

Abstract

A total of 433 extracorporeal lithotripsy procedures was performed for renal, ureteral and bladder stones by means of a system of ultrasonographic detection and piezoelectric destruction in 386 patients. The stones were detected easily in 87 per cent of the patients, difficult to detect in 10 per cent and impossible to detect in 3 per cent. Mean duration of treatment was 35 minutes. Mean number of piezoelectric waves was 2,700 at 1.25 per second. With a frequency of 1.25 to 5 per second, extracorporeal lithotripsy was performed without any local, regional or general anesthesia, and without premedication in 210 patients. Of the 217 patients with a renal stone reviewed at 3 months 161 (74 per cent) had successful results and 56 (26 per cent) failed therapy. Thirty patients (14 per cent) underwent 2 or 3 sessions. The morbidity was low: 2 per cent of the patients suffered ureteral obstruction, 1.5 per cent had subcapsular hematoma and 4 per cent had fever. No significant modifications of laboratory tests were necessary and no patient suffered renal failure. Of the stones 31 in the lumbar ureter, 15 in the pelvic ureter and 8 in the bladder were treated, with success rates of 87, 46 and 50 per cent, respectively. A total of 103 patients was treated on an outpatient basis. This outpatient treatment, together with the low cost and minimal maintenance of the apparatus, and the absence of anesthesia constitute a new progress in the treatment of renal stones.

Extracorporeal Shock Wave Lithotripsy for Lower Caliceal Calculi

“…The second-generation lithotriptors offer significant advances in technology and delivery of shock waves, providing a lower energy density at the entry point combined with improved focusing capacity which afford easier patient handling eliminating treatment in a water bath. As a result, ESWL could be done without anesthesia and complication rates are lower with the second-generation lithotriptors [12, 13]. The Siemens Lithostar Plus, one of the second-generation lithotriptors, is used in our clinic offering the advantages mentioned above.…”

Extracorporeal Shock Wave Lithotripsy for Vesical Lithiasis

“…Open surgery is the oldest method of removing bladder, stones and is still the most appropriate modality for large bladder calculi. Recently, multiple endoscopic procedures are used for the treatment of patients with bladder calculi, including mechanical cystolithotripsy, electrohydraulic lithotripsy [5,6], microexplosion cystolithotripsy [7], and piezoelectric lithotripsy [8]. These modalities are limited in the treatment of large or hard calculi and most require anesthesia.…”

Multimodal Therapy for Stones in Pelvic Kidneys

“…Not only the fragmenting effect of shock waves is greatly diminished by the bony pelvis but visualization of the stone in both the focusing points of the Dornier HM3 lithotripter is impossible. Treatment with the pa tient in the prone position avoids the bony obstacle and does not necessitate any modification of the lithotripter apparatus; the only technical requirement is the posi tioning of a ureteral targeting catheter as fluoroscopic guidance is used [8,9], The sacroiliac region has always been considered a blind space for lithotripters using ultrasonography for stone focusing and calculi in the mid-ureter have never been considered as eligible for EPL [13,19]. However, in case of stones in pelvic kid neys, we could easily detect the calculi under ultrasono graphic guidance by using a simple modified prone posi tion.…”