Treatment of Renal Stones by Extracorporeal Shock Wave Lithotripsy

Abstract

Based on an extensive review of the literature and our own clinical experience, this article attempts to present clear guidelines for the management of various kidney stones that will be acceptable to clinical urologists and their patients. Regarding our own patients, we compared different studies and discussed the results concerning the anatomical kidney situation, stone size, stone localization and observation time. Stone-free rates of patients with calyceal diverticula calculi range from 4 to 58%, with an increase after longer follow-up periods. According to the importance of residual fragments following extracorporeal shock wave lithotripsy (ESWL), we have to distinguish between clinical insignificant residual fragments and clinical significant residual fragments. 24 months following ESWL, stone passage occurs as a continuous process, and if there are no clinical symptoms, any endoscopic procedure should be considered as over-treatment. Newer ESWL technology has increased the percentage of clinically insignificant residual fragments. We consider percutaneous nephrolithotripsy in most of the patients with renal calculi smaller than 30 mm in diameter only as second-line therapy.

O que há de novo no diagnóstico e tratamento da litíase urinária?

“…32,33,34 Despite being the interventionist method that is most used to treat renal and urethral calculi all over the world, ESWL has one major drawback, which is that its results are directly dependent on the size of the calculus being treated. Stone-free rates var y from 14, 22,35,36,37 depending on the size of calculus being treated, its position within the urinary tract, factors related to the patients and the criteria used to assess success, which varies greatly from center to center. The best results are achieved with pelvic stones and calculi of the upper and mid poles that are smaller than 2 cm, with success rates varying from 71 to 91%.…”

“…The best results are achieved with pelvic stones and calculi of the upper and mid poles that are smaller than 2 cm, with success rates varying from 71 to 91%. 22,35,37,38 As lithotripsy equipment has developed, machines have become less powerful and their use less painful, making anesthesia unnecessary and making it possible for patients to be treated with deep analgesia, or sedated but conscious. These changes mean that the rate of calculus fragmentation achieved by modern machines is inferior to that of the first generation equipment, which can no longer be purchased.…”

Bilgisayarlı Tomografi İle Üriner Sistem Taşlarının Yapısı Tahmin Edilebilir Mi?

“…'ları in vitro yürüttükleri bir çalışmada BT attenüasyon değerlerini kullanarak taş yapısının %64-81 doğ-ruluk oranıyla belirlenebileceğini göstermişlerdir (20). Ürik asit, sistin, kalsiyum oksalat monohidrat ve brusit taşları in vitro olarak %85'in üzerinde doğruluk oranıyla gösterilebil-miştir (20)(21)(22)(23). Ancak in vivo şartlarda taş yapısını ayırmak daha zor ve daha az güvenilirdir.…”

“…Farklı yapılar-daki taşların attenüasyon değerleri birbirine yakın olduğu için bu teknikle yalnızca dansiteleri çok yüksek olan oksalat kristalleri ile dansiteleri çok düşük olan ürik asit kristalleri tanımlanabilmiştir. Kalsiyum fostat, sistin, magnezyum amonyum fosfat ve karma kalsiyum oksalat ve fosfat taşları birbirlerinden ayırd edilememektedir (18)(19)(20)(21)(22)(23)(24)(25)(26)(27).…”

Urinary stone characteristics of patients treated with extracorporeal shock wave lithotripsy in Cipto Mangunkusumo Hospital Jakarta, 2008–2014: a gender analysis

“…ESWL found to be the most suitable treatment for this size of stone. 21 From the guidelines ESWL is the first treatment chosen for kidney stone with size 10-20 mm. 22 There are many factors which correlate with successful rate of ESWL such as size, composition, consistency of the stone and elimination process after the treatment.…”