1985 Volume 76 Issue 12 Pages 1770-1783
For the first time in Japan, we have treated renal and upper ureteral stones using ESWL since September 1st 1984. The results have been satisfactory. We present our experience with ESWL.
We have treated 101 cases of renal and upper ureteral stones in 107 treatments. In 90% of these patients epidural anasthesia was used. The ages of the cases ranged from 20 to 74 years old, including 30 cases of women and 71 cases of men. The size of the stones varied from less than 1cm to staghorn calculi. To break up these stones, 400 to 2200 shock waves were necessary. In 80 cases (79%) less than 1500 shock waves were used. The treatments lasted from 7 to 60 minutes with the average time from 11 to 40 minutes (86%).
76% of all cases had spontaneous sandy stone passage without complain. But 24% had such symptoms as fever and/or pain. 5 cases experienced dull pain or fever due to stone fragments that filled the lower ureter after distingrating large stones. Ureteral meatotomy in such cases produced satisfactory results. None of these patients needed open operation.
In 99% of the cases the size of the discharged stone fragments was less than 2mm. Although our observation of the patients was still short we found natural discharge of stone fragments after ESWL treatment in 47 cases. The other cases had only sandy stones that easily discharged. Analysis of the stones showed that 82% were composed of caoxalate. Besides caoxalate 2 cases were composed off urate, 1 case was composed of cystine.
From these present findings, it appears that ESWL can break all stones of any size, composition, and the number of stones. The important thing for the future is how to facilitate the discharge of stone fragments after ESWL treatment.
We are confident that ESWL will soon take the place of surgery in treating urinary tract calculi.
