1987 Volume 78 Issue 12 Pages 2079-2086
Three hundred fifty patients with renal and or ureteral stones underwent extracorporeal shock wave lithotripsy (ESWL) mono-therapy during the ten months from Mar. 1986 to Jan. 1987. These cases were composed of 192 of renal, 139 of ureter and 19 of both site stones. 60per cent of these calculi were 1-2cm in diameter and 25per cent were above 2cm. Treatment required 42 minutes on average excluding the time of auxilliary procedures. Fluoroscopic exposure per patient was 138 seconds. The average number of shock waves delivered per patient was 1552. The incidence of stone street and of complications such as flank pain, obstruction, colic and fever became higher as the stone size increased. The ureteral stent was effective to reduce the complications after ESWL. The average hospital stay was 6.2 days in all patients. 235 patients had been followed for 3 months after treatment. The stone free rate was 65 per cent at 3 months after treatment. The stone free rate of patients with stones less than 2cm was 71per cent in the kidney and 83 per cent in the ureter, respectively. However, the stone free rate of patients with stones larger than 2cm was 40 per cent. Stones were not destructed in 16 cases (4.6%). Of these, 15 were ureter stones impacted for long periods of time. 7 cases with stones in a solitary kidney were treated successfully. The complication by ureteral manipulation was seen in 4 cases including 3 of ureteral perforation and one of extravasation due to rupture of occluding balloon. Renal function impairment was found in 6 cases, 5 of which were caused by urinary stasis due to stone street and infection.
The following conclusions were obtained based on our experiences. First, ESWL mono-therapy is a first choice treatment for small stones in the upper urinary tract. This treatment is safe, non-invasive and required short hospital stay. Second, ureteral stones can be destructed by ESWL. Dislodgement of ureteral stones should be tried since shock waves required reduced in number when the stones were pushed up to the renal pelvis. Third, most serious complication was the stone street formation after ESWL which may result in loss of renal function. The stone street became long as the stone size increased. Fourth, ureteral stenting seems to be an effective auxilliary procedure to reduce the complications following ESWL especially with stones larger than 2cm. Fifth, ESWL mono-therapy without stenting is not indicative to the staghorn calculi. Instead, divided stone destruction by ESWL with ureteral stenting or combined therapy with percutaneous nephrolithotomy and ESWL is recommended for these large stones.
