CURRENT STATUS OF EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY IN THE TREATMENT OF UROLITHIASIS

Abstract

Extracorporeal shock wave lithotripsy became a main treatment method for the upper urinary tract calculi. About 500 ESWL machines of 28 types are currently used in Japan and ESWL therapy occupies more than 90% of the surgical intervention for upper tract stones. The doctors who are engaging in the ESWL therapy are strongly advised to know the features of their own ESWL machines, since the treatment strategy may differ considerably depending on the type of machines. The strategy has changed from the in-patient ESWL under anesthesia by oroginal Dornier HM-3 to out-patient anesthesia-free treatment by machines of second or third generations.
At present, it is reasonable to treat the easy stones by initial out-patient ESWL without anesthesia. When the initial ESWL fails, the second ESWL may be performed under anesthesia with the help of various auxiliary procedures. If one use the machines requiring anesthesia, one should employ every possible ancillary procedures, e. g. ureteral catheterization, stenting, push-up etc. at the time of first session to achieve the highest pulverization rate and the highest stone free rate.
The treatment strategy should be assesed individually in every case of problem stone. Simple repetition of ESWL at out-patient clinic should be avoided in these cases. In the case of staghorn calculi, especially of a large stone burden with calyceal dilatation, ESWL is not advised to be an initial treatment.
In the review article, the author surveyed recent clinical reports on ESWL therapy and tried to convey their treatment strategies. The article may hopefully helps the readers to establish their own policy in the ESWL treatment for urolithiasis.