[Extracorporeal shock wave lithotripsy as surgical therapy in the kidney-ureter calculosis].

BACKGROUND

The coming of the extra-corporeal shock waves lithotripsy (ESWL) represented one of the main progress in medicine of all times.

METHODS

From January '84 up to March '99, 7.508 patients underwent extracorporeal shock wave lithotripsy (ESWL) for renal, ureteral and bladder stones with a total of 13.032 treatments. 6.329 kidney stones, 2.165 ureteral-calculosis and 52 bladder stones, for a total amount of 8.546 stones were treated. Seven different lithotripters have been used: radiologic-based Dornier HM3 with electrohydraulic shock waves production, radiologic-based modified-Dornier HM3 with electrohydraulic shock waves production, ultrasonography-based Dornier MPL 9000 with electrohydraulic shock waves production, ultrasonography-based EDAP LT 01 with piezoelectric shock waves production, ultrasonography and radiologic-based EDAP LT 02 with piezoelectric shock waves production, ultrasonography-based Piezolith 2200 and the Piezolith 2300 only with piezoelectric shock waves production. In 1,451 patients an auxiliary action was necessary.

RESULTS

Only a treatment was sufficient in 5.337 patients (77.7%), two in 1.497, three in 507 patients, four in 248 patients, five in 109, six in 55, seven in 34, eight in 9, nine in 12, ten in 5, eleven in a patient, twelve in a patient, thirteen in a patient, fourteen in two patients and fifteen in a patient. The patients who had a negative abdomen radiograph or ultrasound after two months were considered "stone-free". We have considered urolithies smaller than 3 mm as fragments, with the possibility of natural expulsion, non conditioning lying behind. Totally the results was: 5.950 patients "stone-free", 753 patients with fragments, 257 patients with non-broken calculi and 547 patients with dust only. The "stainstrasse" with spontaneous resolution and the one with instrumental resolution, the hyperpyrexia, the serious colics, the symptomatic renal haematomas and the intolerance to the treatment (vomiting and nausea) have been considered as complications.

CONCLUSIONS

Nowadays, except for the cases in which are necessary admission to hospital and urgency treatment, since imminent colics are present, the ESWL may be performed in day-hospital. Since the first years of employment the ESWL has solved almost all the cases of urolithiasis. Nevertheless the experience has proved the extreme aggressiveness and inappropriate characteristics of a number sometimes too high of re-treatments. The ESWL should maintain the feature of non-spread methodic when it is possible to use it in cases solving with two--maximum three--treatments.