Minimisation of stone deflection during extracorporeal shockwave lithotripsy monotherapy for ureteric calculi in situ

The use of an abdominal compression belt to reduce stone movement during extracorporeal shock wave lithotripsy

We used an abdominal compression belt in 50 patients undergoing extracorporeal shock wave lithotripsy with the Siemens Lithostar lithotriptor to limit diaphragmatic excursion and, therefore, renal calculus movement. Stone movement was measured on the monitor with and without the compression belt. Abdominal compression was found to decrease the range of stone movement by an average of 32% (-4 to 63%). This technique was less effective in patients with limited chest expansion. Abdominal compression was also found to be useful during treatment of renal and upper ureteral stones in reducing overall patient movement. The decreased stone movement during extracorporeal shock wave lithotripsy with abdominal compression may increase stone fragmentation and may decrease the number of shocks per treatment.

Ureteric stone management using a second generation lithotriptor

A series of 209 consecutive patients with ureteric calculi underwent 296 extracorporeal shock wave lithotripsy treatments on the Siemens Lithostar over a 25-month period; 123 stones were upper ureteric, 30 mid-ureteric and 56 lower ureteric; 46.9% were right-sided stones, 53.6% were left-sided and 0.5% (1 patient) were bilateral. On referral, 60 patients had stents and 15 had nephrostomies for obstruction. All treatments were performed without anaesthesia except for 9 patients in whom stent insertion or ureteroscopic manipulations were attempted concomitant to ESWL. The average number of treatments was 1.42, with 27.5% of patients requiring more than 1 treatment. The average number of shocks per treatment was 3995 and the average hospital stay was 1.79 days. Complete clearance of the stone was achieved in 82% of upper ureteric stones, 89% of mid-ureteric and 80% of lower ureteric stones. The facility for X-ray localisation of stones allows a high proportion of ureteric calculi to be treated successfully by ESWL, including the more taxing middle and lower ureteric calculi.