1536 OUTCOME FROM SHOCKWAVE LITHOTRIPSY TO URETERIC CALCULI IN PATIENTS WITH HIGH SKIN-TO-STONE DISTANCE

You have accessJournal of UrologyStone Disease: SWL, Ureteroscopy or Percutaneous Stone Removal (I)1 Apr 20131536 OUTCOME FROM SHOCKWAVE LITHOTRIPSY TO URETERIC CALCULI IN PATIENTS WITH HIGH SKIN-TO-STONE DISTANCE Sara Ramsey, Shirley Wallace, Carolann Stephenson, David Tolley, Ben Thomas, and Simon Phipps Sara RamseySara Ramsey Edinburgh, United Kingdom More articles by this author , Shirley WallaceShirley Wallace Edinburgh, United Kingdom More articles by this author , Carolann StephensonCarolann Stephenson Edinburgh, United Kingdom More articles by this author , David TolleyDavid Tolley Edinburgh, United Kingdom More articles by this author , Ben ThomasBen Thomas Edinburgh, United Kingdom More articles by this author , and Simon PhippsSimon Phipps Edinburgh, United Kingdom More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.3026AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Obesity is increasingly prevalent and can predispose to nephrolithiasis. The outcome from Shockwave Lithotripsy (SWL) is related to a number of factors including skin-to-stone distance (SSD). The focal depth of many second and third generation lithotriptors is limited to up to 13cm; a number of the latest machines have a greater focal depth. We report the outcomes of SWL to ureteric calculi at an SSD of over 13cm, using a contemporary lithotriptor with a focal depth of up to 17cm. METHODS Patients with a solitary radio-opaque ureteric calculus diagnosed on CT scanning, with an SSD of between 13 and 17cm, were selected from our prospective database. Those with a ureteric stent in situ were excluded. Patients were treated on an outpatient basis with a Sonolith I-Sys Lithotriptor (Vaulx-en-Velin, France) at a frequency of 2Hz using intravenous opiate analgesia if required. Outcome was assessed by a plain KUB XRay at 2 weeks then monthly as required. Further treatment was undertaken if significant fragments remained on post-treatment film. Success was defined as complete clearance of stone fragments. Failure was defined as persistence of stone fragments beyond 3 months or the need for ureteroscopy. Outcomes were assessed on an intention to treat basis. RESULTS 98 patients satisfied the inclusion criteria. Patient and treatment characteristics are shown in table 1. The majority of patients were male, mean age 51, with an upper ureteric stone of mean size 8mm, mean SSD 14cm. 2 patients with lower ureteric stones failed to tolerate treatment. 66 (67%) patients were stone free following a single session of lithotripsy. 24 patients underwent a further session of lithotripsy after which the overall stone free rate rose to 78 (80%). 3 patients were left with small residual fragments requiring no intervention. Overall numbers requiring no further procedure were 83%. 12 patients proceeded to ureteroscopy. Stone free rates were 69% for lower and mid ureteric stones, and 85% for upper ureteric stones. CONCLUSIONS The use of a contemporary lithotriptor in an experienced centre can produce excellent stone free rates following treatment of ureteric calculi in patients with SSDs of 13cm or greater. The use of machines with greater focal depths will allow more patients to undergo SWL for urinary calculi despite increasing obesity. Feature Number Gender Male / Female 87 / 11 Age (Years) Mean, Median, (range) 51, 50, (17-79) Left / right 40 / 58 SSD (cm) Mean, Median, (Range) 14, 14, (13-17) Stone Location PUJ / UU / MU / LU 14 / 68 / 5 / 11 Stone size (mm) Mean, Median, (Range) 9, 8, (4-19) Iv analgesia Yes / No 39 / 59 Localisation Fluoro / USS +Fluoro 70 / 21 Shocks Mean, Median, (Range) 3408, 3674, (464-5221) Sessions of lithotripsy 1 / 2/ 3 72 / 22 / 2 Ureteroscopy No / Yes 86 / 12 © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e629-e630 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sara Ramsey Edinburgh, United Kingdom More articles by this author Shirley Wallace Edinburgh, United Kingdom More articles by this author Carolann Stephenson Edinburgh, United Kingdom More articles by this author David Tolley Edinburgh, United Kingdom More articles by this author Ben Thomas Edinburgh, United Kingdom More articles by this author Simon Phipps Edinburgh, United Kingdom More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...