Extracorporeal Shockwave Lithotripsy Dr Gustavo Minuzzi Dr Sandro
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Extracorporeal Shockwave Lithotripsy Dr. Gustavo Minuzzi Dr. Sandro Varea Sanatorio Allende Cerro , Cordoba, Argentina
Extracorporeal Shockwave Lithotripsy model Duet Magna
Duet Magna Equipment 2 Reflectors at 76 degrees Double Shockwave Fluoroscopic and Ultrasonographic Localization In most cases 2 reflectors are used, except some cases involving middle and lower ureter
Prospective Study December 2010 to February 2012 123 patients with urolithiasis (renal and ureteral) 48% were located in the kidney and 52% in the ureter Kidney N % Ureter N % Lower calyx 36 30% Upper 24 20% Middle calyx 6 5% Middle 4 3% Upper calyx 6 5% Lower 36 29% UPJ 10 8%
Distribution According to Stone Size Renal Ureteral 5 -8 mm 29 24 9 - 12 mm 11 27 > 12 mm 18 13 The average size of the treated calculi was 10 mm (min 4 - max 20)
Analgesia / Sedation Used Analgesia 115 patients Diclofenac 75 mg. 4 patients tramadol. Sedation 4 patients with propofol.
Shockwave Details Kidney (average): # Shocks : 3956 Frequency: 84 / minute Treatment time = 47 min. Ureter (average): # Shocks : 3754 Frequency: 84 / minute Treatment time = 45 min.
Results for Renal Stone Treatments Stone-Free Fragments < 4 mm Success Rate Fragments 4 mm > No Fragmentation Total 60. 3% 34. 5% 94. 8% 5. 2% ___ UPJ 50% 40% 90% 10% ___ Upper calyx 83. 3% 16. 7% 100% Middle calyx 16. 6% 66. 7% 83. 3% 16. 7% ___ Lower calyx 63. 8% 30. 6% 94. 4% 5. 6% ___
Results for Ureteral Stone Treatments Stone-Free Fragments < 4 mm Total Success Rate Fragments 4 mm > No Fragmentation 67. 2% 9. 3% 76. 5% 4. 6% 18. 7% Upper ureter 70. 8%% 16. 6% 87. 4% 4. 2% 8. 3% Middle ureter 50% ___ 50% Lower ureter 66. 7% 5. 5% 72. 2% 5. 5% 22. 2
Average Treatment Time General Average: 1. 65 Stone-Free Fragments < Fragments > No Average 4 mm 4 mm Fragmentation Kidney 1. 58 1. 85 1. 5 ___ 1. 67 Ureter 1. 53 1. 5 1. 33 1. 66 1. 54
Subjective Pain Sensation An analog pain scale from 1 to 10 was used 113 patients reported pain sensation between 2 and 5 10 patients reported pain sensation between 6 and 7.
Complications / Side-effects Complications: We had no serious complications such as perirenal Hematoma or sepsis Side-effects: Mild hematuria (less than 24 hours without the need of admission) : 41. 8 % Renal colic : 8. 9 % Stein strasse : 3. 2 %
Conclusion We have tested the feasibility to perform renal and ureteral calculi treatment with Dual Electromagnetic Shock Wave Technology using only oral analgesia. In our experience it yields satisfactory results, comparable to other lithotripsy systems.
