Dr. Gustavo Minuzzi Dr. Sandro Varea Sanatorio Allende Cerro , Cordoba, Argentina Extracorporeal Shockwave Lithotripsy
Feb 01, 2016
Dr. Gustavo Minuzzi Dr. Sandro Varea
Sanatorio Allende Cerro , Cordoba, Argentina
Extracorporeal Shockwave Lithotripsy
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
KidneyKidneyN N %%UreterUreterNN%%
Lower calyx3630%Upper2420%
Middle calyx65%Middle43%
Upper calyx65%Lower3629%
UPJ108%
December 2010 to February 2012123 patients with urolithiasis (renal and ureteral)
48% were located in the kidney and 52% in the ureter
Distribution According to Stone Size
5-8 mm 9- 12 mm > 12mm Renal 29 11 18
Ureteral 24 27 13
The average size of the treated calculi wasThe average size of the treated calculi was10 mm (min 4 - max 20)10 mm (min 4 - max 20)
Analgesia / Sedation Used
Analgesia Analgesia
115 patients Diclofenac 75 mg. 4 patients tramadol.
Sedation Sedation 4 patients with propofol.
Shockwave Details
Kidney (average):
# Shocks : 3956Frequency: 84 / minuteTreatment time = 47 min.
Ureter (average):
# Shocks : 3754Frequency: 84 / minuteTreatment time = 45 min.
Results for Renal Stone Treatments
Stone-FreeStone-FreeFragments Fragments < 4 mm< 4 mm
Success Success RateRate
Fragments Fragments > 4 mm> 4 mm
NoNoFragmentationFragmentation
Total60.3%34.5%94.8%5.2%___
UPJ50%40%90%10%___
Upper calyx83.3%16.7%100%___
Middle calyx16.6%66.7%83.3%16.7%___
Lower calyx63.8%30.6%94.4%5.6%___
Results for Ureteral Stone Treatments
Stone-FreeStone-FreeFragments Fragments < 4 mm< 4 mm
Success Success RateRate
Fragments Fragments > 4 mm> 4 mm
No No FragmentationFragmentation
Total67.2%9.3%76.5%4.6%18.7%
Upper ureter70.8%%16.6%87.4%4.2%8.3%
Middle ureter50%___50%___50%
Lower ureter66.7%5.5%72.2%5.5%22.2
Average Treatment Time
General Average: 1.651.65
Stone-FreeStone-FreeFragments Fragments < 4mm< 4mm
Fragments Fragments > 4 mm> 4 mm
No No FragmentationFragmentationAverageAverage
Kidney1.581.851.5___1.67
Ureter1.531.51.331.661.54
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.