Portal de Periódicos da CAPES

Extracorporeal shock wave lithotripsy with a transportable electrohydraulic lithotripter: experience with >300 patients

2005; Wiley; Volume: 96; Issue: 4 Linguagem: Inglês

10.1111/j.1464-410x.2005.05692.x

1464-410X

David Albala, Khurram Siddiqui, Brant R. Fulmer, Joseph Alioto, Jeffery A. Frankel, Manoj Monga,

Pediatric Urology and Nephrology Studies

Authors from the USA present a multi‐centre experience using a transportable lithotripter for treating stones in all parts of the urinary tract. They found the lithotripter to be safe and effective, and felt that the Medstone STS‐T represents an advance in the development of transportable lithotripters. A very large experience of partial nephrectomy for various reasons is presented by German authors. Of 717 patients, 65 had either a solitary kidney, synchronous bilateral tumours, or renal failure in the opposite kidney. They describe their technique using perfusion‐cooling, and found that long‐term dialysis could be avoided. OBJECTIVE To review a multicentre experience of using a transportable lithotripter (STS‐T, Medstone, Inc, Aliso Viejo, CA. USA) for treating patients with urolithiasis in all parts of the urinary tract. PATIENTS AND METHODS In all, 326 patients with a total of 370 stones were treated as outpatients with the STS‐T lithotripter. All patients received a single shock wave lithotripsy treatment and were followed after 4–6 weeks in the outpatient clinic, the primary endpoint being to determine the efficacy (as defined by the stone‐free rate). Secondary objectives included establishing a database of patient demographic information, stone characteristics, stone location, procedural endpoints, and complication rates. RESULTS In all there were 370 procedures, with a mean of 2394 shocks administered at an energy level of 24 kV. The mean treatment time was 51 min, excluding anaesthesia‐induction time. The mean stone aggregate size was 8.2 mm; 62% of the stones were in the kidney while 38% were in various locations in the ureter. Of the treated stones, 90% had definite or probable evidence of fragmentation. The overall stone‐free rate after one treatment with the STS‐T was 52.8%. Of patients with residual fragments, most (61%) had fragments of <4 mm in aggregate diameter. The overall complication rate was 3.8%, the most common complication being postoperative pain. CONCLUSION The Medstone STS‐T lithotripter was an effective device for treating urolithiasis in all parts of the urinary tract. This system had a high margin of safety, as shown by the low complication rate. With no apparent sacrifice of efficacy compared to first‐generation or fixed (not transportable) second‐generation devices, the Medstone STS‐T represents an important advance in the development of a truly transportable lithotripter.