Fujimoto N, Kyo M, Ichikawa Y, Nagano S
Department of Urology, Hyogo Prefectural Nishinomiya Hospital.
Hinyokika Kiyo. 1994 Dec;40(12):1069-75.
A total of 345 cases of upper urinary tract stones (188 renal and 157 ureteral stones) were treated by extracorporeal shock wave lithotripsy (ESWL) monotherapy using the Dornier lithotriptor MFL5000. Of these cases 294 (85.2%) had stones less than 20 mm in length. A double-J ureteral stent was placed in 40 cases of renal stones and 8 ureteral stones due to large stone burden or failure of in situ ESWL for impacted stones. Epidural or spinal anesthesia was necessary in 32 cases to maximize the generator voltage or to prevent intractable pain. The number of ESWL sessions and shock waves increased in accordance with the stone size, with an average of 1.6 and 4442, respectively. Multiple sessions were required in 68 cases of renal stones (36.2%) and 59 of ureteral stones (37.6%). With a 3-month follow-up, the stone-free rate was 60.5% for renal stones and 89.4% for ureteral stones, with the overall stone-free rate of 74.7%. Including the cases with residual fragments less than 4 mm, ESWL monotherapy was successful for 86.4% of renal stones and 93.6% of ureteral stones, achieving the overall success rate of 89.9%. No serious complications related to ESWL were observed. Four cases of impacted ureteral stones underwent ureteroscopic extraction or open ureterolithotomy for fragment removal. ESWL monotherapy using the Dornier MFL5000 is an effective and noninvasive method of treating upper urinary tract stones. Satisfactory fragmentation and clearance can be achieved with multiple sessions even for large or impacted stones, but alternative procedures may be necessary to salvage fragments of impacted stones.
采用多尼尔MFL5000碎石机，对总共345例上尿路结石（188例肾结石和157例输尿管结石）进行了体外冲击波碎石术（ESWL）单一疗法治疗。其中294例（85.2%）结石长度小于20毫米。由于结石负荷大或原位ESWL治疗嵌顿结石失败，40例肾结石和8例输尿管结石置入了双J输尿管支架。32例患者需要硬膜外或脊髓麻醉，以将发生器电压最大化或防止难以忍受的疼痛。ESWL治疗次数和冲击波次数随结石大小增加，平均分别为1.6次和4442次。68例肾结石（36.2%）和59例输尿管结石（37.6%）需要多次治疗。经过3个月的随访，肾结石的无石率为60.5%，输尿管结石的无石率为89.4%，总体无石率为74.7%。包括残留碎片小于4毫米的病例，ESWL单一疗法对86.4%的肾结石和93.6%的输尿管结石治疗成功，总体成功率为89.9%。未观察到与ESWL相关的严重并发症。4例嵌顿输尿管结石患者接受了输尿管镜取石术或开放性输尿管切开取石术以取出碎片。使用多尼尔MFL5000进行ESWL单一疗法是治疗上尿路结石的一种有效且无创的方法。即使对于大结石或嵌顿结石，多次治疗也可实现令人满意的碎石和清除，但可能需要采用其他方法来取出嵌顿结石的碎片。
