Extracorporeal Shock Wave Cholelithotripsy
Extracorporeal shock wave lithotripsy has revolutionized the management of upper urinary tract stones. Its success and safety have led to a proliferation of machines and of urologists trained in their use. Therefore, it is not surprising that at some institutions, urologists have been asked to apply their expertise to fragment biliary calculi. We have successfully treated 11 patients with retained (post-cholecystostomy or post-cholecystectomy) gallstones in the cystic, hepatic, or common bile ducts using an unmodified Dornier HM3 lithotripter. All patients were initially operated upon by general surgeons and were subsequently evaluated by interventional radiologists. All stones underwent unsuccessful percutaneous or endoscopic manipulation or were considered inappropriate for such procedures because of size or location. In each case imaging was possible by introducing contrast material through the cholecystostomy tube, a nasobiliary catheter, or a T-tube. Following cholelithotripsy, all patients either passed the fragments or had them reduced to a size that could be removed by percutaneous or endoscopic techniques. No complications were encountered. Because the number of situations in which ESWL can be used is limited, it may be difficult for physicians other than urologists to acquire and maintain the skills necessary to operate the lithotripter. Until specific biliary lithotripters become widely available, urologists may continue to be asked to assist in the management of patients requiring extracorporeal shock wave cholelithotripsy.