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Extracorporeal Shock Wave Lithotriptors

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Urinary Tract Stone Disease

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Abstract

After clinical introduction in 1980, extracorporeal shock wave lithotripsy (ESWL) became the primary choice of treatment for most urinary stones within less than 10 years. Stone disintegration and passage of fragments are influenced by technical demands on the lithotripter and clinical prerequisites on behalf of the patient and surgeon. There are no standardized parameters to characterize shock waves physically or to define their optimal configuration. Primarily there is the discussion about the size of focal zone and the energy flux within it. Actually, there is a trend to use smaller focal sizes for ureter stones and larger for renal stones without proof by relevant studies. The shock waves disintegrate the calculi in a sequential process by different mechanisms, for example, spallation, squeezing, cavitation induced by microbubbles, and dynamic fatigue. The propagation of the shock wave from the generator through the patient to the stone has to be ensured by optimal acoustic coupling of the waves. The stones have to be positioned precisely in the focal point imaged by fluoroscopy or sonography. Prospective randomized trials proofed that pulse rate should not exceed 90 pulses/min and shock wave energy should be ramped along ESWL session from low to high level up to the limit of applicable shock wave dose (shot number and energy) to improve stone fragmentation and reduce the risk of kidney trauma. After treatment, including retreatment in some cases, the diagnostic tools of radiology and ultrasound define if the stone is “completely” disintegrated and passage of fragments can be expected. In case of incomplete fragmentation, alternative endoscopic treatments have to be respected. The efficiency of lithotripters can be estimated by calculating quotients including stone-free rate, number of retreatments, auxiliary and alternative treatments. This is a nonstandardized possibility to compare different lithotripters additionally to the possibility of in vitro studies and the rare prospective randomized trials.

Meanwhile the number of ESWL-treatments decrease progressively since efficacy and invasiveness of endourological procedures (e.g., ureterorenoscopy and percutaneous litholapaxy) improves more and more. Since the development of new lithotripters did not reach higher success rates in the last 25 years and optimal fragmentation is achieved by ESWL applying high energy in general anesthesia the endoscopic procedures are reasonable alternatives with a higher immediate stone-free rate in even more cases.

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Acknowledgments

This chapter includes the results of two consensus meetings of the German Society of Shock Wave Lithotripsy in 20058 and 2009.56 The aim of these meetings was to exchange knowledge and to reach a consensus with respect to the physics, technical issues, and applications of ESWL. This unique panel consisted of urological experts as well as representatives of lithotripter manufacturers and incorporated an extensive review of the current literature.

Besides the authors, the following experts were part of the panel:

Thorsten Bergsdorf, Christian Chaussy Department of Urology, Stadtkrankenhaus München-Harlaching, University of Munich, Germany

Christian Bohris, Bernd Forssmann, Department of Research, Dornier MedTech Systems, D 82234 Wesseling, Germany

Michael Burkhardt, Peter Vallon; Department of Research, Richard Wolf, D75434 Knittlingen, Germany

Leandro Burnes, Christian Meinert, R&D Urology, Siemens Medical Solutions, D91052 Erlangen, Germany

Paul Partheymüller; Department of Clinical Application, EDAP TMS GmbH, D24937 Flensburg, Germany

Othmar Wess; Department of Research, Storz-Medical, CH8280 Kreuzlingen, Switzerland

Jürgen Williger; AST GmbH, D07745 Jena, Germany

Dieter Jocham; Department Of Urology, University of Schleswig-Holstein (UKSH) Campus Lubeck Medica, Lübeck, Germany

Gerald Haupt; Department of Urology, St.-Vincentius-Krankenhauses, Speyer, Germany

Dirk Wilbert, Department of Urology, Kantonales Spital, CH-8730 Uznach, Switzerland

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Authors and Affiliations

  1. Department of Urology, Theresienkrankenhaus, Mannheim, Germany

    Kai Uwe Köhrmann

Authors
  1. Kai Uwe Köhrmann
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  2. Jens Rassweiler
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Correspondence to Kai Uwe Köhrmann .

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Editors and Affiliations

  1. Dept. Urology, Spire Manchester Hospital, Russell Road, Manchester, M16 8AJ, United Kingdom

    Nagaraja P. Rao

  2. Division of Urologic Surgery, Duke University Medical Center, Durham, 27710, North Carolina, USA

    Glenn M. Preminger

  3. Department of Urology, South Manchester University Hospitals, Manchester, M20 2LR, United Kingdom

    John P. Kavanagh

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Köhrmann, K.U., Rassweiler, J. (2010). Extracorporeal Shock Wave Lithotriptors. In: Rao, N., Preminger, G., Kavanagh, J. (eds) Urinary Tract Stone Disease. Springer, London. https://doi.org/10.1007/978-1-84800-362-0_23

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  • DOI: https://doi.org/10.1007/978-1-84800-362-0_23

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