Technical Development, Biologic Effects, and Clinical Application of Laser-Induced Shock Wave Lithotripsy
Extracorporeal shock wave lithotripsy (ESWL) provides a noninvasive treatment for most of the renal and ureteric calculi (70%–80%). ESWL has brought a tremendous change in the management of patients with urinary stones. Patient morbidity is lessened compared with other methods of stone removal and only 10%–20% of all patients need subsequent stone particle manipulation by secondary percutaneous or transurethral methods (Lingeman et al. 1987). Impacted or very hard amorphous calculi in the ureter, however, especially when they are not surrounded by fluid for ESWL shock wave coupling to the stone, can only be crushed in situ in about 50%, while the other half needs flushing up to the kidney and disintegration in the kidney pelvis. This procedure has to be done with ureteral catheters or an endoscope, so that direct access to the stone is necessary. Disintegration of ureteral calculi into tiny stone fragments and flushing out of the ureter can be realized with the help of laser-induced shock waves and cavitation, initiated by the so-called laser-induced breakdown (LIB).
KeywordsCatheter Quartz Hydrate Attenuation Sodium Chloride
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