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CLINICAL REPORT OF UROLITHIASIS TREATED BY
THE LITHOTRIPTOR OF DOUBLE IMPULSE
Han Jianzhi1,Liang Lili2,Yang Xin1,Li Bin1,Gao Shaoqing1,
Huang Changing 1,Chen Zhongxin1,Guo Yinglu2
1. The Teaching Hospital of Guangdong Medical College
2. The Institute of Urology of Beijing University
[Abstract]
Purpose
The efficiency of lithotripter, tolerance of patient and complications are observed clinically when the Double Impulse used for ESWL.
Method
Adapt to select 30 case of renal stone or ureter stone to treated by the ESWL machine with Double-Impulse technology.
Result
The crushing degree of calculus on the image and the granular calculus discharged by the patient are better than single pulse lithotripstor .All patients are calm in treatment,no evident uncomfortable,the hematuria is very light,the granular calculuses are thin and the discharged are all right.
Conclusion
Compared to the single-pulse lithotriptor,the Double-Impulse lithotriptor is excellent.The efficiency is higher, the tolerability of patient is better,the injury of tissue is smaller,the complication is lighter.So the Double-Impulse lithotriptor is the progress direction for the ESWL.
[key word] Double-Impulse,Lithotriptor,Urolithiasis
There are 30 cases urolithiasis treated in our hospital from January to Febrery, 2002. All the patients are treated by the HB-VG style ESWL machine with Double Impulse technology which is researched and manufactured by the joint effort of the Institute of Urology of Beijing University and Zhanjiang Haibin Medical Equipment Co.,Ltd(Picture 1).We get very good effect in clinic,the detail is as follows:
Clinic Datas
1.Common Datas
There are 30 cases in total,including 18 man and 12 weman,The age is from 22 years old to 69.
Position of the stone:Left kidney stone 8 cases,left ureteral calculi 7 cases;Right kidney stone 6 cases,right ureteral calculi 9 cases.
The measurement of the stone:staghorn stone 3 cases,5 kidney stone bigger than 2cm,renal pelvic calculi smaller than 2cm 4 case, calyceal stones 2 cases.
2.Method
2.1.Body position: the patients lie down on his back if the stones above the top of the iliac bone and lie prostrate if the stones below the top of the iliac bone.
2.2.The shockwave energy and the times:The kidney stone shock 1000 to 2500 times,the voltage is 5 to 7 kV;The ureteral calculi shock 1500 to 3000 times,the voltage is 5-8kV.The times decided according to the broken situation of the stone.The bigger stone will re-treated after 1 to 2 weeks.All the patients do not use any pain-killer or sedative.
3.Asistant treatment:The 3 cases of staghorn stone and 1 case whose stone is bigger than 2cm are all equipped with the Double J tube before ESWL.The 3 cases whose ureteral calculi stay in the same position more than 6 months are treated with ESWL after insert the ureter pipe.The other patients are all treated directly with ESWL.All the low-pole calyceal stone patients are treated by pating the right area of the patient’s body to help excreting the stones after ESWL..
Results
1.Renal stone
The renal stones not bigger than 2cm treated on time by ESWL,shock times no more than 2500 and the voltage no more than 8kV,the stone-breaking situation in the screen appears satisfied.The renal stones bigger than 2cm and 3 case of staghorn stones treated 2 to 6 times by ESWL,the stone-breaking situation looks satisfied in the screen,the patient’s do not appear clear uncomfortable.The stone broken rate is 100%,the stone-free rate in 1 month is 87.32% and after 2 month it reaches 97%.The Double Impulse technology get satisfied effection than the single pulse.
(Picture 2 A,B)
2. Ureteral calculus
16 cases in total,2 cases whose stone bigger than 2cm treated twice by the ESWL and excreted the stone safe.In the 14 cases whose stone smaller than 2cm,13 cases treated successfully by one time.(Picture 3 A,B,C)The other case who ever treated in other hospital by the imported ESWL machine but failed,we treated again but the effection is not very good appears in the screen.After one week,we check with the ureteroscopy,it is not broken.Then we treat by URSL and the operation is successful.Now we still do not know why it is can not be treated by the ESWL.
3.Complications
3.1. Hematuria:We can see light hematuria from all the patients treated by ESWL.Renal stone patients can not see hematuria after passing urine for 1 to 5 times,the ureteral calculi patients can not see hematuria after passing urine for 1 to 2 times.
3.2.Part of the skin injury:12 cases whose skin appear very little red spot and it disappear next day.No skin damaged.
3.3. Tolerability:27 cases have no uncomfortable or pain.3 cases whose age is over 60 years old(2 cases renal stone,one case ureteral calculi) feel light pain,after stop a few minutes then continue treatment and finish the treatment successful.All patients do not have pain-killer or sedative.
3.4.Stone street:2 cases have the stone street for 3cm to 6cm,one have the Double J tube.The stones looks very small in the screen,the patients do not have the pain or fever sign,after adjust the re-treatment time and adjust the body position shock,the stone free by themselves.
Discussion
1.Double Impulse technology means that the shockwave source create two shockwave pulse continuously in a certen time range,achieve double cavitation.[1-2]According to the concerned study,Double Impulse can rise the effection 40% than the single pulse,After the practice in clinical,we find that the Double Impulse technology can get better effection than single pulse for stone-breaking under the same shock time and voltage.
2.Practice and study shows that the Double Impulse can make the shockwave focus on the target,so it bring smaller injury of the tissue compare with the single pulse.[3-4]For this reason,all patients in this group can finish treatment without pain-killer or sedative.All the patients have light blood in their urine and it disappear after passing urine for several times.
Conclusion
Compared with the single-pulse lithotriptor,the Double-Impulse lithotriptor is excelent, the efficiency is higher, the tolerability of patient is better,the injury of tissue is smaller, the complication is lighter.So the Double-Impulse lithotriptor is the progress direction for the ESWL[5-6].
Reference
[1]£®Chow GK. And Streem SB. Extracorporeal lithotripsy
update on technology. Urologic Clinics of North
America. 2000;27:2 315-322
[2]£®Cleveland RO, Bailey MR, Fineberg N, et al; Design
and characterization of a research electro-hydraulic lithotripter patterned after the Dornier HM3. Review of Scientific Instruments, June 2000, 71, p 2514-2525.
[3]£®Lokhandwalla M. and Sturtevant B..Fracture mechanics
model of stone comminution in ESWL and implications
for tissue damage. Physics in Medicine & Biology,
July 2000, 45, p 1923-1940
[4]£®Onnors, N. The Effect of Discharge Voltage on Renal
Injury and Impairment Caused by Lithotripsy in The
Pig, J Am Soc nephrol, 2000; Feb 11(2): 310-8
[5].Sun Xizhao,ESWL TECHNOLOG,Shanghai,2001.
[6].Han Jianzi,Zhuang Qianyuan,
The Practice of the Science of Endourology,Guangzhou,2001
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