dr. gustavo minuzzi dr. sandro varea

Dr. Gustavo Minuzzi Dr. Sandro Varea

Sanatorio Allende Cerro , Cordoba, Argentina

Extracorporeal Shockwave Lithotripsy

Extracorporeal Shockwave Lithotripsy model Duet Magna

Duet Magna Equipment

2 Reflectors at 76 degrees Double Shockwave Fluoroscopic and Ultrasonographic

Localization In most cases 2 reflectors are used, except

some cases involving middle and lower ureter

Prospective Study

KidneyKidneyN N %%UreterUreterNN%%

Lower calyx3630%Upper2420%

Middle calyx65%Middle43%

Upper calyx65%Lower3629%

UPJ108%

December 2010 to February 2012123 patients with urolithiasis (renal and ureteral)

48% were located in the kidney and 52% in the ureter

Distribution According to Stone Size

5-8 mm 9- 12 mm > 12mm Renal 29 11 18

Ureteral 24 27 13

The average size of the treated calculi wasThe average size of the treated calculi was10 mm (min 4 - max 20)10 mm (min 4 - max 20)

Analgesia / Sedation Used

Analgesia Analgesia

115 patients Diclofenac 75 mg. 4 patients tramadol.

Sedation Sedation 4 patients with propofol.

Shockwave Details

Kidney (average):

# Shocks : 3956Frequency: 84 / minuteTreatment time = 47 min.

 Ureter (average):

# Shocks : 3754Frequency: 84 / minuteTreatment time = 45 min.

Results for Renal Stone Treatments

Stone-FreeStone-FreeFragments Fragments < 4 mm< 4 mm

Success Success RateRate

Fragments Fragments > 4 mm> 4 mm

NoNoFragmentationFragmentation

Total60.3%34.5%94.8%5.2%___

UPJ50%40%90%10%___

Upper calyx83.3%16.7%100%___

Middle calyx16.6%66.7%83.3%16.7%___

Lower calyx63.8%30.6%94.4%5.6%___

Results for Ureteral Stone Treatments

Stone-FreeStone-FreeFragments Fragments < 4 mm< 4 mm

Success Success RateRate

Fragments Fragments > 4 mm> 4 mm

No No FragmentationFragmentation

Total67.2%9.3%76.5%4.6%18.7%

Upper ureter70.8%%16.6%87.4%4.2%8.3%

Middle ureter50%___50%___50%

Lower ureter66.7%5.5%72.2%5.5%22.2

Average Treatment Time

General Average: 1.651.65

Stone-FreeStone-FreeFragments Fragments < 4mm< 4mm

Fragments Fragments > 4 mm> 4 mm

No No FragmentationFragmentationAverageAverage

Kidney1.581.851.5___1.67

Ureter1.531.51.331.661.54

Subjective Pain Sensation

An analog pain scale from 1 to 10 was used

113 patients reported pain sensation between 2 and 5

10 patients reported pain sensation between 6 and 7.

Complications / Side-effects

Complications: We had no serious complications such as

perirenal Hematoma or sepsis

Side-effects: Mild hematuria (less than 24 hours without

the need of admission) : 41.8 % Renal colic : 8.9 % Stein strasse : 3.2 %

Conclusion

We have tested the feasibility to perform renal and ureteral calculi treatment with Dual Electromagnetic Shock Wave Technology using only oral analgesia. In our experience it yields satisfactory results, comparable to other lithotripsy systems.