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1997年5月～1998年2月の間に腎結石40例, 尿管結石40例(男性60例, 女性20例)についてドルニエリソトリプターコンパクトを用いた治療を行った.結石のサイズは5～80mmであった.大多数の症例は無麻酔で行ったが, 3例に硬膜外麻酔を必要とした.また4例に尿管ステント留置後に治療を行った.全ての症例において結石砕石は認められた.1ヵ月後の評価では砕石効果と完全排石率は91%と54%, 又, 3ヵ月後の評価では砕石効果と完全排石率は91%と68%であった.腎盂腎炎や腎周囲血腫, 大量の血尿等の重篤な副作用はみられなかった.ドルニエリソトリプターコンパクトは腎尿管結石の治療において安全で砕石効果が優れていると考えられた, Between May 1997 and February 1998, 40 cases of renal stones and 40 cases of ureteral stones in 60 males and 20 females were treated with the Dornier Lithotripter Compact. The size of the stones ranged from 5 mm to 80 mm. Three patients required epidural anesthesia and 4 patients required a ureteral stent. Fragmentation of the stones was observed in all patients. After 1 month, the efficacy and stone free rates were 91% and 54%, respectively. After 3 months, they were 91% and 68%, respectively. There were no serious side effects such as pyelonephritis, perirenal hematomas, and massive hematuria. In conclusion, the Dornier Lithotripter Compact proved to be a safe and highly effective lithotripter for the treatment of renal and ureteral stones.

We experienced a case of peripelvic extravasation after extracorporeal shock wave lithotripsy (ESWL) treatment. A 62-year-old man was admitted to our hospital with a complaint of macroscopic hematuria. The patient was diagnosed as having a radiolucent stone in the right kidney and ESWL treatment was performed to focus the stone by using drip infusion pyelography (DIP) under epidural anesthesia. The patient had right flank pain two weeks after ESWL treatment. DIP and computerized tomography (CT) showed peripelvic extravasation of contrast medium. Right pain improved after a double-J catheter was placed for decreasing intra-pelvic pressure. As a result, the disappearance of peripelvic extravasation was recognized by DIP and CT. We reviewed four cases of peripelvic extravasation after ESWL treatment including our case in the Japanese literatures and discussed the cause of peripelvic extravasation after ESWL treatment.

At Osaka City University, 1, 987 patients with urolithiasis have been treated by extra-corporeal shockwave lithotripsy (ESWL) during a four-year period. We treated 5 patients with horseshoe kidney and the obtained results were analyzed retrospectively. Three of these patients, who had a solitary stone could successfully be treated by ESWL as monotherapy. One who had multiple stones required transurethral lithotripsy after ESWL due to stone-street. The remaining 1 patient who had undergone heminephrectomy developed perirenal hematoma after ESWL, which spontaneously disappeared without any specific treatment. We discuss the special care related to the use of ESWL in the horseshoe kidney.

過去5年間にDornier社腎結石破砕装置HMIIIを用いてESWLを施行し, 追跡可能であった1, 200例の単一結石について検討した.1)長径20 mm以下の結石については, 腎盂・腎杯部で最も成績がよく84%の成功率をえた.成績不良部位は尿管で62%の成功率であった.2)尿管結石について検討するとin situ症例と尿管カテーテル使用症例の間には成績上, 差はないが, D-Jカテーテル留置症例では10 mmより大きな結石でin situ症例および尿管カテーテル使用症例に比し, 有意に成績は良かった.3)術前IV, We performed extracorporeal shock-wave lithotripsy (ESWL) on 1, 701 patients in a total of 2, 438 sessions using the Dornier kidney lithotriptor Model HM III from July 1985 to the end of June 1990. Among the patients with a solitary stone, 1, 200 cases were available for the follow-up study in which the results of ESWL were analyzed according to the location and size of the stone. ESWL performed against stones at pelvis and calyces gave the best results. The results obtained on stones less than 20 mm in diameter were especially favorable with a success rate of 84%. ESWL performed against ureter stones showed poor results with a success rate of 62% for the stones smaller than 20 mm in diameter. We further studied the results of ESWL performed against ureter stones by dividing the patients into three groups: the patients treated in situ, the patients with ureteral stents and the patients with D-J stents. The results for stones larger than 10 mm in diameter were significantly better in the patients with D-J stents than in the patients treated in situ or the patients with ureteral stents. Among the patients treated in situ, the results were significantly worse for impacted stones than for non-impacted stones when the stone size was 10-20 mm in diameter.

1)尿管結石の長径1 cm以下の場合, 1～2 cmの非嵌頓の場合には無処置ESWL, それ以外の結石ではTUL等との併用を行うべきである.2)シスチン結石の破砕はやや困難であるが, 1回の衝撃波数を増やさず, 治療回数を増し, 経口投与による結石融解を併用したESWLが可能になる, We report our experience with extracorporeal shock wave lithotripsy (ESWL) in the treatment of ureteral and cystine stones, which are known to be difficult to treat by this method. First, in order to determine the effectiveness of the ureteral catheter in the destruction of ureteral stones, we compared the clinical results of 121 patients treated without the catheter and 141 patients inserted with the catheter. There was no significant difference in the success rate between the two groups regardless of stone size, which indicates that the use of the ureteral catheter had no effect on the outcome of treatment. We then studied the clinical results of impacted ureteral stones which are especially difficult to destroy. Excretory urography was performed to non-invasively diagnose these stones, and those without visualization in the ureter below the stone were diagnosed as impacted stones and treated by ESWL without the ureteral catheter. Among the stones with a diameter of 1 to 2 cm, the success rate was significantly lower in impacted stones compared to non-impacted stone. These findings suggest that ESWL treatment without the ureteral catheter may be effective for ureteral stones with a diameter of less than 1 cm and non-impacted stones with a diameter of 1 to 2 cm, while combination therapy with other methods such as TUL may be better for other stones. We also performed ESWL on 6 patients with renal stones and 2 patients with ureteral stones which were cystine stones. Renal stones required an average 4.1 treatment with an average of 1, 875 shocks per treatment, and ureteral stones required 1.5 treatment with an average of 1, 833 shocks.(ABSTRACT TRUNCATED AT 250 WORDS)

ESWLを施行し, 追跡可能であった911例の単一結石について, 1)男性では女性に比し, 尿管結石の頻度が高かった.2)腎盂・腎杯に存在する結石に対するESWLの成績が最も良好で, 20 mm以下で87%の成功率を得た.3) ESWL成績不良部位は尿管で, 嵌頓結石症例では結石サイズが小さくとも, TULやD-Jステントカテーテル留置下でのESWLを行うべきである, At Osaka City University Hospital, we performed extracorporeal shock-wave lithotripsy (ESWL) for 1277 patients in a total of 1788 sessions using Dornier kidney lithotripter Model HM III from July, 1985 to the end of December, 1988. Among the patients with a solitary stone, 911 cases were available for the follow-up study and we have compared the results among these cases in respect to the stone location and size. The results obtained were as follows: the ratio of kidney stone to ureter stone was found to be 2.2:1 in male, and 3.8:1 in female patients. This indicates that ureter stones are more frequently found in male than in female patients. In addition, we compared the size of kidney stones found in the patients including 415 male and 243 female patients. Stones larger than 20 mm were more frequently found in female than in male patients. Moreover, a stone composition study of these patients showed that the contents of both phosphate calcium and magnesium ammonium phosphate were higher in female than in male patients. ESWL performed against stones at pelvis and calyces exhibited the best results. The results obtained with the stones less than 20 mm in diameter were especially favorable with a success rate of 100% for the stones less than 10 mm and 83% for the stones 10-20 mm, in diameter, while the results with the stones larger than 20 mm in diameter were rather poor with a success rate of 31%. ESWL performed against ureter stones showed poor results with a success rate of 63% for the stones smaller than 20 mm in diameter.

1) 121例の上部尿路結石症に対しESWLを施行し, 1ヵ月で56%, 3ヵ月で78%にKUB上結石陰影を認めなくなった.自排可能の大きさとなった19例を含めると95%の症例において良好な成績が得られた.2)血尿, 疝痛などの併発症状を認めたが, これらは数日で消失する軽微なものであり, また血清LDH, GPK, GOT, ALD, T-Bilの上昇を認めたが臨床上特に処置を必要としなかった.3) ESWLは早期社会復帰が可能であり適応となる症例には優れた治療法である, The first 121 cases of upper urinary tract stone treated by extracorporeal shock wave lithotripsy (ESWL) at our clinic were analyzed. Three months after ESWL, 78% of the patients became stone free, and 17% of the patients had residual stone fragments which were less than 5 mm in diameter and considered passable. The success rate was therefore about 94.6%. No severe side effects were observed, although temporary elevations in serum creatinine phosphokinase, lactate dehydrogenase, glutamic-oxaloacetic transaminase, aldolase and total bilirubin occurred. These results indicated that ESWL was a safe and effective procedure for upper urinary tract stones.

The kidney stone of less than 2 cm can be effectively treated by extracorporeal shock wave lithotripsy (ESWL) using a Dornier kidney lithotripter HM3 without any complication that might need other therapy. However, in the case of a large kidney stone and ureteral stone, there are some difficulties in the treatment with ESWL. To obtain better results for these stones with a Dornier kidney lithotripter HM3, in the patient having a large stone a double-J stent was placed and ureteral catheter was indwelling for the ureteral stone before ESWL. In some cases high frequency positive pressure ventilation (HFPPV) was applied to make respiratory movement of the stone minimum. An indwelling double-J stent can significantly decrease the necessity of auxiliary treatment and the incidence of high fever attack. Manipulation of a ureteral stone with a ureteral catheter did not facilitate stone disintegration, and also the success rate as compared with in situ ESWL. HFPPV can decrease the stone movement within 2 mm judged on the X-ray monitor and increase the effectiveness of the shock wave on the stone, leading to minimize not only shock wave dose but also side effects from shock wave exposure.

Eight years have passed since extracorporeal shock-wave lithotripsy (ESWL) was used clinically for the first time, and now its usefulness is recognized all over the world. At first, variable cases were considered to be contra-indicative, one of which was the radiolucent calculi. This time for two cases of the radiolucent calculi we performed ESWL under retrograde pyelography. Using this technique, we brought the filling defect of RP into the focus of the shock waves. The stones were effectively disintegrated and these patients became stone-free in five weeks.

The incidence of upper urinary tract stones is increasing, and it is most often seen in persons in the prime of their lives during their most productive years. It must be taken into account that surgical treatment takes them away from their jobs for long periods of time. We therefore should be careful in choosing a treatment modality for a patient. We evaluated extracorporeal shock wave lithotripsy (ESWL), transurethral ureteroscopy (TUL) and open surgery from the viewpoint of national economy and patient amenity. ESWL offered the fewest hospital days and better amenity, though it was the most expensive. ESWL also offered the fewest days missed from work and this could minimize the loss of national economic productivity. We conclude that as a whole, ESWL is the least expensive therapy in terms of national economy compared with TUL and open surgery.