Al-Marhoon MS, Shareef O, Al-Habsi IS, Al Balushi AS, Mathew J, Venkiteswaran KP
Urology Division, Department of Surgery, Sultan Qaboos University Hospital, Sultanate of Oman

Abstract

OBJECTIVE: To assess the efficacy and safety of extracorporeal shock wave lithotripsy with Modularis Vario Siemens in the management of patients with renal and ureteral stones.

METHODS: Between 2007 and 2009, 225 outpatients were treated with Siemens Modularis Vario lithotripter at Sultan Qaboos University Hospital. Stone size, location, total number of shockwaves, stone-free rate, complications and adjunctive interventions were investigated. Chi-Square and Logistic Regression analyses were used, with p<0.05 set as the level of significance.

RESULTS: Of the 225 initial consecutive patients who underwent extracorporeal shock wave lithotripsy, 192 (85%) had renal stones and 33 (15%) had ureteric stones. The mean±SD stone size was 11.3±4.5 mm, while the mean age of the patients was 39.9±12.8 years with 68.5% males. The mean renal stone size was 11.6±4.7 mm; a mean of 1.3 sessions was required. The mean ureteric stone size was 9.9±3 mm; and a mean of 1.3 sessions was required. Treatment success (defined as complete clearance of ureteric stones, stone-free or clinically insignificant residual fragments of 4 mm for renal stones) was 74% for renal stones and 88% for ureteric stones. Additional extracorporeal shock wave lithotripsy and ureteroscopy were the most adjunctive procedures used for stone clearance. Complications occurred in 74 patients (38.5%) with renal stones and 13 patients (39.4%) with ureteric stones. The most common complication was loin pain (experienced by 16.7% with renal stones and 21% with ureteric stones). Severe renal colic mandating admission occurred in 2% of patients with renal stones and 6% of patients with ureteric stones. In patients with renal stone, steinstrasse occurred in 3.6% and infection post extracorporeal shock wave lithotripsy in 0.5%. Using Multivariate Logistic Regression analysis, factors found to have significant effect on complete stone clearance were serum creatinine (p=0.004) and the number of shockwaves (p=0.021).

CONCLUSION: Siemens Modularis Vario lithotripter is a safe and effective tool for treating renal and ureteric stones.

Oman Med J. 2013 Jul;28(4):255-9. doi: 10.5001/omj.2013.72
PMID:23904918 [PubMed] PMCID:PMC3725239. FREE ARTICLE