El-Halwagy S et al, 2013: Shock wave lithotripsy of vesical stones in patients with infravesical obstruction: an underused noninvasive approach
El-Halwagy S, Osman Y, Sheir KZ
Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
OBJECTIVE: To evaluate the effectiveness and safety of shock wave lithotripsy in the management vesical stones in patients with infravesical obstruction.
MATERIALS AND METHODS: From March 2007 to April 2010, 59 male patients with infravesical obstruction were treated using the Dornier Compact Delta II Lithotriptor for urinary bladder stones. The indications for shock wave lithotripsy included patients refusing invasive procedures or those with orthopedic malformations hindering the lithotomy position. The mean age was 61.6 ± 8.6 years (range 44-78), and the mean body mass index was 29 ± 5.1 kg/m (range 20.5-45). The mean stone diameter was 26.6 ± 9.8 mm (range 12-50). All patients underwent an initial session and were re-evaluated using ultrasonography and urinary tract plain radiography at 2-week intervals.
RESULTS: All patients were treated in the supine position. The number of shocks ranged from 1910 to 9500. Of the 59 patients, 47 and 11 were cleared by 1 or 2 sessions, respectively; 1 patient required a third session to be cleared of stones. All patients develop mild hematuria and started to pass gravel in the first void after the shock wave lithotripsy session. All patients were rendered stone free within 6 weeks. During follow-up, only 2 male patients developed temporary acute urine retention necessitating urethral catheter fixation. Both patients had a neurologic insult.
CONCLUSION: Extracorporeal shock wave lithotripsy is an effective, noninvasive approach to disintegrate vesical stones in patients with infravesical obstruction with adequate fragment clearance.
Urology. 2013 Mar;81(3):508-10. doi: 10.1016/j.urology.2012.11.027. Epub 2013 Jan 17
PMID:23332999 [PubMed - indexed for MEDLINE]
I agree with the authors that SWL is an excellent method for elimination of bladder stones in suitable patients. The results presented in this study also clearly emphasize the value of this non-invasive approach.
My personal routine has been to use a bladder catheter so that the filling of the balder can be controlled if necessary. Administration of shock waves from the abdominal side, as used by the authors, is preferable, but in some patients treatment from the back can be better. Manipulation of the patient positioning may be necessary bin order to get the stone(s) in the most favourable position.