Heretis I et al, 2010: Strategic lithotripsy using the Doli S EMSE 220 F-XP for the management of staghorn renal calculi
Heretis I, Mamoulakis C, Papadimitriou V, Sofras F
Department of Urology, University Hospital of Heraklion, University of Crete Medical School, 71110, Heraklion, Crete, Greece
Abstract
AIM: The presentation of our results using the Dornier lithotripter (Doli) S electromagnetic shockwave emitter (EMSE) 220 F-XP for the strategic management of staghorn renal calculi.
METHODS: Sixteen patients with renal staghorn stones of more than 35 mm in maximum length on plain X-rays were treated by shock wave lithotripsy (SWL) monotherapy with the Doli S EMSE 220 F-XP. Double-J ureteral stent was inserted to all prior to the first SWL treatment. Shock wave counts varied from 2,500 to 3,600 with a shock release frequency of 70-80 pulses per minute. The number of sessions varied from 2 to 6. The interval between the SWL sessions was around 1 month. Fragmentation rate of 20-25% of the stone load per session was considered a valid criterion for progressing to further SWL sessions.
RESULTS: Nine patients became stone free at the end of SWL sessions and two patients had renal stone fragments smaller than 4 mm, which were eliminated 6 months later. Two patients developed streinstrasse that was managed with ureteroscopy. Auxiliary SWL was also performed on three patients with residual ureteral calculi. The mean follow up period was 12 months. The remaining five patients underwent open surgery for incomplete stone fragmentation. No major complications developed during the follow up period. The predominant composition of stones available for analysis was struvite.
CONCLUSION: Doli S EMSE 220 F-XP can be a safe and effective treatment option for renal staghorn stones on an outpatient basis.
Int Urol Nephrol. 2011 Mar;43(1):61-5. doi: 10.1007/s11255-010-9765-0. Epub 2010 Jun 8
PMID: 20532626 [PubMed - in process]
Comments 1
Uups! This paper from Greece was received 2 February 2006 and accepted 10 May 2010.
It is a small series on SWL monotherapy of staghorn stones. All patients received a Double-J stent prior to the SWL treatment until the end of treatment after 2 two 6 months. There is no mentioning of the patients discomfort and probably reduced quality of life during that time.
The authors state: “our region belongs to those parts of the world, where a lithotripter is still the only option other than open surgery given that PNL is currently not available.” Hopefully this has changed.
There are no publications of the authors on the same subject after 2006. They probably have changed to a more guideline conform approach.
Peter Alken