Telha KA et al, 2016: Extracorporeal shockwave lithotripsy monotherapy for treating patients with bladder stones.
Telha KA, Alkohlany K, Alnono I.
Department of Urology, Al-Thawrah Modern General Hospital and Ibn-Siena Hospital, Sana'a Medical College, Sana'a University, Yemen.
OBJECTIVES: To describe our experience with extracorporeal shockwave lithotripsy (ESWL) for the treatment of bladder stones of <20 mm.
PATIENTS AND METHODS: This study was prospectively performed in two hospitals (Althawrah Modern General Hospital, and Ibn Sina Specialized Hospital) between November 2012 and November 2015. In all, 44 patients presented with urethral or bladder stones. The location and size of the stones was assessed by abdominal ultrasonography and plain abdominal radiography of the kidneys, ureters and bladder. All patients with radiopaque stones of <20 mm underwent ESWL monotherapy after fixation of a Foley catheter in a supine position under intravenous analgesia.
RESULTS: The mean size of the stones was 15.8 mm and spontaneous evacuation occurred after removal of the Foley catheter without the need for adjuvant procedures in 40 patients (90.9%). Four patients (9%) developed acute urinary retention due to urethral impaction of large stone fragments. In two of them, the urethral catheter was successfully re-inserted pushing the fragments back to the bladder and a complementary session of ESWL resulted in more fragmentation of the stones, with spontaneous passage after catheter removal. In the other two patients (4.5%), the catheter could not be re-inserted and urgent endoscopic intervention was required.
CONCLUSIONS: ESWL monotherapy is safe and effective method for treatment of bladder stones with no other causes of infra-vesical obstruction. Several indications can be met including patients with high anaesthetic risk, patients fearing anaesthesia or endoscopic procedures, and patients who have difficulty in positioning.
Arab J Urol. 2016 Jul 25;14(3):207-10. doi: 10.1016/j.aju.2016.06.001. eCollection 2016 Sep.
The stones were treated in supine position and were in a stable position throughout the whole session. I wonder why despite these optimal conditions - no respiratory movements like with renal stones and different from ureteral stones a fluid chamber surrounding the stone – “2797 (2000–4000) shocks with a rate of 60–100 shocks/min and a mean (range) voltage of 17.5 (12–18) kV” were necessary to disintegrate the stones.