Presented Monday, 03 September 2007 at the 29th Congress of the Societe International d'Urologie - SIU 2007 - Optimizing Clinical Outcomes in Prostate and Renal Cell Carcinomas - The Second Annual Symposium on Advanced GU Malignancy - Palais des Congres de Paris, France

Introduction: Shockwave energy is meanwhile recognized as the most important shockwave parameter for stone desintegration. Modern lithotripsy systems take this fact into account and are equipped with high energetic shockwave sources. Aim of our study was, to investigate the range of shockwave energy, required for desintegration of stones in different localisations (kidney / ureter).

Methods: In 2006, 100 patients with ureteric stones and 100 patients with kidney stones were treated with the electromagnetic shockwave system SIEMENS Lithoskop® (E_12mm:4-91 mJ). Demographic parameters and stonesize were comparable in both groups. All relevant shockwave parameters were recorded in a MS-Access database for evaluation. All treatment were performed in i.v.analgesia; the result was judged by means of ultrasound and x-ray after 24 h.

Results: Average stone size in both groups was 11 mm (5 - 20 mm). All stones showed fragmentation after 1 ESWL-session (11 % stonefree, 61 % _ 3 mm, 21 % 3 - 5 mm, 7 % _ 5 mm). The maximum shockwave energy for fragmentation was 31 mJ for kidney stones and 55 mJ for ureteric stones in our investigation. Ureteric stones required higher shockwave number and higher shockwave energy for fragmentation; therefore the cumulative energy was about 50 % higher than in kidney stones (Ø 78 J vs. Ø 52 J).

Conclusion: Modern lithotripsy systems supply enough shockwave energy (up to 100 mJ) for the fragmentation of all stones in the urinary tract. Reasons for poor desintegration results might be unfavourable focal geometry, bad coupling of shockwave energy or wrong indication for stone treatment with ESWL.

Authors: Chaussy C, Bergsdorf T, Thueroff S

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