Continuous Flow Extracorporeal Shock Wave Lithotripsy
The use of ESWL in the management of large, branched (partial or complete) staghorn calculi has increased as familiarity with technique becomes commonplace. These stones are often accompanied by complications in treatment such as the need for multiple treatments, formation of steinstrasse, or the inability to fragment the stone.
A new technique termed “continuous flow ESWL” seems to enhance the disintegration of stones of the type mentioned above. A percutaneous nephrostomy tube of drainage caliber only (8.5 to 10 Fr.) is used in association with a ureteral catheter or double- J stent and a urethral Foley catheter.
Irrigation is administered via the nephrostomy tube and exits down the ureter (aided by the ureteral catheter or stent) and then out the urethra by way of the Foley catheter.
The continuous flow of high volumes of irrigant over the stone seems to increase the rapidity of stone disintegration and in some cases seems to allow for stone break-up where little or no fragmentation had occurred in earlier treatments.
KeywordsShock Wave Lithotripsy Foley Catheter Extracorporeal Shock Wave Lithotripsy Ureteral Catheter Nephrostomy Tube
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