The Safety of Extracorporeal Shock Wave Lithotripsy in the High-Risk Patient and in the Patient with Compromised Renal Function
During the first year of operation, the Springfield, Illinois, extracorporeal shock wave lithotripter was used to treat approximately 400 patients with renal and/or ureteral calculi. Of these, 18 patients were identified as particularly challenging cases due to complicated stone disease such as staghorn calculi and associated high-risk medical problems. Over 60% of these patients had severely compromised renal function due to various causes in addition to the complex stone disease. Eleven patients had some form of urinary diversion such as ileal or colon conduits or uretero-sigmoidoscopy. Morbid obesity complicated three patients and two had perinephric abscesses at the time of the initial evaluation. All patients had associated urinary tract infections.
Patients were evaluated with routine renal function studies in addition to the use of single photon emission computer tomography renal scanning to identify any possible deleterious effects of extracorporeal shock wave lithotripsy (ESWL) in the compromised patients. Several patients required the use of ancillary techniques such as placement of stents and/or nephrostomy tubes for drainage during their treatments. However, there was no evidence of overt renal damage following ESWL.
KeywordsShock Wave Single Photon Emission Compute Tomography Shock Wave Lithotripsy Urinary Diversion Extracorporeal Shock Wave Lithotripsy
Unable to display preview. Download preview PDF.
- 3.Chaussy C and Schmidt E: Shock wave treatments for stones in the upper tract. Urol Clin N Am 10: 743, 1983.Google Scholar