Second-Generation Lithotripsy Using the Lithostar: Experience with 4,328 Patients

Abstract

To date more than 5,000 patients with nephrolithiasis have been treated in the 22 stone centers using the Lithostar second-generation lithotripter. The stone disintegration rate is 95% to 96% with a mean of 2,200 shock waves utilized per patient. Auxiliary treatments including the use of double-J stents, Zeiss loops for distal ureteric stones, or percutaneous procedures were 14%. Complications were colic in 9% and fever in 0.5% of patients. Subcapsular hematoma often was related to untreated hypertension and was seen in 0.3%. Patients were treated with local infiltration anesthesia at the coupling site of the shock wave generator or by using oral analgesia/sedation. Peridural anesthesia was applied only in patients who needed retrograde or endoscopic manipulations. Children were always treated with general anesthesia. Three months after discharge 65% to 72% of patients were stone free. The remaining 28% to 35% had residual fragments small enough to pass spontaneously. Thirty patients were treated with cholelithiasis. The indications for extracorporeal shock wave lithotripsy (ESWL) were restricted to common bile duct stones or intrahepatic calculi. In all intrahepatic stones ESWL resulted in successful stone disintegration. The fragments passed spontaneously or were extracted endoscopically. In 15 patients with common bile duct stones, ESWL resulted in successful stone disintegration, and obstruction cleared within days. These patients were treated using a combination of Tramadol 100 mg and Diazepam 10 mg. Electromechanic second-generation lithotripsy is effective, not only for disintegration of urinary calculi but also for lithotripsy of calculi in the bile duct or gallbladder.