New Advances for Anesthesia-Free Treatment Using the Sonolith Lithotripter
First-generation devices for extracorporeal shock wave lithotripsy (ESWL) required general or epidural anesthesia. The first version of the Technomed Sonolith lithotripter was also equipped with a conventional spark gap generator with a 16 cm ellipsoidal reflector. Since 1987 a new 26 cm reflector with a modifier condenser capacity (Diatron) has been used. Three hundred fifty patients were treated with the first generator for a total of 390 treatments (27 upper ureteral stones, 197 calyceal stones, 136 renal pelvic stones; mean size 15 mm); 90% of patients required more than one ESWL session, and an average of 1,650 shock waves were delivered per patient. Fifty-two percent and 81% of patients were stone free at one month and three months, respectively. General or epidural anesthesia was always required in this group. One hundred forty-nine patients were treated with the new Diatron generator. Stone location was in 102 cases in the calices and in 47 cases in the renal pelvis (mean size 11 mm; 1,800 shock waves per patient). Complete stone evacuation was observed in 65% of patients followed at one month and in 84% at three months. Twelve patients (18%) required more than one session. IV sedation (diazepam 5 mg or Phenoperidin 0.5 mg) was sufficient in 90% of patients; in 10% of cases no medication at all was required. Ureteral obstruction requiring complementary maneuvers occurred in four cases.
Our experience shows that it is possible to achieve anesthesia-free treatment in ESWL. Enlargement of the spark gap reflector seems to be crucial and does not appear to affect clinical results.
KeywordsShock Wave Epidural Anesthesia Shock Wave Lithotripsy Extracorporeal Shock Wave Lithotripsy Ureteral Stone
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