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KMID : 0377519900150040369
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Chung-Ang Journal of Medicine
1990 Volume.15 No. 4 p.369 ~ p.378
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Experimental Study on Effects of Stone Fragmentation by Extracorporeal Shock Wave Lithotripsy (ESWL) according to Size, Component and Impaction of Urinary Stones
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Abstract
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An experimental study was done to investigate an effect of the stone size, component and impaction on stone fragmentation by ESWL.
Pieces of chalks as artificial stones and urinary stones which were removed by lithotomies were placed in the isolated segments of rabbit´s small intestine serving as an artificial ureter. And then shock waves of the same frequency, power were shot to the stones for the same duration. The experimental ESWL were done using EDAP-LTO1 piezoelectric lithotriphter.
The results were as follows;
1. The effect of destruction was proportionally decreased to the increment of stone size in the same component stones. For complete fragmentation, the elapsed time was extended to 2.4, 3.8 times and the storage requirement was increased to 2.6, 4.2 times respectively according to the increment of stone size with 2 to 3 times.
2. On ESWL of the same sized stones, the significant difference in degree of the stone fragmentation was not found in accordance with stone components under the same pericalculus condition.
3. The same sized and composite artificial stones were destructed under the freely movable state in contact with saline (non-impacted condition) and the impacted condition in the rabbit´s small intestine. Until complete fragmentations, 3.0 times of the storage and 3,1 times of the duration were required in the impacted condition comparing to the non-impacted condition (p<0.01).
Moreover, the rate of fragmentation was significantly decreased to 31.1´7o in the impacted condition when the aaverage storage (19) of shockwaves for complete destruction in the non-impacted condition was applied.
4. In 20 urinary stones which failed in destruction by repeat ESWL and were removed by lithotomy,
the effect of impaction on fragmentation of the stones was investigated in vitro. There was a significant difference (p<0.05) between impacted and non-impacted state: 87.8 22.8% in the nonim-
pacted condition and 65.8 34.7 % in the impacted condition. Furthermore, of 99 patients who were failed in treatment of urinary stone by repeat ESWL for 3 sessions or more, the complete
obstruction which means no visualization of contrast medium in the urinary tract below the stones was shown in 57 eases (57.6 To) and narrowing of the urinary tract overlying the stone site w present in most cases (92.9%) on the IVP before ESWL treatment.
In conclusion, it is confirmed that the impacted state of the urinary stone is the most influential factor of the stone fragmentation by ESWL and the stone component is not that much contributed to the stone fragmentation. And push-up manipulation of the impacted ureteral stones identified on pre-ESWL IVP is thought to shorten treatment duration and also, to curate higher success rate than those of the in-situ ESWL.
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