Presented at WCE 2006, Cleveland, Ohio, U.S.A.
Unit of Urology - Sanremo Hospital - Italy
Francesco Germinale, Luca Timossi, Paolo Bruno, Franco Bertootto, Paolo Puppo
World Congress of Endourology 2006, Cleveland, Ohio, USA
Introduction
Shock waves are usually produced from a single source at a mean frequency of 120 waves/ min. We utilize a device (Direx Duet) with two reflectors working at 120 waves / min each, forcing 240 waves / min against the stone.
Materials and Methods
From September 2005 to March 2006, 50 patients affected with ureteric and /or renal stones were treated in our unit. On the whole, 58 urinary were treated. All patients were submitted to ESWL under analgesia i.v (ketorolac 30 mg + Tramadolo 100mg + Butilscopolamine 40 mg).
Pain intensity was evaluated by the Visual Analogue Scale (VAS). After the treatment, patients were asked to complete a questionnaire to select tolerable from no-tolerable group. The intensity increase was 1 HV / 100 shock waves, till maximum of 10 HV after 1,000 shock waves.
Stone Size
|
5-10 mm
|
11-15mm |
>16mm
|
Average Size
|
| 36 |
20 |
2
|
8.64
|
| Stone Location |
| UC |
MC
|
LC
|
RP
|
UPJ
|
UU
|
MU
|
| 5 |
13
|
16
|
19
|
0
|
3
|
2
|
Results
All patients (31 male and 19 female, mean age of 50 years) completed the treatment. Only 1 patient did not reach the maximum intensity. The mean pain severity was 3,3 (range 0-9).
After the first treatment, 19-50 patients declared themselves able to undergo the next treatment without analgesia. Fifteen of them completed the second treatment but 10 (8 with stone in superior calyces, 2 in renal pelvis) complained of a more intense pain. The other 4 required analgesia for the completion. No relation was found between pain and stone's size, age and sex of the patient.
Complications occurred in 3 patients (1 renal haematoma and 2 renal colic).
| Results |
Stone Treated
|
Success
|
Partial Fragments
(>4mm)
|
No Fragmentation
|
| 58 |
85%
|
8%
|
7%
|
Conclusion
Our results suggest that ESWL under analgesia is safe, simple and shows good compliance and tolerance. In order to select the patients a careful clinical examination is mandatory.
References
- Oh SJ et al. "Subjective pain scale and the need for analgesia during shock wave lithotripsy" Urol Int.2005;74:54-7.
- Medina HJ et al. "Remifentanil as a single drug for extracorporeal shock lithotripsy: a comparison of infusion doses in terms of analgesic potency and side effects" Anesth Analg. 2005; 101:365-70
- Chin CM et al. "Use of patients-controlled analgesia in extracorporeal shockwave lithotripsy" By J Urol. 1997;79:848-51
|
