Introduction

Effects of ESWL on kidney/ureter and the surrounding tissues had been observed in 10 cases of failed ESWL on an indigenous lithotripter.

Materials And Methods

Between February '96 and August '97; a total of 550 cases underwent ESWL at this centre on an indigenously built lithotripter Vulcan VL-10. Six cases of stag horn renal calculi and 4 cases of ureteric stones had to be later explored for non-fragmentation and complications. Each of these patients had received a minimum of 6000 shock-waves (electro-hydraulic) in two sittings at 19-21 KV settings.

Results

Two cases underwent extended pyelolithotomy and two had lower pole partial nephrectomy along with. The capsule shelled off easily because of surface oedema and the underlying parenchyma was a little more fiery and friable. The procedures were uneventful. One case of perinephric haematoma needed blood transfusion and had nephrectomy six months later for non-resolving mass and low grade fever. Another patient with a JJ stent in-situ had perinephric 'Urinoma' resulting from gross steinstrasse and blockage of all openings in the stent and had to be explored and drained and became alright. The steinstrasse was cleared by basketting and reintroduction of JJ stent. The four ureteric stones on exploration did not show signs of fragmentation as they were impacted. No significant changes were noticed in the periureteric tissues. These cases were explored after a minimum of 15 days after the last ESWL sitting.

Discussion

Considering the loss of one kidney and one case of Urinoma and no significant tissue changes in this series of 550 patients, the procedure of ESWL on this machine is to taken as very safe.

Summary

 Effects of ESWL on 10 cases of failed ESWL and two gross complications in a series of 550 cases on this indigenously assembled lithotripter was discussed and observed. The procedure was safe in this machine.

Author: Dr. (Prof.) R.K. Mahanta
M.S., M.Ch. (URO)
USI number-M-004-FL
Chief Consultant Urologist