THE UROLOGICAL SOCIETY OF INDIA

ANNUAL MEETING: USICON 1994
20-23 December
NRS MEDICAL COLLEGE & HOSPITAL
Calcutta, India

Abstract of Presentation

Extracorporeal shock wave lithotripsy has revolutionized the treatment of Renal and Ureteric stones. It permits removal of Renal and Ureteric stones without any direct surgical intervention. This, a lithotripter has become a necessity for every urologist. As most of the lithotripters available are very costly, so we procured an indigenously-developed lithotripter and evaluated its efficacy in treatment of Renal and Ureteric stones in200 cases since January 1993.

Vulcan VL-10 Lithotripter was used for the treatment of Renal and ureteric stones in 200 patients. The stones were of different sizes (8-30 cm) and, either Renal or Ureteric stenting was done if the stone was more than 15 mm. For treatment of Ureteric stones pushback and stenting was done but if the stones could not be pushed back and in mid-ureteric and lower-ureteric stones, shock-waves were given without any stenting or catheterization. Treatment was started with low KV i.e. 12 and KV was gradually increased up to 20. Sedation was not given as a routine. Except in apprehensive patients or when patients complained of pain. Children below 10 years were not accepted for treatment. Cases with recurrent stones were accepted for ESWL. The clearance was aimed within 3 months of starting the lithotripsy.

The patients were followed for the period of 3 months for stone clearance and any complications. Of the 200 cases treated with Vulcan VL-10 Lithotripter 184 were stone free by the end of 3 months. 3 patients did not show fragmentation and were taken for Percutaneous Nephrolitholapaxy. 8 patients required Ureteroscopic Extraction of fragments in lower ureter. Five patients were followed for another three months and were stone-free by the end of six months. 28 Patients had colic due to passage of small fragments and 2 had fever. They were treated conservatively. No other systematic complication was noticed.

As the objective of the study was to assess the efficacy of the Indian Lithotripter in treatment of stones, the stone clearance was taken as the main objective. 184 patients i.e. 92% were stone-free at the end of 3 months and another 5 patients were stone-free by the end of 6 months of commencement of Lithotripsy without any additional procedure i.e. overall rate of clearance was 94.5% in 6 months. 8 patients with Steinstrasse required Ureteroscopic extraction i.e. 4% and three were adjudged to be failures, requiring PCNL for stone removal i.e. 1.5%. These results are comparable to other published studies using Dornier HM-3 Lithotripter. Hans Goran et al in their studies showed 96% stone clearance at 4 weeks and Francisco et al showed 93% clearance using Dornier HM-3 Lithotripter.

In this study, it has been found that an indigenously developed Vulcan VL-10 Lithotripter is comparable to other as the stone clearance rate. No doubt our patients required multiple sittings and a longer time for stone clearance, but Indian Lithotripter is advantageous in our socio-economic set-up because of its cost-effectiveness. 

Dr.R.S.Chahal
Kidney Hospital, Jalandhar City