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Anesthesia with Acuruncture for ESWL
Calculi 728
729
"TREATMENT OF URETERAL STONES: CONTROVERSIES AND EMERGING· CONCEPTS" *Gerhard J.Fuchs UCLA Stone Center, Division of Urology, University of California, Los Angeles, U.S.A. (Presented by Dr. Fuchs) Since ureteral stones have been included into the range of stones routinely treated by ESWL, controversy as to whether ESWL should be done in an "in situ" fashion or whether it should be preceeded by ureteral stone manipulation has persisted. In this regard, we basically have noticed a continental shift reflecting the peculiarities of different health systems in Europe and the U.S. In the United States, most centers prefer stone manipulation by ureteral stents in a retrograde fashion. This is done in order to reposition the stone into the renal collecting system or to bypass it in order to create an artifical expansion chamber. At UCLA we pursue a differentiated approach which is as follows: based on the radiographic appearance of an existing natural expansion chamber, approximately 10% of stones above the iliac crest, and 25% of stones located in the pelvic window that is in the true pelvis, below the pelvic brim are eligible for ESWL in situ treatment. All other stones, which do not qualify for in situ treatment still undergo ureteral stone manipulation, utilizing stents and extensive ureteral lubrication. This differential approach, has advantages over our previously described combined approach, in that it does not change the success rate and overall hospital stay, but it does save ureteral manipulation for approximately 30% of patients.
ESWL: WHAT IS PROVEN, WHAT IS CONTROVERSIAL? Christian G. Chaussy UCLA Stone Center, Division of Urology, Los An eles Ca.
730
731
EXTRACORPOREAL MICROEXPLOSIVE LITHOTRIPSY-RENAL FUNCTION BEFORE AND AFTER THE TREATMENT ESTIMATED BY 99m-TcDMSA UPTAKE-RATE IN RENOSCINTIGRAM, *Naomasa Iori tani, -:CMasaaki Kuwahara, '11-Kazuyoshi Takayama, ·:i-seiichi Kurosu, ~1-Shizuichi Kageyama, *Koichi Kambe, *Katsuyuki Taguchi, *Seiichi Orikasa, Sendai, Japan, (Presentation to be made by Dr., Ioritani) We performed extracorporeal shock wave lithotripsy using chemical explosive (EML) in 108 patients(ll2 treatments) from March, 1985 to March, 1986. This report describes the results of renal function study estimated by 99m-TcDMSA uptake-rate from 1 to 3 months before and after the treatment. As the explosive material, lead-azicle pellets of 10mg were used and the shock wave focuslng was conducted by an ellipsoidal reflecter in a water bath, The patients were divided into 2 groups: group A; treated by EML monotherapy, gruop B; treated by combined therapy with percutaneous lithotripsy and/or transurethral uretcro lithotripsy, The combined therapy was generally necessitated by the stagnation of fragmentated stones which remained in the same location, usually for more than 2 to 3 weeks. In group A, the uptake-rate of the targeted kidney before and after the treatment was 19.2%, and 18,3%(mean±s,d,, n=30), The difference of the uptake-rate between pre-and post-EML was -0,9% in group A, The difference was statistically insignificant(p>0,05, a paired ttest), In group B, the uptake-rate was 19,3±2,8%, and 14.9±6,5%(meants,d,, n=l 7). The difference in B group was -4,4%, and was statistically significant(p<0.01, a paired t-test), The results indicate that the main factor influencing the renal function in the extracorporeal shock wave therapy is not the shock wave itself, but the period of stagnation of the fragmentated stones inside tbe ureter which caused hydronephrosis, From these results we believe that the fragmentated stones should be removed not later than 2 weeks, if they induced urine stagnation, or caused a non-visualizing kidney on IVP,
ANESIBE.SIA WITII ACUaJN2IURE FOR ESWL. Luke S. Chang, Ming-Tsun Chen, John H. Yin, Jong-Khing Huang, Shirm-Nan Lln (presentation to b2 ffi3.de by Dr.
Six years of routine clinical use have proven ESWL to be a safe and reliable method for noninvasive treatment of urinary stones. It has rapidly superseeded previously used procedures for the treatment of the vast majority of upper tract urinary stones. Worldwide experience with the Dornier lithotripter has also shown that the results are reproducible even when not all differential indications and treatment approaches are uniquely pursued. Especially in the treatment of ureteral stones a "continental shift" has developed between Europe and the U.S.A which basically reflects the peculiarities of the different health systems. In Europe the noninvasive in situ approach is utilized at most centers, which produces the primary success rate of approximately 60% - 70% for a one stage procedure. This is not acceptable in the U.S.,therefore,in this country most ureteral stones are manipulated prior to ESWL for a success rate of greater 95% for one session. In the treatment of staghorn stones a differentiated approach begins to take hold as it has been more clearly defined which stones best qualify for either ESWL, PCN, or the combination of both procedures.
John H. Yin ) 'Ihe rrain aims of anesthesia in ESWL are to relieve the p:lin during ESWL arrl rrore e.asily attack the stone. 'Ihis hospital had treat renal and ureteral store with ESWL for 1739 cases. M:>st of the cases ~ used the epidural or N general anesthesia during ESWL. 'Ihere are 19 cases ~ use the A.cup..mct.ure for anesthesia. We p..mcture at 5 caves with 3 Hz biplaSic electric current stimulation. There are 8 cases need not any other analgesics. '!he rrean p.tl.se numter is 1200. The reraing 11 cases still need other analgesic. 'The rrean p.ilse nuril:er is 1700. N:J significant ccmplication is note:l. For ffifill renal arrl ureteral stone, the Acupuncture is an alternative way for anesthesia in RSWL.
286A
729
"TREATMENT OF URETERAL STONES: CONTROVERSIES AND EMERGING· CONCEPTS" *Gerhard J.Fuchs UCLA Stone Center, Division of Urology, University of California, Los Angeles, U.S.A. (Presented by Dr. Fuchs) Since ureteral stones have been included into the range of stones routinely treated by ESWL, controversy as to whether ESWL should be done in an "in situ" fashion or whether it should be preceeded by ureteral stone manipulation has persisted. In this regard, we basically have noticed a continental shift reflecting the peculiarities of different health systems in Europe and the U.S. In the United States, most centers prefer stone manipulation by ureteral stents in a retrograde fashion. This is done in order to reposition the stone into the renal collecting system or to bypass it in order to create an artifical expansion chamber. At UCLA we pursue a differentiated approach which is as follows: based on the radiographic appearance of an existing natural expansion chamber, approximately 10% of stones above the iliac crest, and 25% of stones located in the pelvic window that is in the true pelvis, below the pelvic brim are eligible for ESWL in situ treatment. All other stones, which do not qualify for in situ treatment still undergo ureteral stone manipulation, utilizing stents and extensive ureteral lubrication. This differential approach, has advantages over our previously described combined approach, in that it does not change the success rate and overall hospital stay, but it does save ureteral manipulation for approximately 30% of patients.
ESWL: WHAT IS PROVEN, WHAT IS CONTROVERSIAL? Christian G. Chaussy UCLA Stone Center, Division of Urology, Los An eles Ca.
730
731
EXTRACORPOREAL MICROEXPLOSIVE LITHOTRIPSY-RENAL FUNCTION BEFORE AND AFTER THE TREATMENT ESTIMATED BY 99m-TcDMSA UPTAKE-RATE IN RENOSCINTIGRAM, *Naomasa Iori tani, -:CMasaaki Kuwahara, '11-Kazuyoshi Takayama, ·:i-seiichi Kurosu, ~1-Shizuichi Kageyama, *Koichi Kambe, *Katsuyuki Taguchi, *Seiichi Orikasa, Sendai, Japan, (Presentation to be made by Dr., Ioritani) We performed extracorporeal shock wave lithotripsy using chemical explosive (EML) in 108 patients(ll2 treatments) from March, 1985 to March, 1986. This report describes the results of renal function study estimated by 99m-TcDMSA uptake-rate from 1 to 3 months before and after the treatment. As the explosive material, lead-azicle pellets of 10mg were used and the shock wave focuslng was conducted by an ellipsoidal reflecter in a water bath, The patients were divided into 2 groups: group A; treated by EML monotherapy, gruop B; treated by combined therapy with percutaneous lithotripsy and/or transurethral uretcro lithotripsy, The combined therapy was generally necessitated by the stagnation of fragmentated stones which remained in the same location, usually for more than 2 to 3 weeks. In group A, the uptake-rate of the targeted kidney before and after the treatment was 19.2%, and 18,3%(mean±s,d,, n=30), The difference of the uptake-rate between pre-and post-EML was -0,9% in group A, The difference was statistically insignificant(p>0,05, a paired ttest), In group B, the uptake-rate was 19,3±2,8%, and 14.9±6,5%(meants,d,, n=l 7). The difference in B group was -4,4%, and was statistically significant(p<0.01, a paired t-test), The results indicate that the main factor influencing the renal function in the extracorporeal shock wave therapy is not the shock wave itself, but the period of stagnation of the fragmentated stones inside tbe ureter which caused hydronephrosis, From these results we believe that the fragmentated stones should be removed not later than 2 weeks, if they induced urine stagnation, or caused a non-visualizing kidney on IVP,
ANESIBE.SIA WITII ACUaJN2IURE FOR ESWL. Luke S. Chang, Ming-Tsun Chen, John H. Yin, Jong-Khing Huang, Shirm-Nan Lln (presentation to b2 ffi3.de by Dr.
Six years of routine clinical use have proven ESWL to be a safe and reliable method for noninvasive treatment of urinary stones. It has rapidly superseeded previously used procedures for the treatment of the vast majority of upper tract urinary stones. Worldwide experience with the Dornier lithotripter has also shown that the results are reproducible even when not all differential indications and treatment approaches are uniquely pursued. Especially in the treatment of ureteral stones a "continental shift" has developed between Europe and the U.S.A which basically reflects the peculiarities of the different health systems. In Europe the noninvasive in situ approach is utilized at most centers, which produces the primary success rate of approximately 60% - 70% for a one stage procedure. This is not acceptable in the U.S.,therefore,in this country most ureteral stones are manipulated prior to ESWL for a success rate of greater 95% for one session. In the treatment of staghorn stones a differentiated approach begins to take hold as it has been more clearly defined which stones best qualify for either ESWL, PCN, or the combination of both procedures.
John H. Yin ) 'Ihe rrain aims of anesthesia in ESWL are to relieve the p:lin during ESWL arrl rrore e.asily attack the stone. 'Ihis hospital had treat renal and ureteral store with ESWL for 1739 cases. M:>st of the cases ~ used the epidural or N general anesthesia during ESWL. 'Ihere are 19 cases ~ use the A.cup..mct.ure for anesthesia. We p..mcture at 5 caves with 3 Hz biplaSic electric current stimulation. There are 8 cases need not any other analgesics. '!he rrean p.tl.se numter is 1200. The reraing 11 cases still need other analgesic. 'The rrean p.ilse nuril:er is 1700. N:J significant ccmplication is note:l. For ffifill renal arrl ureteral stone, the Acupuncture is an alternative way for anesthesia in RSWL.
286A