Extracorporeal shock wave lithotripsy (ESWL) has been used in the treatment of urolithiasis since 1980s. The method has proven to be effective and minimally invasive, but in last years the effectiveness of the method has decreased significantly from 90 % to 60 %. Studying of the causes of this phenomenon and methods of improving treatment outcomes are important problems of modern minimally invasive urology.
The objective: to evaluate the effectiveness of the application of ESWL on Siemens Modularis Uro in the treatment of patients with ureterolithiasis.
Materials and methods. ESWL was performed in 662 patients with ureteral stones ranging in size from 5 mm to 19 mm on Siemens Modularis Uro.
Results. In 95.01 % of cases, the urinary tract was free of stones by the method of ESWL, the removal of stones in 1 session occurred in 376 (56.8 %) patients, with repeated – in 253 (43.2 %) patients. In 33 (4.99 %) patients the result of ESWL was unsatisfactory, fragmentation or elimination of stone fragments did not occur and for these patients ureteroscopy (ureterolithotripsy) was performed as second stage of treatment. During endoscopic intervention in 78.8 % of patients the fragmentation was satisfactory (fragments were smaller than 4 mm), but the elimination of fragments did not occur due to changes of the wall of the ureter in the area of its primary location. The overall rate of stone fragmentation after ESWL sessions in the patients in the trial was 98.94 %. Conducting ESWL with the proposed parameters did not affect the effectiveness of the method (p>0.1), but allowed to significantly increase the life of medical equipment. No complications directly related to lithotripsy were detected.
Conclusion. The obtained results make possible to consider ESWL as a priority method of treatment for patients with ureteral stones up to 15 mm, taking into account the risk factors of inefficiency.
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