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Related Experiment Videos

[ESWL-resistant lithiasis].

C González Enguita1, J L Rodríguez Miñón-Cifuentes, J Cabrera Pérez

  • 1Servicio de Urología, Fundación Jiménez Díaz, Universidad Autónoma, Madrid.

Actas Urologicas Espanolas
|June 11, 1999
PubMed
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Some kidney stones resist treatment with shock wave lithotripsy (SWL). Calculus composition, particularly calcium phosphate dihydrate and calcium oxalate monohydrate, influences SWL success. Advanced imaging may predict treatment outcomes.

Area of Science:

  • Urology
  • Nephrology
  • Biophysics

Background:

  • Shock wave lithotripsy (SWL) is a common treatment for kidney stones, but treatment failures occur.
  • The reasons for SWL failure are multifactorial, involving lithotripter technology, stone characteristics, and patient factors.
  • Cavitation phenomena are hypothesized to explain SWL mechanisms, but calculus fragility is a key determinant.

Purpose of the Study:

  • To analyze SWL failures and identify factors contributing to treatment resistance.
  • To investigate the role of calculus chemical composition and crystalline architecture in SWL outcomes.
  • To evaluate the potential of diagnostic imaging for predicting SWL success.

Main Methods:

  • Analysis of 20 SWL failure cases from a series of 6,500 procedures.

Related Experiment Videos

  • Review of diagnostic tests including X-rays, helical CT, and densitometry for pre-SWL calculus recognition.
  • Correlation of calculus composition with SWL treatment outcomes.

    • Main Results:

    • 65% of cases experienced negative results after multiple SWL sessions (average 5).
    • SWL-resistant stones were often calcium phosphate (57%), calcium oxalate monohydrate (COM) (29%), or hypercalciuria-related (14%).
    • Surgical intervention, ureterorenoscopy with ultrasound lithotripsy, or watchful waiting were used for unresolved cases.

    Conclusions:

    • Certain calculi, including calcium phosphate dihydrate (brushite), COM, and cystine, are resistant to current SWL technology.
    • Pre-SWL chemical recognition of calculi using methods like helical CT may help predict treatment response.
    • Understanding calculus composition is crucial for optimizing SWL treatment strategies and managing resistant cases.