Primary treatment of ureteral stones by new multiline lithotripter

During the last 15 years, a second and a third generation of lithotripters have been developed. We present the results achieved by primary extracorporeal shockwave lithotripsy (SWL) of ureteral calculi treated with the new Multiline Lithotripter (Siemens).

From April 1996 until February 1997, 50 men and 17 women ages 19 to 82 (mean 50.9) years, underwent SWL as a primary treatment of ureteral stones at the Department of Urology, University of Düsseldorf. Data were analyzed retrospectively. More than half (60%) of the 67 patients had left ureteral stones. The most frequent site was proximal (46%) followed by distal (37%). The mean stone diameter was 9 mm. A total of 118 treatments were performed.

The success rates of SWL monotherapy for upper, mid, and lower ureteral calculi were 71%, 82%, and 72%, respectively. Although in 62% of the cases, complete, and in 33% partial, stone disintegration was achieved, auxiliary procedures (ureteral stenting, nephrostomy, and ureteroscopy) were necessary in 43% of the patients. Renal hematoma occurred in two patients, who were treated for upper ureteral calculi. Two thirds of the patients were discharged from the hospital free of stones.

Primary SWL treatment of ureteral stones with the new Multiline showed good results in about 84% of cases, although 43% of patients required auxiliary procedures. The occurrence of renal hematoma after the treatment of upper ureteral stones is an unexpected complication and makes reduction of the applied energy necessary if the kidney lies within the field of shockwave application.