[Results of extracorporeal lithotripsy in urolithiasis patients in different modes of shock wave generation]

The authors analyse the results of extracorporeal shock-wave lithotripsy (ESWL) of nephroliths conducted on the units with different generation of the shock waves: electrohydraulic (n = 25, group 1), electromagnetic (n = 25, group 2), piezoeffect (n = 25, group 3). The results of dopplerography of renal vessels, densitometry of the concrements using spiral and multispiral computed tomography served control for comparison. It is shown that patients of groups 1 and 2 developed persistent impairment of intrarenal hemodynamics manifesting with a considerable rise of systolic and fall of diastolic blood flow velocity, with increased indices of peripheral resistance on day 1 and 5 after ESWL. Severity of intrarenal blood flow disorders should be considered when deciding on further sessions of ESWL. In this case extracorporeal lithotripsy with piezoelectric generation of shock wave is an optimal treatment. Depending on the effect on the intrarenal circulation, the second session in groups 1 and 2 should be performed at least in 5 day interval, in group 3--in 3 days. In large concrements (1.0-2.0 cm in size) with high structural density (801-1500 Hu) further sessions of ESWL must be made and piezolithotripsy is indicated as a low-traumatic method of the concrement fragmentation. In small fragments (0.5-1.0 cm) with low structural density (150-800 Hu) one session of lithotripsy is adequate. In this case any generation method can be used.