[Experience with ultrasound-guided ESWL]

The ESWL treatment of gallstones has led to the development of ultrasound-guided lithotripters. The interdisciplinary use of these new ESWL systems by urologists, general surgeons and gastroenterologists means that different requirements have to be met. As a result of this development, ultrasound in urology is gaining even more significance. While ESWL treatment of renal calculi under ultrasound guidance has quickly become a routine method, the in situ treatment of ureteral calculi is much more problematic. In our study the validity of diagnostic ultrasound for the localization of ureteral stones was investigated. In an unselected preliminary series only 30% of ureteral calculi could be located by ultrasound. The success rates were 39% for distal stones and 16% for proximal calculi. The treatment results of renal calculi are on a par with those previously obtained under fluoroscopic guidance. Once exact localization is obtained by ultrasound, disintegration rates for ureteral calculi are fully comparable to those performed under fluoroscopic guidance. However, 60% of ureteral stones can not be located by ultrasound. Therefore, retrograde manipulation and ureteroscopic stone disintegration gains more importance in interdisciplinary shock wave centers equipped with ultrasound-guided machines. A real alternative to second-generation lithotripters in the treatment of ureteral stones will thus only be obtained if an X-ray device can be added to the locating system if necessary. With this combination device the treatment of most ureteral calculi will thus be possible.