[Experience with ultrasound-guided ESWL]

Area of Science:

• Urology
• Medical Imaging
• Nephrology

Background:

• Extracorporeal shock wave lithotripsy (ESWL) for gallstones spurred ultrasound-guided lithotripter development.
• Ultrasound's significance in urology is increasing due to interdisciplinary ESWL system use.
• While ESWL for renal calculi under ultrasound guidance is routine, ureteral calculi treatment remains challenging.

Purpose of the Study:

• To investigate the diagnostic validity of ultrasound for localizing ureteral stones.
• To assess the feasibility of ultrasound-guided ESWL for ureteral calculi.

Main Methods:

• An unselected preliminary series of patients with ureteral stones was evaluated.
• Diagnostic ultrasound was used to attempt localization of ureteral stones prior to treatment.
• Treatment outcomes were compared to fluoroscopic guidance where applicable.

Main Results:

• Only 30% of ureteral calculi were successfully located by ultrasound.
• Localization success rates were 39% for distal and 16% for proximal ureteral stones.
• When localized, ultrasound-guided ESWL disintegration rates for ureteral calculi were comparable to fluoroscopic guidance.

Conclusions:

• Diagnostic ultrasound has limited efficacy in locating ureteral stones, with 60% remaining undetected.
• Retrograde manipulation and ureteroscopic stone disintegration become more important in ultrasound-guided ESWL centers.
• A combination device with both ultrasound and X-ray capabilities is necessary for effective ureteral stone treatment.