Renal ultrasonography in the management of calculus disease

Our experience with piezoelectric ultrasound-guided lithotripsy began in December 1985, and in the three years to February 1989, we have treated stones in more than 2200 kidneys in 2000 patients. Stones of any size or composition were treated. All stones apart from those situated in the area hidden by the pelvic bones could be localized by ultrasound. Focusing of the shock waves on stones located inside the kidney is as easy, fast, and safe as using an x-ray location system. Ureteral stones treated in situ accounted for 10 per cent of all treatments. The disadvantage of needing more time and experience to identify ureteral stones with ultrasound-guided localization is minor compared to the advantage of no x-ray exposure and the possibility of a continuous visual control of lithotripsy. At our hospital, the "old" x-ray-guided lithotripsy system (Dornier HM3) is used only in the rare cases of ureteral stones located in "no man's land" that cannot be pushed back or moved a little more toward the urinary bladder. In addition to the benefits of stone location by ultrasound, it is possible to detect urinary obstruction and dilatation of the collecting system more easily and effectively than by the use of radiographic contrast material. Renal ultrasonography must be considered an optimal technique in the management of calculus disease by lithotripsy.