[Extracorporeal shock wave lithotripsy monotherapy for upper urinary tract stones using the Dornier lithotriptor...

A total of 345 cases of upper urinary tract stones (188 renal and 157 ureteral stones) were treated by extracorporeal shock wave lithotripsy (ESWL) monotherapy using the Dornier lithotriptor MFL5000. Of these cases 294 (85.2%) had stones less than 20 mm in length. A double-J ureteral stent was placed in 40 cases of renal stones and 8 ureteral stones due to large stone burden or failure of in situ ESWL for impacted stones. Epidural or spinal anesthesia was necessary in 32 cases to maximize the generator voltage or to prevent intractable pain. The number of ESWL sessions and shock waves increased in accordance with the stone size, with an average of 1.6 and 4442, respectively. Multiple sessions were required in 68 cases of renal stones (36.2%) and 59 of ureteral stones (37.6%). With a 3-month follow-up, the stone-free rate was 60.5% for renal stones and 89.4% for ureteral stones, with the overall stone-free rate of 74.7%. Including the cases with residual fragments less than 4 mm, ESWL monotherapy was successful for 86.4% of renal stones and 93.6% of ureteral stones, achieving the overall success rate of 89.9%. No serious complications related to ESWL were observed. Four cases of impacted ureteral stones underwent ureteroscopic extraction or open ureterolithotomy for fragment removal. ESWL monotherapy using the Dornier MFL5000 is an effective and noninvasive method of treating upper urinary tract stones. Satisfactory fragmentation and clearance can be achieved with multiple sessions even for large or impacted stones, but alternative procedures may be necessary to salvage fragments of impacted stones.