Extracorporeal shock wave lithotripsy for ureteric calculi with the Dornier MFL5000 lithotriptor at a multi-user...

We have reviewed 241 consecutive cases of ureteric calculi managed with the Dornier MFL5000 lithotriptor. The patients were individually managed by 24 visiting urologists between October 1990 and September 1991. There were 153 cases of upper ureteric calculi, of which 59 were successfully manipulated back to the renal pelvis prior to treatment, and 94 were treated in situ. There were 27 mid-ureteric and 61 lower ureteric cases; in 51% of stones treated in situ ureteric stents were placed prior to extracorporeal shock wave lithotripsy. All stones were radio-opaque and localised with on-line fluoroscopy. The outcome of treatment was assessed at 3 months, with failure defined as residual calculi > or = 4 mm. The follow-up rate was 89%. The overall fragmentation rate after a single treatment was 72%, which increased to 81% with re-treatment. Of the upper ureteric calculi, manipulated stones had a significantly higher fragmentation rate (85%) compared with in situ stones (63%). The fragmentation rate was 89% for mid-ureteric stones and 71% for lower ureteric stones. Factors that significantly influenced fragmentation were retrograde manipulation of stone, number of impulses delivered and age of the patient. Stone size, the presence of a ureteric stent and mode of anaesthesia did not significantly influence fragmentation. These results suggest the Dornier MFL5000 lithotriptor is effective for the management of ureteric calculi in a multi-user setting.