The Dornier Lithotripter U 30: first clinical experience

Since August 1993, the Dornier Lithotripter U 30 has been used at the Department of Urology of the Katharinenhospital in Stuttgart. The machine consists of an endourologic table with an X-ray unit mounted on a C-arm and an electromagnetic shockwave source equipped with an inline ultrasound scanner and oblique shockwave coupling with a water cushion. Stone location can be performed with fluoroscopy or simultaneous ultrasound scanning. Until December 1994, 1092 stones had been treated, requiring 1533 sessions: 497 stones (45.5%) were situated in a calix, 426 (39%) in the renal pelvis, 130 (11.9%) in the upper ureter, and 39 (3.6%) in the distal ureter. Auxiliary measures were necessary before SWL in 245 patients (16%): double-J stent placement in 184 patients (12%), percutaneous lithotripsy in 43 patients (2.8%), and percutaneous nephrostomy in 15 patients (1%). The mean number of shockwaves was 3018, ranging from 250 to 3750. The time needed for positioning ranged from 1 to 10 minutes (mean 3 minutes). The mean treatment time was 30.5 minutes (range 10-50 minutes). There were 26 treatments (1.7%) performed without analgetic medication. In 1359 cases (88.6%), analgetics were utilized, and in 108 cases (7.0%), a sedative was added. In 40 patients (2.6%), general anesthesia was necessary. Complete stone disintegration was achieved in 94%. Auxiliary measures after SWL were ureteroscopy in 8.4% and percutaneous nephrostomy in 1.3%. Perirenal hematomas were found in 10 patients (0.6%). Colic pain necessitating analgetic medication was reported by 247 patients (16.1%). Body temperature above 38 degrees C occurred after 20 treatments (1.3%). At 3 months' follow-up, 110 patients of 128 patients (85.9%) were stone free. The Dornier Lithotripter U 30 has proven highly effective for SWL of renal and ureteral stones, radiolucent and radiopaque, and can be used as a full endourologic work-station.