[Extracorporeal shock wave lithotripsy: prophylaxis, complications and therapy]

ESWL has proved to be a safe and effective method in the treatment of urinary tract calculosis. The method is hardly invasive when compared to all other methods known so far, except for the treatment of calculosis with a selective pharmacotherapy. Moreover, the method is contactless, extracorporeal, mostly necessitating no anaesthesia and spasmoanalgesic therapy, except in the very small number of patients. The importance of the problem of urinary tract calculosis is enormous. Calculosis affects children, and particularly adults, predominantly psychically and physically active individuals in the most productive phase of their lives as well as elderly population. All this makes considerable its adverse effects on health, producing great interest of specialists for this disease. However, the incidence of the disease requires much better surveillance of the patients, since the preventive measures must be undertaken in time as they are of utmost importance. The treatment of urinary tract calculosis has brought great improvements enabling resolution of all types of concrements, irrespectively of their size and chemical composition, in absence of surgical incisions and anaesthesia, except for the small number of patients. Therefore, ESWL therapy has been most advantageous in different types of lithotriptors, particularly lithotriptors of the second generation, such as lithostar lithotripter. Renal calculi are the most convenient for this therapeutical procedure. Ever since its introduction into the clinical practice, the method has become the first therapeutical choice in the treatment of urinary tract calculosis. The indications for this type of therapy are enlarger and now they include all types of urinary tract calculi. Hospitalization and convalescence periods following ESWL are reduced when compared to nephrolithotomy, pyelotomy or ureterolithotomy. The study included a series of 2034 patients treated by this method. Our results revealed a low morbidity rate. Transitory haematuria occurred in almost all patients. Significant fall in haemoglobin levels was extremely rare, occurring only in four of patients with prolonged haematuria resolved following blood transfusion. In 321 patients enormous "Steinstrasse" was evidenced. In 54 patients percutaneous nephrostoma was created. Ureteroscopical removal of the stone was attempted in 14 patients; however, the success was moderate. Urosepsis developed in 29 patients. In 107 patients of the series, heart-related problems were recorded during and immediately after ESWL treatment. Paroxysmal supraventricular tachycardia was recorded in 20 patients. Arterial hypertension was evidenced in 63 patients, although they had previous history of hypotension. Skin lesions were found in 1004 patients, and none of them necessitated the therapy. It may be concluded that ESWL is the optimal method in the treatment of urinary tract calculosis; it is free of risk of development of predicted and unpredicted complications, which are now readily resolved failing to induce higher mortality rates among the patients treated by this method. The patients with cardiac problems should be previously well compensated, and after achievement of satisfactory compensation (sinus rhythm of the heart, etc.), the patients may be subjected to the treatment. This therapeutical postulate also applies to patients with coagulation disorders, when they are first subjected to an intensive treatment; after the satisfactory condition is accomplished they can undergo the treatment without any risk of haemorrhage or similar complications. Silica ureteral probes protect the kidney from complications following ESWL. Morbidity induced by ureteral obstruction is minimized, particularly if calculi of greater size than 2.5 cm are treated. Careful assessment is mandatory in patients at high risk, as well as appropriate preoperative conselling with relevant specialists. (ABSTRACT TRUNCATED)