EXTRACORPOREAL SHOCK-WAVE LITHOTRIPSY FOR URETERAL CALCULI WITH THE DORNIER MFL5000 LITHOTRIPTOR AT A MULTIUSER CENTER

We have reviewed 241 consecutive cases of ureteric calculi managed wit h the Dornier MFL5000 lithotriptor. The patients were individually man aged by 24 visiting urologists between October 1990 and September 199 1. There were 153 cases of upper ureteric calculi, of which 59 were su ccessfully manipulated back to the renal pelvis prior to treatment, an d 94 were treated in situ. There were 27 mid-ureteric and 61 lower ure teric cases; in 5 1% of stones treated in situ ureteric stents were pl aced prior to extracorporeal shock wave lithotripsy. All stones were r adio-opaque and localised with on-line fluoroscopy. The outcome of tre atment was assessed at 3 months, with failure defined as residual calc uli greater-than-or-equal-to 4 mm. The follow-up rate was 89%. The ove rall fragmentation rate after a single treatment was 72%, which increa sed to 8 1% with re-treatment. Of the upper ureteric calculi, manipula ted stones had a significantly higher fragmentation rate (85%) compare d with in situ stones (63%). The fragmentation rate was 89% for mid-ur eteric stones and 71% for lower ureteric stones. Factors that signific antly influenced fragmentation were retrograde manipulation of stone, number of impulses delivered and age of the patient. Stone size, the p resence of a ureteric stent and mode of anaesthesia did not significan tly influence fragmentation. These results suggest the Dornier MFL5000 lithotriptor is effective for the management of ureteric calculi in a multi-user setting.