EXTRACORPOREAL SHOCK-WAVE LITHOTRIPSY OF GALLSTONES IN DIFFERENT BILES AND WATER IN-VITRO

Twenty-four gallstones were fragmented by extracorporeal shock wave li thotripsy (ESWL) to compare the influence of three different biles (bo vine bile, human bile, synthetic bile) and water on the rapidity of fr agmentation. Four groups of comparable stones were used for lithotrips y in vitro. The stones were collected from 6 patients, four nearly ide ntical 'sister' stones from each patient. The number of shock waves re quired for adequate fragmentation (fragments less than or equal to 4 m m) was measured for comparison. Overall highly significant differences were found for the four different 'biles' with regard to the number o f shock waves required for adequate fragmentation. Using synthetic bil e, which was artificially composed according to a textbook on hepatolo gy, significantly more shock waves were necessary for fragmentation co mpared to the use of water, bovine bile or human bile. On the other ha nd, no significant difference between water and human bile could be re gistered. We conclude that the number of shock waves required for adeq uate lithotripsy is influenced by the composition of bile in which the stone is fragmented. Possibly results of ESWL can be improved by mani pulation of the bile.