EXTRACORPOREAL SHOCK-WAVE LITHOTRIPSY - MULTICENTER STUDY OF KIDNEY AND UPPER URETER VERSUS MIDDLE AND LOWER URETER TREATMENTS

Six institutions throughout the United States participated in this stu dy. Each center used a multifunctional flat table lithotriptor (Dornie r MFL-5000) to treat 658 patients with kidney and upper ureteral stone s (766 treatments) and 323 with middle and lower ureteral stones (391 treatments), for a total of 925 patients (1,157 treatments). Some pati ents received more than 1 treatment (that is the kidney and ureter), f or a total of 981 patient events. Complete followup was available for 81% of the patients. The overall stone-free rate at followup of approx imately 90 days was greater in the middle and lower ureter group (83%) than in the kidney and upper ureter group (67%). The proportion of si ngle stones treated was greater for the former group (89.5%) than for the latter group (72%). A larger proportion (18%) of the middle and lo wer ureter group required 2 or more treatments to the targeted stone t han did the kidney and upper ureter group (13%). Anesthesia was requir ed or selected in only 26.7% of the kidney and upper ureteral stone pa tients and in 18.5% of those with middle and lower ureteral calculi, u sually at the request of the patient or physician, or for performance of an adjunctive procedure. The relative safety of this treatment is d emonstrated by a low overall rate of complications reported during and after treatment, including a ureteral obstruction rate of 2.1% for ki dney and upper ureteral stones and 2.5% for middle and lower ureteral stones. There were no demonstrated trends in a review of laboratory da ta to suggest significant treatment side effects. The diastolic blood pressure increased to more than 95 mm. Hg after extracorporeal shock w ave lithotripsy (ESWL) in 6% of the kidney and upper ureteral and 4% of the middle and lower ureteral stone patients, while pretreatment hy pertension resolved after ESWL in 11% of both groups. The results of t his clinical evaluation indicate somewhat greater effectiveness for th e specified indications of ESWL of stones in the ureter below the uppe r rim of the bony pelvis, as opposed to those in the kidney and upper ureter, with a low incidence of complications and side effects.