Jt. Ehreth et al., EXTRACORPOREAL SHOCK-WAVE LITHOTRIPSY - MULTICENTER STUDY OF KIDNEY AND UPPER URETER VERSUS MIDDLE AND LOWER URETER TREATMENTS, The Journal of urology, 152(5), 1994, pp. 1379-1385
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.