Today, I would like to share with you the chapters “Analysis of the Failure Causes of ESWL Treatment for Periureteral Inflammatory Lesions” and “ESWL Treatment for Obese Patients” in the book “Basic and Clinical Medical Shock Waves” edited by Academician Guo Yinglu and others. Welcome to reading and forwarding
Analysis of the failure causes of inflammatory lesions around ureteral calculi after ESWL treatment
The author used Dornier HM3 lithotriptor to treat 2600 cases of ureteral calculi from 1987 to 1997 , of which 58 cases were unsuccessful, diverted to ureteroscopic lithotripsy and ureterotomy. During the operation, it was found that the calculi had been crushed or partially crushed by the shock wave, but not all were excreted. Among the 58 cases, 6 cases discontinued extracorporeal ESWL treatment due to heart disease and other diseases. Among the remaining 52 cases, there were 15 cases of ureteral adhesion stenosis, 12 cases of ureteral wall thickening, 11 cases of polyps, 9 cases of granulation tissue encapsulation, 4 cases of stone incarceration, and ureteral distortion. 1 case of deformity.
The 58 patients in this group underwent extracorporeal shock wave lithotripsy for a total of 98 times. The average is 1.69 times. Due to the underdeveloped CT technology in the 1980s and early 1990s, KUB, B-ultrasound and IVU were basically used for clinical judgment. Now, CT examination has been added, which can clearly show the overall condition of the urinary system. It can help clinicians to judge the pathological changes of the tissues around the stones, and help doctors to make correct diagnosis and treatment plans.
Shock wave lithotripsy is not a panacea, the most important thing is to know the medical history, the size of the stone and the length of time the stone stays in place, the latter is one of the direct factors affecting the success rate of lithotripsy (especially is to stay in the ureter for 1 year or even longer). Patients are often asymptomatic, and ureteral stones are found with hydronephrosis on physical examination. Due to the long-term retention of ureteral calculi, local inflammation and hyperplasia of the ureter are stimulated, and the close contact between the calculi and the tissue forms polyps, granulation encapsulation, calculus incarceration, and even damage to renal function. If it fails, other methods such as ureteroscopic lithotripsy should be used in time (Lili Liang et al., 1997.)
Treatment of ESWL in Obese Patients
Obesity is an important factor affecting the effect of ESWL. Obesity is a serious problem for patients and physicians, and ESWL treatment is often abandoned due to the failure to locate the stone in its focal point. Obesity can lead to excessive shock wave energy loss and increased refragmentation rate.
It is generally believed that the center of the shock wave source to the focal point of the stone is 150 mm, and the domestic lithotripter is about 130 mm.
In obese people, the focus of lithotripsy cannot be focused on the calculi, so extracorporeal lithotripsy should not be selected, and other endoscopic methods should be used for treatment.
The above content is excerpted from Chapter 4, Section 4
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