ESWL Treatment Result with DiREX Integra

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ESWL Treatment Result with DiREX Integra
Kumamoto Urological HP Yasuhiro Yamamoto,
Yasufumi Nabekura, Hidetaka Ih, Akihiro
Nojiri Kengun Kumamoto Urological Clinic Hitoshi
Sakiyama
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Background
About 700cases/year of urolithiasis were treated
in our hospital. (ESWL/TUL/f-TUL/PNL/Vesical
Lithotomy) The number of ESWL treatments was
about 600cases/year and we expect that the number
of patients will increase still more in the
future. We have started to use a new ESWL device
(DiREX Integra) since April of 2009, in parallel
to the use of Storz Modulith SL20, which has been
used for a long time in our hospital. We report
here the results of ESWL treatment with Direx
Integra during April 2009 - January 2010.
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DiREX Integra
Electromagnetic SWL System (3rd generation
ESWL) Supine position is the standard, but prone
position is also possible. Compact
body(12m) Stone localization is made by X-ray
fluoroscopy. (Echo is not mounted.) This
hospital is the 2nd user of Integra in Japan.
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Case Report
305cases were treated with Direx Integra. (Term)
10months during April 2009-January 2010 (Sex)
Male213cases? Female92cases (Age) 19102y.o
Average56.2y.o (Details) Number of shocks
Max 5000 shocks/session (Renal
stones Max 3500 shocks/session) Level 120
(Max Power300Bar) Evaluate the overall success
rate (stone free cases cases with residual
fragments less than 4mm) within 3months after
treatment.
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Stone information
Stone maximal diameter
Stone Location
8cases
89cases
208cases
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Treatment Result according to stone
location(Average number of sessions)
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Treatment Result according to stone
location(Overall success rate)
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Treatment Result according to maximal diameter
(Average number of sessions)
Average number of sessions
3.5
3
2.5
2
1.5
1
0.5
0
Stone maximal diameter(cm)
?1
1lt,?2
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Treatment Result according to maximal diameter
(Overall success rate)
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Complication
Mild complicationGross hematuria(Almost all
cases) Subcutaneous
hematoma Colic
attack(painnauseavomiting) Serious
complicationRenal subcapsular hematoma
(2cases)
Pyelonephritis(3cases)
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2009 ESWL number of treatments and the graph of
fragmentation results
SL20
SLX
80
Integra
BOTH
TOTAL
70
Number of treatments
60
50
40
30
20
10
0
Jan
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec/2009
Feb
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2009 ESWL number of treatments and the graph of
fragmentation results
SL20
SLX
80
Integra
Installation of Integra
BOTH
TOTAL
70
Number of treatments
60
50
40
30
20
10
0
Jan
Mar
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec/2009
Feb
Apr
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2009 ESWL number of treatments and the graph of
fragmentation results
Ratio of number of treatments (single/multiple)
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Summary
This is a report of ESWL treatment results with
Integra. We confirmed that ESWL treatments with
Integra were effective for urinary stones with
less side effect. The treatment results for
renal stones were little worse than for ureteral
stones. The cause might be the setting up the
restriction of number of shocks and HV level for
the safety, because we are still the second user
of this machine in Japan. We are going to treat
still more patients in order to conduct further
examination of this machine.