尿路結石症 - その治療の変遷 - Dornier Kidney Lithotripter HM3を用いたESWL

Abstract

The kidney stone of less than 2 cm can be effectively treated by extracorporeal shock wave lithotripsy (ESWL) using a Dornier kidney lithotripter HM3 without any complication that might need other therapy. However, in the case of a large kidney stone and ureteral stone, there are some difficulties in the treatment with ESWL. To obtain better results for these stones with a Dornier kidney lithotripter HM3, in the patient having a large stone a double-J stent was placed and ureteral catheter was indwelling for the ureteral stone before ESWL. In some cases high frequency positive pressure ventilation (HFPPV) was applied to make respiratory movement of the stone minimum. An indwelling double-J stent can significantly decrease the necessity of auxiliary treatment and the incidence of high fever attack. Manipulation of a ureteral stone with a ureteral catheter did not facilitate stone disintegration, and also the success rate as compared with in situ ESWL. HFPPV can decrease the stone movement within 2 mm judged on the X-ray monitor and increase the effectiveness of the shock wave on the stone, leading to minimize not only shock wave dose but also side effects from shock wave exposure.