Anesthesia for extracorporeal shockwave lithotripsy: Teikyo University Hospital experience using the third generation lithotripter

Abstract

A single-board certified urologist with training and experience in anesthesiology was assigned to treat 502 patients (185 with renal stones, 317 with ureteral stones) using the Dornier Compact Delta lithotripter under general or epidural anesthesia. Data were obtained regarding stone location, stone size, shockwave use, stone-free rate, and complications. In all, 502 stones were treated with the Dornier Compact Delta lithotripter. Among renal stones, 73% were in the renal pelvis. Among ureteral stones, 60% were in the upper, 10% in the middle, and 30% in the lower ureter. Diameters of 61.8% of stones were less than 1 cm. The mean number of shocks was 3, 471 at a mean power setting of 5. The stone-free rate for renal stones was 71.5%, while for ureteral stones this reached 99%. The efficiency quotient was calculated as 0.65. One patient with a renal stone developed perinephric hematoma requiring 3 units of transfusion. With a success rate higher than that reported for other lithotripters, the Dornier Compact Delta lithotripter represents a feasible treatment for urolithiasis. We stress that even in the third generation machines the lithotripsy under anesthesia can improve the treatment efficacy.

目的:Dornier Compact Delta lithotripterの腎および尿管結石に関する有用性に関する報告は少ない。われわれは尿路結石に対するDornier Compact Delta lithotripterの有用性を検討した。方法:泌尿器科専門医で麻酔科専門医である1人の医師(KK)が502例の尿路結石患者(腎結石185例, 尿管結石317例)を全身麻酔ないしは硬膜外麻酔下に, Dornier Compact Delta lithotripterで結石破砕を行った成績を, 結石存在部位・使用衝撃波数・stone free rate・副作用について検討した。結果:腎結石の73%は腎盂に存在した。尿管結石は60%が上部尿管に10%が中部尿管に30%が下部尿管に存在した。結石径は61.8%が1cm未満であった。平均使用衝撃波数は3, 471発衝撃波強度は5であった。Overall stone free rateは83.9%であった。腎結石のstone free rateは71.5%であり, 尿管結石のstone free rateは99%であった。Efficiency quotientは0.65であった。副作用は腎結石患者で腎周囲血腫を生じ, 3単位の輸血を必要とした。結論:Dornier Compact Delta lithotripterは, 他の破砕器と比較して尿路結石の治療に有用であると考えられた。また, 本論文の結果は, 第3世代のlithotripter を用いた場合でも, 麻酔下に破砕を行うことの意義を再認識させるものであった。(著者抄録)