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Piezoelectric lithotripsy (PEL) is a painless method of extracorporeal treatment of renal calculi. Using a Wolf 2300 (Richard Wolf Medical Instruments Corp.) piezoelectric lithotripter, 32 adult patients (30 renal units) were treated at Duke University Medical Center from February 1988 through December 1988. Average treatment time was 45 minutes using an average of 3,662 shock waves. Stone size ranged from 1 mm by 1 mm to 30 mm by 23 mm All but one of 59 stones treated were located in the kidney. Twenty-two renal units had solitary stones smaller than 15 mm in diameter (Group I); fragmentation was confirmed 24 hours after treatment in 82% of these stones. Eleven renal units had multiple stones smaller than 15 mm in diameter (Group II); fragmentation was confirmed at 24 hours in 100% of these stones. Three patients had stones 16 mm to 25 mm in diameter (Group III), and all of these demonstrated fragmentation at 24 hours. Group IV consisted of two patients with stones greater than 25 mm; one of these stones demonstrated fragmentation at 24 hours. The overall fragmentation rate as demonstrated 24 hours after treatment was 87%. The overall stone-free rate at three months was 29%. All but one of these patients were in Group I. Partial success, defined as a decrease in overall stone burden at three months, was achieved in 40% of renal units. Overall failure rate was 31% (including 100% of patients in Group IV and 44% of patients in Group II). Two patients (three renal units) were lost to follow-up. The most common side effect was hematuria, occurring in sixteen patients (50%). Four patients (12.5%) developed colic within 24 hours after treatment. No one developed fever, sepsis, or perirenal hematoma. Six patients (19%) received repeat PEL treatments within three months. One of these required two additional PEL treatments, and two were subsequently treated with spark gap generated shock wave lithotripsy. PEL is a painless method of treating renal calculi. Initial experience at Duke University suggests that it is most effective in patients with solitary stones smaller than 15 mm. |
