SWL : Our twenty-four year experience

Treatment of renal and ureteral stones by SWL has been proved safe and effective in the last 25 years. We reviewed our twenty-four year experience, which began in January 1985 with an original HM3 Dornier lithotripter and has continued along the years with second and multifunctional third generation lithotripters. Dysrhythmias occurred almost exclusively in stone kidney treatments and never in distal ureteral ones. No significant correlation was found between the side of the treated kidney, the number and strength of shockwaves, or the administration of analgesics and the occurrence of dysrhythmia. SWL without ECG triggering was not associated with the occurrence of dysrhythmic episodes of any particular clinical significance. We followed for an average of 42 months patients treated with SWL for different types of stones. At discharge, 31.5% of the patients were stone free, whereas 65.3% had stone dust or passable fragments. At three-month follow-up, 64.8% were stone free and 33.6% had dust or passable fragments. After a follow-up of over 24 months, 55% of the patients were still stone free, recurrence was observed in 13.8% and regrowth of fragments in 22.3% of the patients. Small fragments less than 5 mm are defined as clinically insignificant residual fragments (CIRF); although they are likely to pass spontaneously and remain asymptomatic, they are considered by some authors a factor that favours regrowth and an increased risk for symptomatic episodes. Patients with fragments in our experience do not require systematic retreatment but they could be followed and treated if necessary if stones recur or symptoms persist. Most of the CIRF pass spontaneously after treatment without any complication, but since about 20% of patients become symptomatic or require intervention, a close follow-up is required. Extracorporeal shock wave lithotripsy is the first choice treatment today for most renal and ureteral stones, however adequate evaluation of the patient and of the stone is required, and all possible treatment options should be considered.