OUR 2021 COMPETITION HAS CONCLUDED

I started ESWL in 1992 and have treated about 7,000 cases of urinary tract stones using MPL-9000, U/50 and Compact Sigma. In almost all cases, stones were detected by inline echo and treated under echo guidance. Stone detection by inline echo has a very long learning curve and requires a great deal of ingenuity, including body compression. This may have been possible because Japanese people are basically thin. If we could detect the stones by echo, we could monitor them constantly and treat them efficiently. It is possible to break stones with a small number of shock waves and no radiation exposure, making it a patient-friendly treatment.

I will never forget a case a 1year-old girl. The pediatric department consulted us, and we discussed the treatment method.

(Figure 1 X-rays taken before treatment)

Open surgery, URS, and ESWL were considered as possible treatment methods. The size of the stone was over 10mm in length and diameter, and it was expected to be difficult to treat.

The stone could be clearly confirmed even when urine was stored in the bladder by ultrasonography. Therefore, based on our previous experience with inline echo type of ESWL, we judged that the procedure could be safely performed and chose ESWL. Before this case, we had experience in treating children around 10 years old, and we knew empirically that stones were more easily broken by shock waves than in adults, which was another reason why we chose ESWL. We did not have enough data to know how much the ovaries, uterus, and intestinal tract would be affected by ESWL because the patient was a girl. However, we judged that safe lithotripsy was possible by reducing the area of the shock wave generator with a buffer material, careful treatment under constant ultrasound monitoring to prevent accidental irradiation, minimizing the shock wave energy, and setting the frequency of generation to 60 times per minute.

The treatment was performed with a Dornier lithotripter U/50 (in-line eco type). After general anesthesia was induced by an anesthesiologist, the patient was placed in a prone position and placed on a shock wave generator shielded by cushioning material, and the stone was probed by inline echo. It was easy to bring the stone into focus and treatment was started immediately. Fine adjustments were made while the surgeon moved the patient’s body by hand and monitored the monitor. The movement of the stone during the treatment also revealed the status of lithotripsy. The treatment was completed in about 20 minutes. There were no major problems after the patient awoke from the general anesthesia. After the treatment, there was no other complication, although gross hematuria was observed. The stone fragments started to pass on the first postoperative day, and a small amount of fragment was discharged daily.

(Figure 2 and 3)

When the patient visited the outpatient clinic on the second postoperative week, the stones had been completely drained and hydronephrotic had disappeared. The stone treatment was completed without any complications.

(Figure 4, 5 and 6: X-rays taken after treatment, the next day, 5 days later, and 14 days later)

Later, the pediatrician performed a systemic search and found no obvious underlying disease that could have caused stone formation. Stone analysis showed calcium oxalate stones.

Shock waves are an excellent energy source for medical use that was discovered by mankind in the 20th century. I am convinced that this energy has the potential to further improve treatment results by devising irradiation methods and routes of entry into the body. I hope that it will be used more effectively in the future to treat many people.