title: Experience with percutaneous nephrostomy, extracorporeal shock wave lithotripsy and chemolysis in the treatment of obstructive uric acid stones.
abstract: Intravenous pyelography (IVP), retrograde ureteral catheterization and percutaneous nephrostomy (PCN) have been used to locate radiolucent stones during ESWL in an X-ray localization system lithotripter. We also used an alternative method combining PCN, ESWL and chemolysis to treat 8 obstructive uric acid stones. The average number of shock wave pulses was 1,725 (range 1,000-2,000), the generator voltage of the HM-3 Dornier lithotripter was 20-22 kV, and the local chemolysis lasted 4 days (range 2-7). All radiolucent uric acid stones were successfully disintegrated. Of the 8 patients treated, 5 were completely free of stones and the other 3 had insignificant residual stones after 3 months. Three patients who developed fever during local chemolysis with 0.1 M sodium bicarbonate solution were managed conservatively without severe sequelae. Only 1 patient retained a PCN tube after discharge. Because PCN can provide a path for local chemolysis and better localization, it is especially helpful in treating obstructive uric acid stones.
authors.affiliation: Department of Surgery, Veterans General Hospital, Taipei, Taiwan.
authors.forename: Y H
authors.initials: YH
authors.lastname: Lee
authors.forename: L S
authors.initials: LS
authors.lastname: Chang
authors.forename: M T
authors.initials: MT
authors.lastname: Chen
authors.forename: J K
authors.initials: JK
authors.lastname: Huang
authors.forename: K K
authors.initials: KK
authors.lastname: Chen
authors.forename: A D
authors.initials: AD
authors.lastname: Lin
mesh_terms: D001639:Bicarbonates / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000737:chemistry / Q000000981:diagnostic imaging / Q000628:therapy*; D008096:Lithotripsy; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous; D011859:Radiography; D012964:Sodium / Q000627:therapeutic use*; D017693:Sodium Bicarbonate; D014527:Uric Acid / Q000032:analysis*
chemical_list: D001639:Bicarbonates; D014527:Uric Acid; D017693:Sodium Bicarbonate; D012964:Sodium