[Current strategy in the treatment of urinary calculi since the introduction of the EDAP lithotripter].
The extracorporeal lithotripter has radically changed the treatment of urinary stones. Three-hundred and seventy-four stones in 356 patients were treated over an eight-month period. Extracorporeal lithotripsy (262 cases) is mainly indicated in pelvic and calyceal stones measuring less than 2.5 cm, stones located in the lumbar ureter and previously flushed, and some stones of the pelvic ureter. Analysis of results showed that extracorporeal lithotripsy achieved fragmentation in 80% of cases and complete elimination 3 months after the procedure in 70% of cases. Repeat procedures were needed in 23% of patients. Complementary procedures were required to relieve obstruction in 4% of patients. Percutaneous nephrolithotomy now has very few indications but remains useful in large pelvic stones, failures of EDAP (7 cases), and some staghorn stones with few ramifications. Open surgery (24 cases) is still useful for complex staghorn stones, soft stones in febrile patients, calyceal stones with destruction of the neighboring renal parenchyma, incarcerated lumbar stones, and stones associated with an obstructive malformation of the urinary tract. Ureteroscopy (69 cases) proved highly reliable in stones located in the pelvic ureter. An improvement, therefore, but no miracle.
Ferrière
J M
JM
Service d'Urologie, Le Tripode, Hôpital Pellegrin, Bordeaux.
Gaston
R
R
Piechaud
T
T
Brucher
P
P
Le Guillou
M
M
D004724:Endoscopy; D006801:Humans; D007669:Kidney Calculi / Q000145:classification / Q000601:surgery / Q000628:therapy*; D008096:Lithotripsy / Q000009:adverse effects / Q000295:instrumentation*; D009403:Nephrostomy, Percutaneous; D014514:Ureteral Calculi / Q000628:therapy
Stratégie actuelle dans le traitement des lithiases urinaires depuis l'implantation du lithotripteur EDAP.