Christian G. Chaussy

Transurethral ultrasonic ureterolithotripsy using a solid-wire probe

A multicenter study evaluates a new technique for transurethral ultrasonic ureterolithotripsy utilizing a solid-wire probe. The transverse vibrations of the probe cause greater stone disintegration. A small ureteroscope is used and a basket is not required. There was a 96.6 per cent success rate in 118 cases. This technique has significantly improved ultrasonic lithotripsy. It has proved to be useful for upper ureteral stones not amenable to extracorporeal shock-wave lithotripsy and lower ureteral stones including steinstrasse.

Treatment of ureteral calculi by extracorporeal shock-wave lithotripsy UCLA experience

One hundred sixteen patients underwent extracorporeal shock-wave lithotripsy (ESWL) for ureteral stones. In 108 patients, the stones were manipulated pre-ESWL whereas 8 patients underwent ESWL without prior stone manipulation. Ureteral lubrication using a 2% Xylocaine jelly solution greatly facilitated the retrograde advancement of the calculus or the passage of ureteral catheters alongside the stone. ESWL disintegrated all but 4 stones for an overall success rate of 96.6 per cent. It is considered that the combination of retrograde ureteral stone repositioning and ESWL is a highly successful alternative in the management of ureteral calculi.

Calcification of Ureteral Stent Treated by extracorporeal Shock Wave Lithotripsy

A patient with stones presented with large calcifications of the J ends of a Double-J stent that had been placed in the ureter for an obstructing ureteral stone 1 month previously. The J end located in the renal pelvis was treated with extracorporeal shock wave lithotripsy and the calcification was disintegrated completely. This noninvasive procedure appears to be the method of choice in the treatment of such complications.

The In Vitro and In Vivo Effects of Extracorporeal Shock Waves on Tumor Cells

The in vitro cytotoxic effect of extracorporeal shock waves (ESW) on renal cell carcinoma (RCC) cells was compared to the effect on normal human embyronic kidney (NHEK) cells. In the in vitro studies, cell samples were brought into the second focal point and exposed to different numbers of shock wave (SW) impulses. All four parameters of RCC tumor cell injury which were measured (cell viability, cell growth, cell attachment, and electron microscopic evidence of damage) directly correlated with increasing SW levels. At 2,000 SW a significant decrease in RCC cell viability, cell growth, and cell attachment was seen compared to NHEK cells. In the in vivo experiment, bladder tumor induced by the carcinogen Fanft was transplanted into the right hind legs of C3H/HE mice, and the tumors were exposed to 1,400 SW. Preliminary data showed that at Day 12 post-transplant, 1,400 SW significantly inhibited tumor growth. Combining 1,400 SW with cis-diamminedichloroplatinum (4 mg/kg) did not enhance the tumor inhibitory effect. However, combining doxorubicin (5 mg/kg) and 1,400 SW produced a significant synergistic tumor inhibitory effect.

Differentialindikationen bei der Behandlung des Ausgußsteines

Mit der Einfuhrung der neuen Therapieverfahren (perkutane Steinentfernung, ESWL) hat die Behandlung des Ausgussteines der Niere eine grundlegende Wandlung genommen. Die der Anwendung der perkutanen Steinentfernung und der ESW-Desintegration von Ausgussteinen als Monotherapieformen inharenten technischen Schwierigkeiten und Komplikationen sind zwischenzeitlich bekannt und begrunden die Ratio zur Anwendung der Kombination beider Methoden. Unklar und kontrovers ist derzeit noch, bei welcher Steinkonstellation welche Methode die besten Ergebnisse mit der geringsten Belastung fur den Kranken ergibt.

Ultrasound Ureterolithotripsy Utilizing a 10.5-French Rigid Ureteroscope and a 2.5 Wire-Probe Transducer

Between July, 1986 and July, 1987, 128 patients with large impacted ureteral stones or persistent Steinstrasse required ureterolithotripsy at UCLA (Table 1). Indications were: failed stone manipulation with or without ESWL for stones located a) above the iliac crest, b) in the true pelvis, c) in the “stonecracker’s nomansland” between the iliac crest and pelvic brim, and d) in the management of ureteral Steinstrasse when the debris did not pass spontaneously within eight weeks after insertion of a percutaneous nephrostomy (PCN)-tube. Of the stones treated, 29% were located above the iliac crest, 24% in the stonecracker’s nomansland, and 47% in the lower third of the ureter (Table 2).

In-vivo und in-vitro Effekte von hochenergetischen Stoßwellen auf Tumorzellen

In einem in vivo Experiment wurde die Auswirkung von hochenergetischen Stoswellen auf eine menschliche Nierenkarzinomzellreihe (RcPa) und normale menschliche embryonale Nierenzellen (NHEK) untersucht. Von jedem Zelltyp wurden 10000000 Zellen/ ml prapariert. Die Untersuchungszellsuspension wurde im behandlungsseitigen Fokus des Dornier Lithotripters positioniert, eine Kontrolle im Wasserbad auserhalb des Stoswellenbereiches. Bei einer Generatorspannung von 20 kV wurden 800, 1400 und 2000 Stos wellen mit einer Frequenz von 60/min. appliziert. Es ergab sich fur die Nierentumorzellen eine energiedosisabhangige signifikante Verminderung der Zahl der vitalen Zellen (92% Kontrolle; 78% nach 800 SW, 76% nach 1400 SW, 64% nach 2000 SW) wahrend fur die NHEK-Zellen eine deutlich geringere Abnahme der Vitalitat (94% Kontrolle; 88%, 85%, und 77%) nach entsprechenden Stoswellenzahlen dokumentiert wurde.

Klinik der ESWL und therapeutischer Ausblick

In der modernen Medizin ist zunehmend eine Entwicklung zu beobachten, bei der rein operative Verfahren durch den Einsatz moderner Technologien teilweise erganzt oder gar ersetzt werden. Gerade in der Urologie hat diese Entwicklung in den letzten Jahren besondere Bedeutung bekornrnen.