Masuyoshi Harada

Extracorporeal Shock Wave Lithotripsy in von Willebrand's Disease

A renal calculus in a patient with von Willebrands disease was successfully fragmented by extracorporeal shock wave lithotripsy (ESWL) with the administration of Haemate® P. No serious bleeding was observed after ESWL. With supplementation of the missing von Willebrands factor, ESWL may be applied to patients with this bleeding diathesis.

The Utility of Double-J Stents in the Treatment of Staghorn Calculi

One hundred patients with staghorn calculi (40 complete and 60 partial) were treated between April 1986 and December 1988 by extracorporeal shock wave lithotripsy (ESWL*) using a Dornier HM3 lithotripter. The number of treatments ranged from one to nine with an average of 2.3. The number of shock waves ranged from 650 to 20,100 with an average of 4,173. Sixty-two patients were treated with preoperative auxiliary procedures (50 patients, double-J stents; 11 patients, percutaneous nephrostomies; 1 patient, single-J stent), and 38 patients were treated without preoperative auxiliary procedures. Only 14 patients had no postoperative complications. One patient had a ureteral obstruction. Sixty-eight patients had no postoperative auxiliary procedures. The patient with a ureteral obstruction required a nephrectomy. Thirty-nine patients had residual fragments within three months of the first treatment. Fifty-five of 91 patients (60.4%) with follow-up had no residual fragments at the end of 1988. These 55 patients were divided into three groups by using the number of shock waves to evaluate the utility of the double-J stent for the size of stone. There was no difference in the frequency of postoperative complications between the patients treated with double-J stents and the patients treated without auxiliary procedures in all groups. However, the frequency of postoperative auxiliary procedures is higher in the patients treated without auxiliary procedures than in the patients treated with double-J stents in all groups.