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ESWL Treatment Result with DiREX Integra Kumamoto Urological HP Yasuhiro Yamamoto, Yasufumi Nabekura, Hidetaka Ih, Akihiro Nojiri Kengun Kumamoto Urological.

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Presentation on theme: "ESWL Treatment Result with DiREX Integra Kumamoto Urological HP Yasuhiro Yamamoto, Yasufumi Nabekura, Hidetaka Ih, Akihiro Nojiri Kengun Kumamoto Urological."— Presentation transcript:

1 ESWL Treatment Result with DiREX Integra Kumamoto Urological HP Yasuhiro Yamamoto, Yasufumi Nabekura, Hidetaka Ih, Akihiro Nojiri Kengun Kumamoto Urological Clinic Hitoshi Sakiyama

2 Background About 700cases/year of urolithiasis were treated in our hospital. (ESWL/TUL/f-TUL/PNL/Vesical Lithotomy) The number of ESWL treatments was about 600cases/year and we expect that the number of patients will increase still more in the future. We have started to use a new ESWL device (DiREX Integra) since April of 2009, in parallel to the use of Storz Modulith SL20, which has been used for a long time in our hospital. We report here the results of ESWL treatment with Direx Integra during April 2009 - January 2010.

3 DiREX Integra Electromagnetic SWL System (3 rd generation ESWL ) Supine position is the standard, but prone position is also possible. Compact body(1×2m) Stone localization is made by X- ray fluoroscopy. (Echo is not mounted.) This hospital is the 2 nd user of Integra in Japan.

4 Case Report 305cases were treated with Direx Integra. ( Term ) 10months during April 2009-January 2010 ( Sex ) Male : 213cases 、 Female : 92cases ( Age ) 19 ~ 102y.o [Average : 56.2y.o] ( Details ) ・ Number of shocks : Max 5000 shocks/session ( Renal stones : Max 3500 shocks/session ) ・ Level : 1 ~ 20 ( Max Power : 300Bar ) ・ Evaluate the overall success rate (stone free cases & cases with residual fragments less than 4mm) within 3months after treatment.

5 Stone Location Stone maximal diameter ≦ 1cm 1cm <、≦ 2cm 2cm < 208cases 89cases 8cases Stone information R1 ・・・ 0case R2 ・・・ 23cases R3 ・・・ 34cases U1 ・・・ 153cases U2 ・・・ 36cases U3 ・・・ 59cases

6 Treatment Result according to stone location ( Average number of sessions ) 0 0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 1.8 2 R1R2R3U1U2U3 R1 R2 R3 U1 U2 U3 [ Stone location ] [ Average number of sessions ]

7 Treatment Result according to stone location ( Overall success rate ) 0 10 20 30 40 50 60 70 80 90 100 R1R2R3U1U2U3 R1 R2 R3 U1 U2 U3 [ Overall success rate (%)] [ stone location ]

8 Treatment Result according to maximal diameter (Average number of sessions) 0 0.5 1 1.5 2 2.5 3 3.5 ≦1≦11<,≦21<,≦2 2<2< ≦ 1cm 1cm <, ≦ 2cm 2cm < [ Average number of sessions ] [ Stone maximal diameter ( cm )]

9 Treatment Result according to maximal diameter (Overall success rate) 0 10 20 30 40 50 60 70 80 90 100 ≦ 1cm 1cm <, ≦ 2cm 2cm < [ Overall success rate (%)] [ Stone maximal diameter ( cm )] ≦1≦1 1<,≦21<,≦22<2<

10 Complication ・ Mild complication ・・・ Gross hematuria ( Almost all cases ) Subcutaneous hematoma Colic attack ( pain ・ nausea ・ vomiting ) ・ Serious complication ・・・ Renal subcapsular hematoma ( 2cases ) Pyelonephritis ( 3cases )

11 2009 ESWL number of treatments and the graph of fragmentation results 0 10 20 30 40 50 Jan Feb MarAprMayJunJulAugSepOctNovDec/2009 70 80 SL20 SLX Integra BOTH TOTAL 60 [Number of treatments]

12 2009 ESWL number of treatments and the graph of fragmentation results 0 10 20 30 40 50 Jan Feb Mar Apr MayJunJulAugSepOctNovDec/2009 70 80 SL20 SLX Integra BOTH TOTAL 60 Installation of Integra [Number of treatments]

13 2009 ESWL number of treatments and the graph of fragmentation results Ratio of number of treatments (single/multiple)

14 Summary ・ This is a report of ESWL treatment results with Integra. ・ We confirmed that ESWL treatments with Integra were effective for urinary stones with less side effect. ・ The treatment results for renal stones were little worse than for ureteral stones. The cause might be the setting up the restriction of number of shocks and HV level for the safety, because we are still the second user of this machine in Japan. ・ We are going to treat still more patients in order to conduct further examination of this machine.


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