Srloumcor esos Erpeat elk Rte Uaovea Anocuni.Ine VESICAL LITHIASIS: OPEN SURGERY VERSUS CYSTOLITHOTRIPSY VERSUS EXTRACORPOREAL SHOCK WAVE THERAPY \VIPAN BHATIA* avo CHANDRA SHEKHAR BIYANI ‘AnsTRACT We compare the different methods of treating vescal calculi to etablsh the most effective and safe modality. Of 128 patients with bladder ealeal 5 underwent an open operation, 80 underwent ‘chanical cystolithotrpsy and 43 underwent extracorporeal shock wave therapy. Severe compl ations included hematuria, bladder perforation and mucosal injury the mechanical cyto lithotripey group. We find extracorporeal hock wave therapy to be a simple ‘modality for the management of vescal ithisis. ‘tfective and safe ‘Key Wout winay eal, ae, tsp erage okey ‘asia stones ar aid to be raz inthe weston homiphore tuto nda they ave been a npr problem fom the tne of eas (200%0 30) B.C) and are more common in the nreweat cof the country. Andersen reporced the incidence of ser "ne in Tn tobe 13 per 100000 population ‘Open surgery isthe eldest mot of removal of + Hader stone, although centuries po Hippocrates said that “to eat {trou the dew et: Lien oth ete Alsop technique the teste fader call. Twinern eporeed that he ft Lote as peeled iy S64" and ‘tes flowed bythe development of sun tolapary” The Ue of the elecuobyazaulic ithetetebeean in 1858 when the {tsi soli Coldbors roped the fret ure. of etait ‘aris develope hy Vokin In 18" Lataeer etal demon. ‘rte the chimcal ure of ultrasound in the fragmentation af ‘ner eel in 1976 Micr-eplesion thot, popula fae by shia etal? and laser thotripey as reported by ‘Watson ota ave azo bown serabyefoive modalities, ‘Urthl traume, vescal injury und perforation aes not ‘uncommon during iasuretral endoscope removdl of veil ‘omen! Lana alan Crooks noted aretha sitesi Rand 60% of the eaveo aher tansurthal procedure? Balan ot al sscoesuly treated patents with pteueaneoos fpeapubie jstaihotoms:" In thls modern wrong ra 0 en spf patents tie pein pnt ur, {Setoplasty ahd uretiropsts) any prose with bdr eae ‘ous dreae necoustating totaly noninvaste oF misimaly ‘nese approach, pe shock wan ithotepoy (BSW) i curently the sdeal and leat nesive herpy for most pper et eae ‘Our intl soos with shockwave therapy fr vein Iithiass ‘hs encoaraged ur to consider ESWL ut preferred modality forblader sone therapy To determine the mos appropiate treatment for vesieal calcul, we retrepectvly reviewed 128 patents and compared the cacy and iy ofthe vt {ous modalities, We reviewed our experiences during a 4-year period in the management of vial leans in 158 ptints There were 2 Stomen more than 0 years old and 2 eden, Fie patients UEndereent suprapubic estolithotomy, 30 were treated with ‘ptca mechanical eysto-ithotipey and BSW war performed Ina: Pretentmentevakotion triode fll pha exami -nion, complete blood count, elecepeardingraphy, bled ao ‘hemtiry, urine ear, ultasound, exeretory rogram and ‘Sto-panendoscopy. Standard suprapubic eetlthotomy Was spd ptexson Aug 1 sg Uy, Mata Khater op ie only Sn ta ay Ramee "Ser Seal Stee ne Atte, Csr performed withthe pstint under spinal anesthesia, One pa Unt in this proup aar espcited igh sud ureteral ones wich mild nal nstfiey and roqued teal Doubled? Rens for renal deomprsion. A Z-way Foley catheter ws eft Indwelling postoperativdy and removed afer 1 week in all Mechanical esto ithutepty was performed for tons 2010 ‘min the largest mension sing he Store estorthotet Wich the pactent under sina anestbesa afer edaat ure dation. Urethoscopyvvenled that 8 pasons hed rade (Gonabrzstve flat itera lobes meting in the mine and Zhad made? (obstrtine and eonver lateral bee meting = ‘he mllin) benign prcatie hyperplane (BPE, and both Underrent uneventaltensurtrelprsteteeeetion after treks, Two patents with aft anntlar Buber stetre fo ‘juved urethral dilaton 2a Foley catheter ees pce ‘her the procedure and emoved ater 24 dave RSW mas performedeith he Siemens Libontar in patents with stones le than 3) mm nthe nnget diension, Ure: {hrowcopyseveled grade! BPH in Spates end sof ennlar bute scture in, wile 1d a blader eck consrectre Fourpatients with acteretentin bad prosaticurethral stones hat were mechanically shed into the Dlnder. One patient Fd large stone (4) 25 mm.) ins mal eapacty bladder (20m) wile | prcrtod with solitary functioning Wey ‘rth oexting renal, ureteral sd blader stones, and m0 {enia Pretreatment procedures withthe pation! under inten ‘enous sedation and andgela included mestotomy (patent) ormultpe let omer rer sone, optical internal eto ‘omy (2) snd urethral dastion (is Toe cate af adder neck {ion and the 2 chliven requited intravenous etane ‘Nine young coopretiveptieste wih stone bulk of Tos than 20m were teated ca an ution basis, Propactic ‘Double senting was nein 7 patients fr asocated upper {gla (130 rh he patent ae eatin algeria. Sobvequt, thew calcul were alo rested ‘ith ESWL A Sway Foley catheter was lee indweling for oatinuous saline infin during therapy. n 8 patents gentle agment evacuation Usough «25 gauge sbeoth wih tie ‘Toomey sfringe was doe immediatly eter treatment. To Astemine the therapete scones xray wad nonopraphy ofthe elie were done inal pent ater #8 hour ‘Tule shows the distribution of patents, stone szo and ‘complications foreach peo therapy. In the mechanical eyton Iithursy group poor seility due to bleeding in 2 patente ‘ecetated second steep to complete the treauinet- One patent with winery tat infection had pose hematuria afer 1 Madi Bnpsering New York, New Yor“Tamu 1, Priced date nt compains Sarapatie See eae tim im the procedure, and was rose with apropriate antes, oncnvooe bier ination andl nt of bed eraafanon. ‘Xtal Bader perforation in 1 patient wan noted daring fagment evacuation and as manages conservatively. Compl ction a1 Year Inluded bulbar wel sitar and stone Fecutrenein 2 ends patients, respectively. nthe ESWL group both children uted intravenous kt amine Proeite Ume ranged from 10 to 7 minutes and umber of shocks varied fom 400 to 4.800, with an average of TES Wy. All peste were tretedwhle in the prove potion Wit the patient heed evay fom the plane? say generator. No iis ws enoontered in the sock bed coupling No aor complications were noted. Ony 4 patients regued 2 ‘sins for complete fragmentation Urethral fapment apa tion occured in 2 patents with a tare burden of rete ha ‘25mm, and necestated repeat panexdoscopy ad easy ae ‘ont rine ander nteavenoue sedation aad alge be 2) Duration of posteatnen ethetezation and hospital ‘ion i std nab ‘edo-logy and ESWL have curry replaced surgery os the fist line of management of mow uray Noes: Open Sige is undoubtedly tl he ras propriate mai for lenge Bacer ela nor sros me eo refered renee Cael ie ore than $0 mm ih marae eal ‘Sotnmy Moctansacyt-ithotrips hes cenywilrood {he tetof time since Bigelow deveoped the Motte ot oat problems wit this technique include bens and large iat ‘ents unsltaiiy for large an hard stone, greater degree ‘fl equiv ability fo be seed in ein, and pat ‘pent ofthe wn! Feld by fine toe fragments and blood ‘Although, visual esto lenges permite sar and mee arte tectment of veal stones, re tothe ladder and Uretie remain potent and elt rent completions Tasers of 100 patients Hepat reporadsiniant hematuria for to 3 days apd heepiaation for? to 4 days” Song end Densedt reported an 18% rato of complications including blader trem, = broken host, hematin ‘etetin, in spite of 38 patients teat with mecenical {pst lthotip""They alo reported an averag procedure {ne of 4 mime, mh crf chat uses The seeie drat lcatheteration a Gr copa io 22 TESWL for veal stones wis chance encounter for ws when spain with lange cleats (2025 minim armal capac’ blader quested nonoperative treatment Cystoscopy rela ‘120 al bladder capacity and peimary mechanical eyo Tibetpay wat judged tmprecical Atal of ESWL showed fod rerlts Sine then, ths modal as replced mecha ‘the veal capac eb ny frm of ileveseal abstraction ‘an impede oF prevent frauen clearance Same postive ae ects elude les vascular compared wih the Key and Seence of jxtapomeralrapparstus Therefor, post BSWL, Tematria and hypertension st unllely A seco taion ex Sefioem the nxt day wih us pony of Slserim eet ‘tnd am adequte id media around the sone ele noo Ieagmentaon. We reer to keep «Foley eater incwelling ‘Goring therapy we resultant called laser daring dain fee, whlch mininier stone aii, and inerapted elie {zation through the catbeter to teate « good expansion ‘chamber for better fragmentation. Irgaton tn altrataly amped and celaaed during therapy" Boas and Nihal pilered Foley catheter drainage dering BSW." In contrast, Nindeuren and Baer” and Hussin oa” treat thei pa Uinta without az indweling Foley catheter We belive that ‘eating the patient in the prone position ress ine cleat ‘Stone tage in plane 2 whch allow for es localization and ued smctament of fapmetain With the patient in the prone positon on he Siemens thos, the ple 2a unit [sprale to the pelvic oie but inthe eopine positon the ‘pubic bone and rar shadow overlap the sone Fragment were eseuntdinpatnts with moe than a 28, ‘gm sonn bulk: We sbiered complete legen of sone {ragmentin patentswith ey nonerctve HPH.A sear huervation has been repored by Vandeurcen and Beer Prabubiy the mort controversial aes relited tothe ae of BSWL fr bladder alu wane revurenc Ino enpoiece tetacopy teveued no moa injury afer BSW therapy bat Uladier washing for fegmentetacution resulted in ptechial bemontgs in he ESWL and. menial coso-ihotipy ‘oops, implying mca jr. Yip and Tin alo reported ‘onl cigeation afer eetrobydradie cyoithotrpey Urea! vemoval because sal egments embedded in the ‘rohit provide nid forthe formation of new aula, Crenshaw obuered 78% and 45% recurence ats following tueeanial eto lthotrsy and speach, we Smith and OFyna report a recurrence rte of 128% with tchoapeny compared with 2% for veal ibetomy in series 32 patente Strovite hinder stone wre not need In the ty. We bleve tht linge follows required to eee. tain the ue stone ecierence fe Bader BSWL therapy ot662 to minimize chances of recunrnos, fragment evacuation if required should be eteauoate, ‘Blader ealul are usually aseocntd with blader outlet cbatrutin, which nso require testent Tn the BSWL croup re tiated? ptt binder neck stotivtion in Lad re ‘hr strict in) bare ESWE Inthe same sein ard mo ‘complications were noted, Nsej et l reported 2°" compl ‘ation rte when vstolitholapeny ws performed in comin {lan with rawurethel rection of the prostate a out series tdko prosaic rcstons were dae ater 4 Woks i the me hana eystortotrpey group. We elev that ESWI, may fe combined safely wth tancuetral prostatic resection ‘eee and Nich sucessfully perfonned prostatic resection in 4 paints alongwith ESWL™ ‘Our data sugzost that ESWL for veel stones may be perormed in children and in pation witha small contracted der, in whom endourologial procedures may be difielt fd hoardous, Huta tel lie repored successful BSW in ‘b.yearold child wth» veal stone in. reconstructed biaider "In clden or putiots with a reconstructed urethra cia a whe aoc tote { pathclopel conditions the mechanical iatone Intfineneon pecion he Prieto nore procedures or an Open operation, ESWL outsnres cer avail [ble treatment medalise. Despite the listed mater tie, ‘wealeo belive that the most igniieane advantage of ESWL E’diar allows treatment on tn outptieat bassin slice {Goup of patients As confonce wih blader BSWL incensed {our series, cooperative young patients were treated without omalnton and even receiv miprved urethral calculus tear treated bythe saline jet “push and bang" method in the lade wih ubsequen vial SW (ur experiences symost that RSWL for vesial this ropresnts a simple fective and leet taste approach Ie ‘a nsocinted with nial moray with no major comp ia tions bat some pales tay need setresments Ie shoud be onside fvorebly in the current therapeutic spectrum ot ‘ial as 1. Andere, D. A: The nto! siense af inary Mader a. ang Ey dane rosa New Yk i nd the “aig tbe Rei ‘UrolngsalAriition 3 Urey 97: VESICAL LTHIASIS 4. Bigot based option, Ae Med 8, | Yellin, LA toi tc, Pabied Uso of Sot “Sit Noe Sagat Taman: Unted Sate De aso Comes ie of Tenia Sein. Docent Bibs cts an se ‘tages he Pobns Tebot Bd Seon M: Di Yvon en Haran rian ¢Bepesestele ‘Gtensagcen Ur ng 25 1,199 4 veil, Wetmabe Hs Rakogma T Fjt, A, Kiana, Staind msc A conron aha fn nce Ura 180 is, 106 1 WSs fer oat ay eae Ul 8 8. Qu 0, Moran, BM, aod rach, W Blade aes oe Sart ofr Jaina 4 Sabin H 1 Latte H.C, Mtn, We, ort J Ds ad Mia, J ‘rth tne lowes anual potato re ‘ew of vant 3 Ure 10 1 10, Chin Unni lowingtranaratal vction "pcs tale Urs 130 1. Bale GH Doorn Te and Sait, AD? Peeatantoat "las pose UCN. Ase” 176 150 12. Bhi ad yan 8 Exteel chs ome bey "eres nal ees Bae J. Uy 7! 1, 12, Rape S: Ends reno of Rede oer ina Be Stink war es 14, Sing and Daa 3D: Compara of sane, de ‘Saket ad waren scp tr val eB Sars upd re 8 ac 15, Bac J MelNih pF xoncorpora eck av tsps tm cmbiation ee camara mages ft aaa oe Mela one 16, Vente Hs and MeL: Extracupoalsk was ho “sas mantra Sner tna ih ths eee ‘So harps Url: 1810 1H Atos la Pah SR Anne ‘Eiage cla 3 Endourol, sop 386 act Hs, 1 Vip, Land Ti, ts Bae ihn of blader apa Hong Roa eperene Ul 02018 888, 19, Geese J Vase coun JAMA, 77H, 10 ‘BL Sih tPAl sca oon! Drama mal of eer "oe ls of aan. Uy 9 0, 2 Nigar Op Re Cah 8 eet A ect eget cosianien wth eltelapsy? og 20: a