Extracorporeal shock wave lithotripsy

Extracorporeal shock wave lithotripsy In (ESWL ) is the smash of urinary stones by shock waves from outside the body ( extracorporeal ) are generated. When applying the method of lithotripsy (from Greek λίθος 'stone' and τρίβειν, rub ') as a treatment for kidney stones can usually dispense with a stationary interference.

Method

Extracorporeal shock wave lithotripsy When an attempt is made without a percutaneous interface to be crushed so far with the help of directed to the affected area focused sound waves the foreign body, that it may be either naturally or surgically removed.

The treatment method was first time in 1980 by doctors at the University Hospital Grosshadern (Munich, Germany ), and engineers and technicians of the company Dornier System (Friedrichshafen, Germany ) carried out successfully (see Dornier lithotripter ). Involved in the development of the urologist Christian Chaussy, Ferdinand Eisenberger, a physicist Bernd Forssmann ( Dornier ) and the engineer Wolfgang Hepp and the clinical test were also Dieter Jocham and Egbert Schmiedtberger ( the head of urology in Munich). Further dissemination found the process with the introduction of the lithotripter device HM3 1983 by Dornier.

While the first devices ( see Figure 1 HM ) still had a water-filled tub in which the patient was, the newer devices now resemble a modern x-ray machine with only one sun. The patient lies on a movable table and is moved up to the coupling bellows or this to the patient. The consists of the shock wave generator with a water-filled silicone sleeve ( bladder ) and is slightly pressed against the patient's body to make good contact with the body. Do so, a hydrous gel is still placed between the surface of the Koppelbalges and skin to ensure a smooth passage of the shock wave. During the treatment, the unit automatically acquires the location of the stone and corrects the position of the patient, if the stone during shock wave treatment in the kidney shifts slightly. This ensures that the stone is always in the shock wave center and surrounding tissue is spared.

In this method, the patient does not require general anesthesia, as a rule only a mild analgesic is administered intravenously, the patient remains responsive. Against the noise resulting from the treatment ( approximately 3000 low-frequency impulses in 30 minutes), the patient receives hearing protection. Very often, this treatment can be performed on an outpatient basis. The exposure to the patient is low and by the targeted convergence of the shock waves less painful than the first type devices with a bathtub.

Also, for newer devices, in addition to X-ray cameras and ultrasonic devices for stone setting are used. Established methods for shock wave generation are electrohydraulic ( spark gap ), electromagnetic and piezoelectric generators. Today, more than 3000 devices ( lithotripters ) are used worldwide, about 90 % of all kidney stones are crushed in the industrialized countries in this way. In 2008 there were around 21,892 in Germany ESWL treatments.