Extracorporeal shock wave lithotripsy
In the extracorporeal shock wave lithotripsy (ESWL) is the smashing of calculi by shock waves generated outside the body (extracorporeally). When using the lithotripsy procedure (from the Greek λίθος 'stone' and τρίβειν 'rub') as therapy against kidney stones , inpatient surgery is usually not necessary. In addition to the treatment of kidney stones, extracorporeal shock wave lithotripsy is also used to treat salivary stones ( sialolithiasis ) and gallstones ( cholelithiasis ).
method
In extracorporeal shock wave lithotripsy, the stone is crushed with bundled sound waves so that the remains can come off naturally.
The treatment method was successfully carried out for the first time in 1980 by doctors from the Grosshadern University Hospital (Munich, Germany) and engineers and technicians from the Dornier System company ( Friedrichshafen , Germany) (see Dornier kidney stone smashers ). The urologists Christian Chaussy , Ferdinand Eisenberger , the physicist Bernd Forssmann (Dornier) and the engineer Wolfgang Hepp were involved in the development, and Dieter Jocham and Egbert Schmiedt (Head of Urology in Munich) were involved in the clinical test . The process became more widespread with the introduction of the lithotripter device HM3 in 1983 from Dornier.
While the first devices (see picture HM 1) still had a tub filled with water in which the patient lay, the newer devices now resemble a modern X-ray device with only one bed. The patient lies on a movable table and is moved to the coupling bellows or the latter to the patient. The coupling bellows consists of a water-filled silicone cover, underneath is the shock wave generator. This unit is pressed gently against the patient's body in order to establish good contact with the body. In addition, a water-containing gel is placed between the surface of the coupling bellows and the skin in order to ensure that the shock wave crosses easily. During the treatment, the device automatically detects the position of the stone and corrects the patient's position if the stone moves slightly in the kidney during the shock wave treatment. This ensures that the stone is always in the center of the shock wave and the surrounding tissue is spared.
With this procedure, the patient does not need general anesthesia, usually only a mild pain reliever is administered intravenously, the patient remains responsive. The patient is given hearing protection against the noise generated during the treatment (around 3000 low-frequency impulses in 30 minutes). Very often this treatment can also be carried out on an outpatient basis. The burden on the patient is low and, thanks to the targeted bundling of shock waves, less painful than with the first-class devices with a bathtub.
In addition to X-ray cameras, ultrasound devices are also used for stone setting in newer devices. Established methods for generating shock waves are electrohydraulic (spark gap), electromagnetic and piezoelectric generators. Today more than 3000 devices (lithotripter) are used worldwide, around 90% of all kidney stones in industrialized countries are smashed in this way. In 2008 there were around 21,892 ESWL treatments in Germany.
Individual evidence
- ↑ S. Müller, R. Hofmann, K. Köhrmann, A. Hesse: Epidemiology, instrumental therapy and metaphylaxis of urinary stones. Deutsches Ärzteblatt 2004, 101 (19), pp. A-1331 / B-1101 / C-1065
- ↑ Bettina Cathrin-Wahlers: The most expensive bathtub in the world. 25 years of extracorporeal shock wave lithotripsy . Innovation report 2005
- ↑ C. Chaussy, E. Schmiedt, D. Jocham, W. Brendel, B. Forssmann, V. Walther First clinical experience with extracorporeally induced destruction of kidney stones by shock waves , J. Urology, Volume 167, 2002, No. 5 , Pp. 1857-1960
- ↑ Gerold Lingnau : Lithotripter. With shock waves against kidney stones. In: Faz.net of September 29, 2011
