Mahmood Yousuf, Zubair M, Maria Shabbir, Ali M, Hassan Ramzi.
Feasibility and effectiveness of ESWL for selected vesical calculi.
Pak J Surg Jan ;23(3):192-4.

Objective. To assess the feasibility and effectiveness of ESWL for selected Urinary Bladder stones. Design & Duration: Retrospective quasi experimental study from September 2004 to February 2007. Setting. The Stone Center, Taj Medical Complex, Karachi. Patients: Twenty six consecutive patients of over 12 years of age with bladder stones of less than 2.5 cros and without symptoms of outflow obstruction. Methodology. Detailed clinical work-up of all the patients was done. The diagnosis of bladder stone was made either on an IVP or an ultrasound combined with X-ray KUB. Bladder outflow obstruction was excluded on clinical grounds. All patients received shock waves ranging from 14 to 20 kV, up to a maximum of 3000 shocks in a single session. If complete fragmentation was seen before this, the treatment was stopped. Patients were reviewed after 72 hours with a KUB X-ray. Patients with residual stones received a 2nd session at this stage. If no fragmentation was seen after two sessions, the patients were offered alternate modes of treatment. If there was any residual fragment left after two sessions, a third session tookplace. Results: During the study period, 31 patients presented with bladder stones. Two patients with significant outflow obstructive symptoms, one patient with a stone of 3.5 centimeters and two children (age <12 years) were excluded from the study. Of the 26 remaining patients, 19 were males and seven females. Eighteen patients had complete stone clearance after one session and five after two sessions, while one patient required three sessions for complete stone clearance. Two patients did not have any significant fragmentation and were offered alternate treatment modalities. Overall 24 out of 26 (92.3%) patients had a complete stone clearance. Conclusion: ESWL is a very effective and safe modality for treatment of selected bladder stones. The treatment can be provided on an out patient basis.

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