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Year : 2003  |  Volume : 20  |  Issue : 1  |  Page : 46-49

The steinstrasse : A legacy of extracorporeal lithotripsy

Department of Urology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India

Correspondence Address:
P B Singh
Department of Urology, Institute of Medical Sciences, Banaras Hindu University, Varanasi - 221 005
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Source of Support: None, Conflict of Interest: None

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Objectives: To determine the causes of steinstrasse and to assess the success of primary ureteroscopic removal using pneumatic lithotripsy. Methods: Three hundred and two patients with urinary stones (242 renal and 60 ureteric) underwent extracor­poreal shock wave lithotripsy treatment using Stonelith electrohydraulic lithotripter from June 1999 to July 2002 in the Department of Urology, Institute of Medical Sci­ences, Banaras Hindu University. Of these, 29(9.6%) de­veloped steinstrasse. There were 23 males and 6 females in the age group of 24-66 years. After ESWL the patients were followed weekly using plain films and ultrasonogra­phy for the 1 st month and thereafter monthly for 2 months. Their radiological appearance was classified into 3 types. Majority of the patients developing steinstrasse had a stone size of 2-3 cm and most of the steinstrasse was found in the lower ureter usually after 6001-9000 shocks at a mean power of >16 kv. The length of the steinstrasse was 3-4 cm in the majority of patients. Results: Conservative management was successful in 15 patients (51.7%); repeated ESWL in 4 (13.8%). Ureteroscopic removal using pneumatic lithotripsy under i/v sedation was successful in 10(34.5%) patients. Conclusions: Large stone burden (>2 cm) and use of high energies (>16 kv) are leading factors responsible for the development of steinstrasse. Ureteroscopic removal using pneumatic lithotripsy is a definitive and predictable treatment modality with a high success rate.

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