| RESEARCH ARTICLE |
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| Year : 2003 | Volume
: 20
| Issue : 1 | Page : 46-49 |
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The steinstrasse : A legacy of extracorporeal lithotripsy
Mufti Mahmood, Arif Hamid, Vipul Tandon, US Dwivedi, Harbans Singh, PB Singh
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
India
 Source of Support: None, Conflict of Interest: None  | Check |
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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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