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Abstract presented at CAU 2012, Cartagena, Colombia

Sandro M. Varea, Gustavo Minuzzi, Belén Leithold, Sanatorio Allende Cerro. Córdoba. Argentina

Use of Oral Analgesia in Extracorporeal Shockwave  Lithotripsy: Analysis of Effectiveness and Pain  Tolerance using a Dual Electromagnetic Shockwave System.

Introduction and Objectives
Extracorporeal shock wave lithotripsy remains the Gold Standard treatment  modality for most urinary stones.
A new technology has been developed, that uses 2 electromagnetic shock wave generators concentrating the energy on the stone from 2 different angles.  Since the total energy is distributed between 2 reflectors, patient pain is reduced notoriously

.
The aim of this study was to evaluate the efficacy and pain tolerance of patients treated with Dual Shock Wave Electromagnetic lithotripsy using oral analgesia only.

Material and Methods
We performed a prospective descriptive study of all patients with urinary stones treated with extracorporeal shockwave lithotripsy between January 2011 and January 2012.
The device used was the Duet Magna (Direx Group) using 2 electromagnetic generators at 76 degrees between them , that can be fired individually or simultaneously. The treatments were performed under oral analgesia with diclofenac sodium 75 mg.


The variables were: age, sex, BMI, size and location of the stone, analog pain score, number of sessions, complications and complementary treatments.
Patients were followed with  KUB  X-Ray, ultrasound or CT as appropriate, Treatment success was considered in case the patient was Stone Free  or with   fragments smaller than 4 mm.

Results
189 lithotripsy were performed in 123 patients ,leading to an average number of sessions per patient of  1.53. There were  81 men and 42 women, mean age was  43.9 years. Of them 48% were located in the kidney and 52% in ureter. The average size of the stones  was 10 mm.
According to the analog pain scale (1 to 10), 91.8% of patients reported to be between 3 and 5.
For kidney stone treatment the success rate was 94% (stone free: 60.3% + ˂ fragments 4 mm: 33.7%) and for ureteral stones the success rate was 76.5% (stone free: 67.2% + ˂ fragments 4 mm: 9.2%).

As for complications :  8.9% of patients had renal colic and no major complications were observed.

Conclusion
Our experience, confirms the feasibility to  treat renal and ureteral calculi with Dual Technology Electromagnetic Shock Wave , using only oral analgesia with  satisfactory results comparable to other  lithotripsy systems .

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