الفهرس | Only 14 pages are availabe for public view |
Abstract Uolithiasis is a the commonest disease facing the urological clinic. The prevalence of urinary stones has progressively increased in the industrialized nations, and a similar trend is being observed in developing countries due to changing social and economic conditions. In addition, many patients will be affected by multiple stones throughout their lifetime. Nowadays non-contrast Multi-Detector Computed Tomography (MDCT) is recognized as the most accurate method for detection of calculi in the urinary tract. Many methods of treatment of the urolithiasis are present, among which the extracorporeal lithotripsy with shock waves (ESWL) remain the gold standard in management of urinary calculi. ESWL has changed dramatically the management of urolithiasis. Widespread use of the technology, development of smaller devices, modified indication, and the lower cost of the procedure revolutionized the approach to stone patients. ESWL offers several advantages over other modalities of stone treatment; it is a minimally invasive procedure often not requiring deep anesthesia, it is an outpatient treatment, and most of the patients can resume their work within two days after the procedure. The outcome of stone clearance after ESWL is strongly related many factors such as stone size and composition, the number of stones. Key factors in the management of these patients remain the location, size and chemical composition of the stone .The ability to SUMMERY & CONCLUSION 126 predict outcome of ESWL before treatment enables the urologist to select the appropriate therapy. Smaller stone size will increase the success rate of ESWL. On the other hand larger stone size will further increase the required sessions for ESWL success & even failure of ESWL. Kidney stone less than 2 cm & ureteric stone less than 1cm are more suitable for ESWL and give good result. Small stone density will increase the success rate of ESWL. While larger stone density will increase the hardness of the stone and thus require more ESWL sessions & even ESWL failure. The suitable stone density for ESWL usually below 1000HU. Stone density less than 500 usually need one session while stone density range from 500 to 1000 HU usually need two session. Concerning stone location, lower calyx stones were the least site for the stone clearance after ESWL while upper & middle calyx were the highest site for stone clearance after ESWL, location of stone in the urinary tract play a role but in combination with other factors in predicting the outcome of ESWL. Multi-detector Computed tomography(MDCT) provides accurate size & density of the stone in additional to accurate anatomical detail of vital structures, providing valuable data for management decisions, and predicting the outcome of ESWL. |