ESWL Treatment Result with DiREX IntegraKumamoto Urological HPYasuhiro Yamamoto, 　 Yasufumi Nabekura, Hidetaka Ih, Akihiro Nojiri

Kengun Kumamoto Urological 　 ClinicHitoshi Sakiyama

BackgroundAbout 700cases/year of urolithiasis were treated in our ho

spital. (ESWL/TUL/f-TUL/PNL/Vesical Lithotomy)The number of ESWL treatments was about 600cases/year and we expect that the number of patients will increase still more in the future.We have started to use a new ESWL device (DiREX Integra) since April of 2009, in parallel to the use of Storz Modulith SL20, which has been used for a long time in our hospital.We report here the results of ESWL treatment with Direx Integra during April 2009 - January 2010.

DiREX Integra

Electromagnetic SWL System (3rd generation ESWL)

Supine position is the standard, but prone position is also possible.

Compact 　 body(1×2m)

Stone localization is made by X-ray fluoroscopy. (Echo is not mounted.)

This hospital is the 2nd user of Integra in Japan.

Case Report305cases were treated with Direx Integra.

（ Term ）　 10months during April 2009-January 2010

（ Sex ）　 Male ： 213cases 、　 Female ： 92cases

（ Age ）　 19 ～ 102y.o 　 [Average ： 56.2y.o]

（ Details ）・ Number of shocks : Max 5000 shocks/session

（ Renal stones : Max 3500 shocks/session ）・ Level : 1 ～ 20 　（ Max Power ： 300Bar ）・ Evaluate the overall success rate (stone free cases &

cases with residual fragments less than 4mm) within

3months after treatment.

Stone LocationStone maximal diameter

≦1cm

1cm ＜、≦ 2cm

2cm ＜

208cases

89cases

8cases

Stone information

R1 ・・・ 0case

R2 ・・・ 23cases

R3 ・・・ 34cases

U1 ・・・ 153cases

U2 ・・・ 36cases

U3 ・・・ 59cases

Treatment Result according to stone location（ Average number of sessions）

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

2

R1 R2 R3 U1 U2 U3

R1

R2

R3

U1

U2

U3

［ Stone location］

［ Average number of sessions］

Treatment Result according to stone location（Overall success rate）

0

10

20

30

40

50

60

70

80

90

100

R1 R2 R3 U1 U2 U3

R1

R2

R3

U1

U2

U3

［ Overall success rate （％）］

［ stone location ］

Treatment Result according to maximal diameter (Average number of sessions)

0

0.5

1

1.5

2

2.5

3

3.5

≦1 1 ＜ ,≦2 2 ＜

≦1cm

1cm ＜ ,≦2cm

2cm ＜

［ Average number of sessions ］

［ Stone maximal diameter （ cm ）］

Treatment Result according to maximal diameter (Overall success rate)

0

10

20

30

40

50

60

70

80

90

100

≦1cm

1cm ＜ ,≦2cm

2cm ＜

［ Overall success rate （％）］

［ Stone maximal diameter （ cm ）］≦1 1 ＜ ,≦2 2 ＜

Complication・ Mild complication ・・・ Gross hematuria （ Almost all cases ）　　　　　　 Subcutaneous hematoma　　　　　　 Colic attack （ pain ・ nausea ・vomiting ）

・ Serious complication ・・・ Renal subcapsular hematoma （ 2cases ）　　　　　　　 Pyelonephritis （ 3cases ）

2009 　 ESWL number of treatments and the graph of fragmentation results

0

10

20

30

40

50

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec/2009

70

80

ＳＬ２０ＳＬＸ

IntegraBOTH

TOTAL

60

[Number of treatments]

2009 　 ESWL number of treatments and the graph of fragmentation results

0

10

20

30

40

50

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec/2009

70

80ＳＬ２０

ＳＬＸIntegra

BOTHTOTAL

60

Installation of

Integra[Number of treatments]

2009 　 ESWL number of treatments and the graph of fragmentation results

Ratio of number of treatments (single/multiple)

0

10

20

30

40

50

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec/20090%

10%

20%

30%

40%

50%

60%

70%

80%

90%

60

70

80 ＳＬ２０ ＳＬＸ

Integra BOTH

TOTAL Full fragmentation at first session

More than 2sessions to achieve full fragmentation

60

Installation of Integra

［ number of treatments ］

Summary・ This is a report of ESWL treatment results with Integra.

・ We confirmed that ESWL treatments with Integra were effective for urinary stones with less side effect.

・ The treatment results for renal stones were little worse than for ureteral stones. The cause might be the setting up the restriction of number of shocks and HV level for the safety, because we are still the second user of this machine in Japan.

・ We are going to treat still more patients in order to conduct further examination of this machine.