Author/Editor		Smrkolj, Tomaž; Tršinar, Bojan
Title		Zunajtelesno drobljenje kamnov v sečilih
Translated title		Extracorporeal shockwave lithotripsy in urolithiasis
Type		članek
Source		Med Razgl
Vol. and No.		Letnik 42, št. 4
Publication year		2003
Volume		str. 351-9
Language		slo
Abstract		It has been more than 20 years since extracorporeal shockwave lithotripsy came into clinical use. The physical principles of shockwave formation and the effects of shockwaves in lithotripsy are described with coexistent models. There are three basic sources of shockwaves that can be used: electromagnetic, piezoelectric and electrohydraulic sources. Development of extracorporeal shockwave lithotripsy machines is concerned with better shockwave focusing, radiologic and ultrasound imaging enhancement, decreasing shockwave machine dimensions, and the patient's safety and comfort. The clinical results of extracorporeal shockwave lithotripsy depend on many variables, of which the most commonly reported ones are the size and location of the stone. Special attention is paid to the lithotripsy of lower pole kidney stones due to its lower success rates and residual stone fragments, which frequently remain in the lower renal calyx due to an unfavourable gravitational position. A stone's fragility also depends on its chemical composition. The most fragile are magnesium-ammonium phosphate stones. Even though extracorporeal shockwave lithotripsy is a less invasive procedure, there are both short- and long-term complications. Most frequently these include renal colic, »steinstrasse«, symptomatic urinary tract infection and macrohematuria.
Summary		Od prve klinične uporabe zunajtelesnega drobljenja kamnov v sečilih je minilo že več kot 20 let. Fizikalni principi drobljenja kamnov z udarnimi valovi so opisani s tlačnim modelom, modelom kavitacije, kohezivnim modelom in binarnim modelom. Uporabljamo lahko tri osnovne izvore udarnih valov: elektromagnetni, piezoelektrični in elektrohidravlični. Razvoj aparatov gre v smeri izboljševanja zbiranja udarnih valov, slikovnega prikaza kamnov z rentgensko in ultrazvočno tehniko, zmanjševanja dimenzij aparata, varnosti in udobja bolnika. Klinični rezultati zunajtelesnega drobljenja so odvisni od mnogih dejavnikov, najpogosteje opisovana sta velikost in lega kamna v sečilih. Posebno pozornost zaradi slabših uspehov drobljenja posvečajo kamnom v spodnjem ledvičnem polu ter pomenu zaostalih drobcev kamnov v sečilih, ki so zaradi gravitacijsko neugodne lege največkrat prisotni ravno v spodnji ledvični čaši. Drobljivost kamna je odvisna tudi od njegove kemične sestave, najbolj drobljivi so magnezij-amonij fosfatni kamni. Zunajtelesno drobljenje kamnov prištevajo k maloinvazivnim metodam, vendar so opisani tudi možni kratko- in dolgoročni zapleti, najpogosteje ledvične kolike, veriga drobcev, simptomatska okužba sečil in makrohematurija.
Descriptors		URINARY CALCULI LITHOTRIPSY ANALGESIA BIOMECHANICS KIDNEY CALCULI URETERAL CALCULI BLADDER CALCULI COLIC KIDNEY DISEASES HEMATURIA