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Specialties: Lithotripsy

The American University of Beirut Medical Center installed the Philips Diagnost M Lithotriptor in February 1998. This is a cost-efficient system whose modular design is adaptable to several particular requirements and permits upgrading in several stages. The features include urological X-ray diagnosis, cystoscopy, and URS. Also the system is adaptable to percutaneous endo-urology (PCN), digital radiography and fluoroscopy, with real time image processing.

The most outstanding feature of the litho Diagnost M system is the ability of performing anesthesia-free ESWL with high shock rate. This system, which combines all round access to patient, with latest X-ray technology for digital spot imaging, and swiveling shock-wave bb applicator system for greater efficiency of shock wave delivery, presents a state-of-the-art progress in our armamentarium in managing stone disease in Lebanon and in the region. The ESWL - Lithotripsy unit has been functional since February 1998 but most of the treatments were performed in 1999. The clinical application was initiated with intensive training of the four urologists at the University in March of 1998, and the acquisition of a full-time urologic technician, who is currently stationed in our Ambulatory-Lithotripsy unit in the Basement Level, Near X-Ray Department, Extension 5925, 5926 or 5927.

Since July 1998 the total number of patient-lithotripsy therapies has grown annually, and exceeded 500. The number of patients requiring two or more sessions for stone fragmentation was almost 40%. Most patients (90%) undergo the procedure without any anesthesia or minor sedation. The fragmentation rate has exceeded 85%, but is higher for upper tract stones particularly in the upper ureter and the kidney pelvis. The inclusion of lower ureteral stones has diminished the rate of success, yet is more attractive to patients because of its minimal invasiveness and the possibility of undergoing lithotripsy when the extra-corporeal lithotripsy fails. Thus the encouraging success rate in the upper ureter and kidney has tempted us to utilize the Diagnost M Lithotriptor for virtually all stones in the urinary tract regardless of the position in the ureter, realizing that the success rates for the lower ureteral stones are higher with endoscopic lithotripsy than extra-corporeal shock wave Lithotripsy. In 2000, the Division has acquired the Holmium: Yag laser technology and two flexible ureteroscopes were purchased. This expanded the armamentarium to tackle difficult upper tract stones. We believe that the introduction of the diagnost M Lithotriptor and the Holmium: Yag laser to the Division is a great advance in our ability to expand the urology armamentarium and has been a welcome feature to this Division.

Division of Urology American University of Beirut Medical Center Department of Surgery