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The authors report an uncommon case of renal adenoma, a metanephric adenoma in a 21 year-old man. Treatment consisted in a tumorectomy. The review of the literature, shows it to be a benign tumor with no malignant potential.

Introduction: Electrohydraulic lithotripters use a R-wave triggering system as episodes of cardiac arrhythmia were observed during early clinical experiments. This study was designed to assess the safety of non triggered shock wave treatments using an external fixed rate device (120/min) on the Sonolith 4000 Plus (*), a non bathtub electroconductive lithotripter., Methods: Our study is the first prospective evaluation of non-EKG-gated lithotripsy where the patient under continuous Holter monitoring served as his own control during a randomized alternation of periods with or without R-wave triggering. This design allowed for a direct comparison of the effect of EKG-gated and non-EKG-gated lithotripsy respectively. The sequence of the different periods was randomly assigned. The recordings were compared to a pre-treatment recording, the cardiologist ignoring the randomization., Results: 25 consecutive patients without cardiac history have been treated for urinary stones. Ventricular and supraventricular excitability disorders have been noted in 7 patients, always during a non-EKG-triggered period. There was no correlation with stone location. No cardiac rhythm disturbances have been observed during triggered periods in the 25 patients. Auricular extrasystoles (0.1-0.5/min) were observed in 6 patients, and auricular couplets (0.5/min) in one. Ventricular extrasystoles were noted in 4 patients, and ventricular couplets in one. One patient had an asymptomatic non sustained ventricular tachycardia which resolved spontaneously. No clinically significant disorder occurred. Treatment time and analgesics requirements were reduced by non-EKG-triggering., Conclusions: Non-EKG-triggering lithotripsy has a definite potential for cardiac disturbances, but appeared to be clinically safe in these patients with no cardiac history.

Electroconductive lithotripsy uses a highly conductive liquid to bathe the electrodes rather than water. The effect is to channel energy between the electrodes and force it to pass directly from the anode to the cathode, exactly at F1. The Sonolith 4000 (Technomed Medical Systems) uses this new generation of "electroconductive" shock waves. Experimental and clinical results are presented. The typical electroconductive technique creates a linear relationship between energy level, in kilovolts, and the amplitude of the acoustic shock at F2 over a wide range of power. There is also a linear relationship between power and effectiveness of desintegration. More than 800 patients have been treated to date. Follow-up has reached 3 months in the 166 treatments reported here. Overall success rate without residual stone was 82%. The percentage of patients with residual stones smaller than 5mm was 5%. The rate of clinical success was 87%. The rate of retreatment in patients without residual stone was 10%. For 11 to 20 mm stones, the success rate (0 fragments), the rate of retreatment and the rate of auxiliary procedures were 83%, 4% and 2% respectively for stones < or = 10 mm and 78% for 11 to 20 mm stones. The electroconductive generator used in this study provided very satisfactory results, better than those generally obtained with classical generators. Tolerance was excellent.