1939 PATIENT GUIDED REAL TIME STONE TRACKING METHOD. CAN THE PATIENT HAVE AN ACTIVE ROLE IN THE TREATMENT DURING EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY?

Abstract

You have accessJournal of UrologyStone Disease: New Technology/SWL, Ureteroscopic or Percutaneous Stone Removal1 Apr 20111939 PATIENT GUIDED REAL TIME STONE TRACKING METHOD. CAN THE PATIENT HAVE AN ACTIVE ROLE IN THE TREATMENT DURING EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY? Achilles Ploumidis, Ioannis Kariotis, Efrem Serafetinidis, Georgios Papadopoulos, Georgios Garaganis, and Dimitrios Delakas Achilles PloumidisAchilles Ploumidis Athens, Greece More articles by this author , Ioannis KariotisIoannis Kariotis Athens, Greece More articles by this author , Efrem SerafetinidisEfrem Serafetinidis Athens, Greece More articles by this author , Georgios PapadopoulosGeorgios Papadopoulos Athens, Greece More articles by this author , Georgios GaraganisGeorgios Garaganis Athens, Greece More articles by this author , and Dimitrios DelakasDimitrios Delakas Athens, Greece More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2120AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Respiratory cycle and patient movement due to discomfort render renal stones a moving target with trajectories often outside the smaller focal zones of third generation lithotripters. We propose an active role of the patient in readjusting stone position inside the focal zone by ultrasound imaging feedback after specific training. METHODS From February 2008 to August 2010, 120 consecutive patients with renal pelvic stone (7–20mm) were randomized in three groups for ESWL treatment (Dornier Lithotripter S EMSE 220F-XXP) by a single urologist. The number of shockwaves delivered was 2500–3000 (80/min). The therapy started from a low energy level 1 (49 Mpa) and gradually increased to a maximum of level 7 (84 Mpa). Targeting of the stone in group A (n=56) and group B (n=48) was achieved by fluoroscopic and ultrasound imaging respectively in a classical manner. In group C (n=48) patients were briefly educated in advance by video on identifying the kidney and stone on ultrasound imaging. They were informed on how depth of respiration and inadvertent movement can harm the kidney, diminish the percentage of fragmentation and were asked to maintain the stone on target at all times, adding responsibility to their treatment. Follow-up included plain radiography at 20 days. One-way ANOVA and Chi-square test (p<0.005) were used to compare means and categorical variables respectively. RESULTS The mean age (Group: A=52.3±17, B=52.4±15, C=50.7±15.5) stone size (group: A=11.35±3.1, B=11.7±3.2, C=11.4±2.8) and amount of analgesics were comparable between groups. In group C we observed, less mean number of comments of the operator to the patient for position readjustment (group: A=8.11±1.6, B=8.23±1.12, C=4.7±1, p<0.001), less mean number of times for manual repositioning of the target by the operator (group: A=5.14±0.78, B=5.13±0.7, C=2.75±0.9, p<0.001), less mean interruptions of the treatment (group: A=3.9±0.8, B=4±0.7, C=0.55±0.7, p<0.001) and less overall time (min) of therapy (group: A=51.5±6.5, B=52.5±6.1, C=46.22±5.5, p<0.001). No significant difference was found in the stone free rate during the first session (group: A=73,8%, B=76,3%, C=87,5%, p=0.27). No complications were observed in any group. CONCLUSIONS This method has similar stone free rates, relieves the operator from continuous readjustments, and reduces treatment time, while maintaining all the advantages of limited patient exposure to fluoroscopy. It is cost effective and can be applied in any lithotripter with ultrasound imaging. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e775-e776 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Achilles Ploumidis Athens, Greece More articles by this author Ioannis Kariotis Athens, Greece More articles by this author Efrem Serafetinidis Athens, Greece More articles by this author Georgios Papadopoulos Athens, Greece More articles by this author Georgios Garaganis Athens, Greece More articles by this author Dimitrios Delakas Athens, Greece More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...