MP05-13 COMPARISON OF EFFICACY AND SAFETY OF NARROW FOCUS VERSUS WIDE FOCUS SHOCK WAVE LITHOTRIPSY IN MANAGEMENT OF 1-2CM RENAL CALCULI USING TRI-FOCAL LITHOTRIPSY MACHINE: FIRST DOUBLE-BLIND RANDOMIZED STUDY

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP05-13 COMPARISON OF EFFICACY AND SAFETY OF NARROW FOCUS VERSUS WIDE FOCUS SHOCK WAVE LITHOTRIPSY IN MANAGEMENT OF 1-2CM RENAL CALCULI USING TRI-FOCAL LITHOTRIPSY MACHINE: FIRST DOUBLE-BLIND RANDOMIZED STUDY Yasser Noureldin, Walid Abdel Halim, Ezzat Elnahif, Ahmed Abdelbaky, and Salah El Hamshary Yasser NoureldinYasser Noureldin More articles by this author , Walid Abdel HalimWalid Abdel Halim More articles by this author , Ezzat ElnahifEzzat Elnahif More articles by this author , Ahmed AbdelbakyAhmed Abdelbaky More articles by this author , and Salah El HamsharySalah El Hamshary More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003216.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The objectives of this study were to compare efficacy and safety of shock wave lithotripsy (SWL) using a narrow focus of 2 mm (F1) versus a wide focus of 8 mm (F3) for renal stones 1-2 cm using a new tri-focal SWL machine. METHODS: This double-blind randomized study recruited adult patients presented with solitary radio-opaque renal pelvic stone 1-2 cm. Patients were electronically randomized into two groups; F1-group received narrow focus (2 mm) SWL while F3-group received wide focus (8 mm) SWL using Piezo Lith3000 plus (Richard Wolf, Germany). Ramping protocol was employed under simple analgesia, with maximum shocks of 3000 and maximum sessions of 3, two weeks apart. Baseline patient’s and stone characteristics were collected. The SFS (%) and complications were identified. Primary outcome was overall SFS (%) calculated one month following the 3rd session. Secondary outcomes were presence of complications in terms of pain and hematuria. Two urinary renal injury markers [neutrophil gelatinase-associated lipocalin (NGAL) and Kidney Injury Molecule-1 (KIM-1)] were measured with ELISA before, 2 hours after and 72 hours after the 1st SWL session. RESULTS: A total of 135 patients were recruited; 67 in F1 group and 68 in F3 group. Preoperative parameters were comparable in terms of age (p=0.16), female gender (p=0.52), BMI (p=0.71), stone size (1.2±0.3 vs. 1.1±0.3 mm; p=0.18), and HU (858±2 vs. 844±2; 0.70), NGAL (101.7±32.5 vs. 104.1±38.33 ng/dL; p=0.71), KIM-1 (4.3±0.9 vs. 4.5±1.1 ng/dL; p=0.17). The overall SFS and auxiliary interventions were comparable (92.5% vs. 91.2%; p=0.77) and (23.4% vs. 23.2%; p=0.23), respectively. In terms of complications, patients in F1 group had significantly higher experience of hematuria (Clavien 1) (95.5% vs. 83.8%; p=0.02), and pain (Clavien 1) (65.7% vs. 19.1%; p<0.001). Following the first SWL session, the rise in 2-h NGAL was comparable (109.6±32.7 vs. 112.7±40.6; p= 0.62). However, the rise in the 2-hr KIM-1 was significantly higher in F1 (4.9±1.1 vs. 4.4±1.4; p=0.022). Nevertheless, both markers were significantly improved to almost half of the baseline after 3 days (56.7±14 vs. 59.7±16.2; p=0.26) and (2.1±0.55 vs. 2.1± 0.5; p=0.96), respectively. CONCLUSIONS: Narrow and wide focus were associated with comparable lithotripsy outcomes and re-treatment rates. However, narrow focus was associated with significantly higher pain and hematuria. Both F1 and F3 SWL of Piezo Lith3000 plus were potentially safe in terms of the renal injury. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e48 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yasser Noureldin More articles by this author Walid Abdel Halim More articles by this author Ezzat Elnahif More articles by this author Ahmed Abdelbaky More articles by this author Salah El Hamshary More articles by this author Expand All Advertisement PDF downloadLoading ...