MP54-18 EMERGENCY EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY (EESWL) FOR ACUTE RENAL COLIC DUE TO URETERAL STONES

Abstract

You have accessJournal of UrologyStone Disease: Shock Wave Lithotripsy1 Apr 2016MP54-18 EMERGENCY EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY (EESWL) FOR ACUTE RENAL COLIC DUE TO URETERAL STONES Paolo Umari, Stefano Bucci, Michele Rizzo, Nicola Pavan, Giovanni Liguori, Diego Marega, and Carlo Trombetta Paolo UmariPaolo Umari More articles by this author , Stefano BucciStefano Bucci More articles by this author , Michele RizzoMichele Rizzo More articles by this author , Nicola PavanNicola Pavan More articles by this author , Giovanni LiguoriGiovanni Liguori More articles by this author , Diego MaregaDiego Marega More articles by this author , and Carlo TrombettaCarlo Trombetta More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.588AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The aim of this study is to understand the role of extracorporeal shockwave lithotripsy (ESWL) as first-line treatment in patients with acute renal colic due to obstructive ureteral stones. METHODS We prospectively studied 70 patients presenting with their first episode of ureteric colic undergone extracorporeal shockwave lithotripsy (ESWL) over a 14 months period. Patients were randomized to emergency ESWL within 12 hours (eESWL group) or deferred ESWL until 20 days (dESWL group). Inclusion criteria were: acute renal colic, ureteral radiolucent or hyperechogenic stones from 5 to 20mm, no urinary infection or acute renal failure. Follow up included ultrasound or CT-scan at 24 hours, 7 days, 1 and 3 months. When it was necessary, repeated ESWL (re-ESWL) or ureteroscopy (URS) was performed. Preoperative and postoperative data between the two groups were compared and stone free rate (SFR) and efficiency quotient (EQ) were evaluated. Analyses were performed using SAS (9.3 version) statistical software. RESULTS 36 patients from eESWL group and 34 patients from dESWL group were well matched for age, gender, BMI and clinical and pathological characteristics. The mean patient age was 48.7 (range 24-81). Mean stone size was 9,8 mm (range 5-20mm). 25 stones (35.7%) were located in the upper and 45 (64.3%) in the distal ureter. Mean ESWL energy was 19,2 kV (range 14-24kV) and mean number of shock waves was 2650 (range 1000-3600). ESWL treatment lasted on average 44 minutes (range 17-60 minutes). All the procedures were conducted at the frequency of 1 Hz. No treatment was interrupted because of poor tolerance. Patients in the dESWL group spent more time in the hospital (2.21 vs 1.36 days) and the complication rates were paragonable in both groups (p<0.05). eESWL patients needs less auxiliary URS than dESWL patients, 11.1% vs 44.1% respectively and less re-ESWL 8.3% vs 32.4% respectively (p<0.05). The SFR at 24 hours was 52.8% and 11,8% in the eESWL and dESWL group respectively (p<0.05). The SFR at 3 months was 94.4% and 79.4% (p=0.07) and EQ was 79.1% and 57.5% in the eESWL and dESWL group respectively (p<0.01). CONCLUSIONS eESWL is a safe procedure and delivers high SFR even within 24 hours. It offers effective decompression of the collecting system and pain relief independently on the degree of hydronephrosis and especially in smaller stones (<10mm). It is able to reduce the number of auxiliary procedures and hospitalization. We believe that emergency timing of the precedure is of remarkably importance because of progressive development of ureteral edema and stone impactation. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e733-e734 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Paolo Umari More articles by this author Stefano Bucci More articles by this author Michele Rizzo More articles by this author Nicola Pavan More articles by this author Giovanni Liguori More articles by this author Diego Marega More articles by this author Carlo Trombetta More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...