Extracorporeal Shock Wave Lithotripsy Research Articles

Penile rehabilitation after radical prostatectomy using low-intensity shockwave therapy for erectile function: late results findings from a randomized clinical trial.

There is still few evidence to support the use of low-intensity extracorporeal shockwave therapy (LiESWT) in rehabilitation of erectile function after radical prostatectomy (RP). The aim of this study is to assess the long-term results of LiWEST as a penile rehabilitation method in patients who underwent RP. This is an assessment of the late results outcomes of our previous clinical trial registered in ReBEC (ensaiosclinicos.gov.br) RBR-85HGCG. Patients were randomized in two groups with two parallel arms and an allocation ratio of 1:1. The control group received tadalafil 5mg/day, while the experimental group received tadalafil 5mg/day and were submitted to 2400 shocks/session-week distributed on four different penile regions across 8weeks of treatment. Both groups started the penile rehabilitation after the removal of the transurethral catheter. Sexual function was assessed by International Index of Erectile Function (IIEF-5) score. A difference in IIEF-5 without statistical significance between the experimental and control groups. Among 77 patients included in our previous analysis, 35 patients were reassessed after a median follow-up of 45months (95% CI, 42-50months). Seventeen of them had to be excluded from the analysis for biochemical recurrence and/or new interventions. Remaining 7 and 11 patients in the experimental and control group, respectively. The final mean IIEF-5 score between experimental and control groups showed a difference in favor of the LiWEST group, not statistically significant (18.85, SD 5.66, 95% CI, 13.61-24.1 x 16.63, SD 5.48, 95%CI, 12.9- 20.31; respectively; P = 0.42). Subgroup analysis in patients still using IPDE5 there is a higher difference between mean IIEF5, however not statistically significantly (18.5, SD 6.12, 95%CI 12.07-24.92 x 15.85, SD 3.62, 95% CI, 12.50-19.20, P = 0.35). This study highlights that LiESWT may offer limited long-term benefit for erectile function recovery after RP. This study provides valuable long-term data on the use of LiESWT as a penile rehabilitation method after RP. The randomized design and parallel group structure strengthen the reliability Journal of Sexual Medicine Journal of Sexual Medicine For Peer Review of findings, with clear intervention protocols. However, limitations include a small final sample size due to patient exclusions, which likely impacted statistical power and the generalizability of results. Additionally, while differences in IIEF-5 scores favored the LiESWT group, the lack of statistical significance limits the ability to draw definitive conclusions about its effectiveness. The LiESWT showed no impact on long-term results of penile rehabilitation in patients submitted to RP.

The necessity of therapeutic ERCP after extracorporeal shockwave lithotripsy in chronic calcific pancreatitis.

The necessity of therapeutic ERCP after extracorporeal shockwave lithotripsy in chronic calcific pancreatitis.

Effects of Instrument-Assisted Soft Tissue Mobilization and Extracorporeal Shock Wave Therapy in Individuals With Lateral Elbow Pain: A Randomized Single-Blind Clinical Trial.

In lateral elbow pain (LEP), it is important to improve pain, grip strength, and function. The aim of this study is to compare the effects of Instrument-Assisted Soft Tissue Mobilization (IASTM) and extracorporeal shock wave therapy (ESWT) methods on pain, grip strength, and function in LEP. Randomized single-blind clinical trial. Forty-eight adults with LEP were randomly assigned to the IASTM, ESWT, and control groups. Home exercise consisting of special static stretching and eccentric strengthening exercises was given to the control group. The ESWT group received a total of 8 sessions of ESWT in addition to home exercise. The IASTM group received a total of 8 sessions of IASTM in addition to home exercise. The visual analog scale for pain, hydraulic hand dynamometer for grip strength, and Patient-Rated Tennis Elbow Evaluation scale for functionality were used for assessment. Data were collected at baseline, after intervention, and at 4-weeks postintervention. At the end of the treatment and the 4-week follow-up, a decrease in pain scores and improvement in muscle strength and functionality was detected in all 3 groups (P < .001). IASTM applications were more effective than ESWT and control groups in reducing pain both after application and at follow-up (P < .001), whereas ESWT application was also effective compared with the control group (P < .001). IASTM applications were more effective than the ESWT and control groups in reducing Patient-Rated Tennis Elbow Evaluation total scores both after the applications and follow-up (P < .001). IASTM was more effective in grip strength than ESWT and control groups (P < .001). It was determined that IASTM and ESWT treatments were effective in reducing pain and increasing grip strength and functionality in both the short and long term in patients with LEP. It was determined that IASTM treatment was superior to ESWT treatment in reducing pain and improving grip strength and functionality.

Effectiveness of therapeutic interventions on myofascial trigger points: Literature review

Introduction: Myofascial trigger points (MTrPs) are most prevalent cause for musculoskeletal pain in everyone at some point of life leading a motor, sensory and autonomic symptoms with variability in etiopathogenesis and currently many interventions are used for its management. Aim of the study: This review is aimed to compare the overall effectiveness of different interventions used in treatment of myofascial pain linked to myofascial trigger points using literature. Methodology: Using key terms, identified about 1527 studies published in Google Scholar, PubMed, and Scopus, and after retrieval and serial exclusion only 28 recent level I and II studies were included and used simple statistical methods to analyze data and formulate results. Results &amp; Discussion: Therapeutic modalities like Low Level Laser Therapy (LLLT), Extra Corporeal Shock Wave Therapy (ESWT) and minimally invasive techniques like dry needling, cupping, trigger point injections will give Immediate short-term results whereas manual techniques like Ischemic compression (IC), Muscle Energy Techniques (MET) shown long term effect compare with other techniques. Conclusion: A Combination of manual therapy either with therapeutic modalities or with minimally invasive techniques are more effective form of treatment for Myofascial trigger points than any isolated intervention for long term effect on Pain, Range of Motion, Quality of life and overall improvement in functionality.

"Is oral antioxidant (Vit C & E) helpful in minimizing shock wave induced renal damage? A study from a tertiary care Center from eastern India" A prospective study.

Extracorporeal shock wave lithotripsy (ESWL) causes trauma to the renal parenchyma. Due to the kidney injury, free radicals are generated, and an inflammatory process develops. Inflammatory markers like interleukin's (IL), C-reactive protein (CRP), and procalcitonin (PCT) are released into the circulation. Antioxidants have the potential to mitigate the effects of the inflammatory process. Our objectives were the measurement of the effect of supplementation with Vit C and Vit E (antioxidants) and their effect on the reduction of CRP and procalcitonin and further kidney damage. There were two groups with 100 patients each. Group A, receiving oral Vitamin E (400 mg twice a day) and oral Vitamin C (500 mg twice a day) beginning 3 days before the lithotripsy and continuing for up to 7 days after the lithotripsy (total of 10 days). Group B served as the control group. Serum levels of CRP and procalcitonin were measured on the day of lithotripsy, day 2, and day 10 post ESWL. In Group B, CRP and PCT values are statistically significantly elevated as compared to Group A. In Group A, pre-ESWL, day 2 and day 10 CRP values are 1.23, 3.58, and 1.61. In Group B pre-ESWL, day 2 and day 10 CRP values are 1.38, 6.70, and 3.09 (p value < 0.001 in day 2 and 10). In Group A, pre-ESWL, day 2 and day 10 PCT values are 0.41, 1.42, and 0.44. In Group B pre-ESWL, day 2 and day 10 PCT values are 0.36, 3.03, and 1.10 (p value < 0.001 in day 2 and 10). The serum levels of the inflammatory marker for acute renal injury are decreased when vitamins C and E are taken orally, which can help to minimize kidney damage after lithotripsy for renal stone disease.

The effects of extracorporeal shock wave therapy in children with cerebral palsy: a systematic review.

Spastic Cerebral Palsy (CP) is a major cause of movement disorders in pediatric rehabilitation. Current treatments are often invasive and may lead to substantial discomfort. Extracorporeal shockwave therapy (ESWT) presents a potential alternative, offering a less invasive approach with a reduced side effect profile. However, the impact of ESWT on children with CP remains unclear. This systematic review aims to summarize the current evidence on ESWT's impact in children with spastic CP across various domains of the International Classification of Functioning, Disability, and Health for Children and Youth. To answer the main question, a systematic literature study is used. The studies, collected from four databases, were screened and data on outcome measures and methodological quality were extracted. Effect sizes were calculated to facilitate study comparison. In total, twelve randomized controlled trials met inclusion criteria, with PEDro scores ranging from three to eight. The combined study population included 421 children. Positive effects were observed on resistance to passive movements, passive range of motion, and gross motor skills, with effect sizes ranging from moderate (0.65) to very large (7.69). ESWT demonstrated positive effects across multiple domains in children with spastic CP.

Measurement and spectral analysis of medical shock wave parameters based on flexible PVDF sensors.

Extracorporeal shock wave therapy (ESWT) achieves its therapeutic purpose mainly through the biological effects produced by the interaction of shock waves with tissues, and the accurate measurement and calculation of the mechanical parameters of shock waves in tissues are of great significance in formulating the therapeutic strategy and evaluating the therapeutic effect. This study utilizes the approach of implanting flexible polyvinylidene fluoride (PVDF) vibration sensors inside the tissue-mimicking phantom of various thicknesses to capture waveforms at different depths during the impact process in real time. Parameters including positive and negative pressure changes (P+, P-), pulse wave rise time ([Formula: see text]), and energy flux density (EFD) are calculated, and frequency spectrum analysis of the waveforms is conducted. The dynamic response, propagation process, and attenuation law of the shock wave in the phantom under different impact intensities were analyzed. Results showed that flexible PVDF sensors could precisely acquire the characteristics of pulse waveform propagating within the phantom. At the same depth, as the driving pressure increases, P+ and P- increase linearly, and [Formula: see text] remains constant. At the same driving pressure, P+, P-, and EFD decay exponentially with increasing propagation depth. At the same depth, the spectra of pulse waveforms are similar, and the increasing driving pressure does not cause significant changes in carrier frequency and modulation frequency. The research findings could provide a reference for developing ESWT devices, improving treatment strategies, and enhancing the safety of clinical applications.

Extracorporeal shockwave therapy rescued mouse critical limb ischemia via upregulating GPR120 against inflammation and promoting angiogenesis for restoring the blood flow in ischemic zone-experimental study.

This study tested the hypothesis that extracorporeal shockwave therapy (ECSWT) effectively rescues critical limb ischemia (CLI) in mice through the upregulation of GPR120, which protects against inflammation and angiogenesis to restore blood flow in the ischemic area. Compared with the control, ECSWT-induced GPR120-mediated anti-inflammatory effects significantly suppressed the expression of inflammatory signaling biomarkers (TAK1/MAPK family/NF-κB/IL-1β/IL-6/TNF-α/MCP-1) in HUVECs, and these effects were abolished by silencing GPR120 or by the GPR120 antagonist AH7614 (all P < 0.001). C57BL/6 mice (n =40) were equally categorized into Groups 1 (sham-operated control), 2 (CLI), 3 (CLI+ECSWT), and 4 (CLI+ECSWT+AH7614). By Days 7, 14, and 28 just prior to harvesting the quadriceps muscle, the laser Doppler results showed that the ratio of ischemia to normal blood flow (INBF) in the CLI area was highest in Group 1, lowest in Group 2, and significantly greater in Group 3 than in Group 4 (all P < 0.0001). Endothelial cell markers (CD31/vWF) and GPR120+cells exhibited identical patterns of INBF among the groups, whereas angiogenesis biomarkers (CXCR4/SDF-1/VEGF/VEGFR2) were significantly and progressively upregulated from Groups 1 to 4 (all P < 0.0001). The protein levels of inflammation (MMP-9, IL-6, and TNF-α) and oxidative stress (NOX-1 and NOX-2) and the cellular levels of inflammation (CD68+)/DNA damage (γ-H2AX+) displayed opposite patterns, whereas the small vessel density in the CLI area displayed an identical pattern of INBF among the groups (all P < 0.0001). ECSWT rescued CLI by increasing GPR120-mediated suppression of inflammation and enhancing angiogenesis via activation of VEGFR2.

Urolithiasis management: An umbrella review on the efficacy and safety of extracorporeal shock wave lithotripsy (ESWL) versus the ureteroscopic approach.

This Umbrella Review aims to gather high-quality evidence on urolithiasis outcomes and complications, comparing extracorporeal shockwave lithotripsy (ESWL), ureteroscopic lithotripsy (URSL), and retrograde intrarenal surgery (RIRS). We incorporated systematic reviews, some containing meta-analyses, into two separate reports, focusing on quantitative and qualitative results. Additionally, when data permitted, a secondary meta-analysis was conducted using final effect estimates from multiple meta-analyses. Stone-free rate (SFR) served as the primary outcome, with complications, retreatment, and hospital stay as secondary outcomes. Adhering to Joanna Briggs Institute (JBI) guidelines, we initially screened 282 titles, narrowed down to 166 titles and abstracts, ultimately selecting 55 full-text articles for review. Of these, 22 met our inclusion criteria for the umbrella review. We evaluated study quality using JBI criteria, excluding five low-quality studies. Analysis showed ESWL had lower SFR compared to RIRS (RR: 0.577, 95% CI: 0.482-0.692) and URSL (RR: 0.570, 95% CI: 0.450-0.722); lower overall risk compared to ureteroscopy (RR: 0.58, 95% CI: 0.51-0.66). ESWL had fewer complications than RIRS (p < 0.001), but lower SFR than ureteroscopy. However, the need for retreatment and auxiliary procedures in RIRS and URSL were lower than that in ESWL. In contrast, individuals undergoing ureteroscopy experienced a greater frequency of complications and longer duration of operation compared to those undergoing ESWL.

Pain, Function, and Elastosonographic Assessment After Shockwave Therapy in Non-Calcific Supraspinatus Tendinopathy: A Retrospective Observational Study

Background: Non-calcific supraspinatus tendinopathy (SNCCT) is a frequent cause of shoulder pain, often associated with functional impairment and reduced quality of life. Recent advancements in diagnostic imaging, including shear wave elastography (SWE), provide quantitative data on tendon stiffness and thickness, facilitating more precise evaluations. Extracorporeal shockwave therapy (ESWT) has emerged as a minimally invasive and effective treatment for SNCCT, but its effects on tendon properties measured through SWE require further investigation. Objective: This retrospective observational study aimed to evaluate the impact of ESWT on supraspinatus tendon characteristics in patients with SNCCT by assessing tendon thickness, SWE velocity, and clinical outcomes. Methods: This observational study enrolled 39 patients with SNCCT, aged 30–75 years, who received three ESWT sessions over 3 weeks. The intervention was delivered using a Modulith SLK system at an energy level of 0.20 mJ/mm2 with 2400 pulses per session. SWE and conventional ultrasound were used to measure tendon thickness and SWEv at baseline (T0) and 6 months post-treatment (T1). Clinical outcomes were assessed using the Visual Analog Scale (VAS), Constant and Murley Score (CMS), and modified Roles and Maudsley scale. Data were analyzed using paired t-tests and correlation analyses. Results: At baseline, affected tendons exhibited increased thickness (7.5 ± 0.9 mm) and reduced SWEv (3.1 ± 0.7 m/s) compared to healthy tendons (4.5 ± 0.7 mm and 6.9 ± 1 m/s, respectively; p &lt; 0.05). Six months after ESWT, tendon thickness decreased significantly (6.2 ± 0.9 mm, p &lt; 0.05), and SWEv increased (5.7 ± 1.8 m/s, p &lt; 0.05), indicating improved elasticity. Clinical outcomes improved significantly, with the VAS scores decreasing from 6.5 ± 1.4 to 3.2 ± 2.1, the CMS score rising from 59.1 ± 17.3 to 78.2 ± 17.7, and the modified Roles and Maudsley scale improving from 2.3 ± 0.6 to 1.5 ± 0.8 (p &lt; 0.05 for all). SWEv positively correlated with the CMS (r = 0.4) and negatively with the VAS and the modified Roles and Maudsley scale (r = −0.6 and r = −0.5, respectively). Conclusions: ESWT significantly reduces tendon thickness and enhances elasticity, correlating with improvements in pain and functional scores. SWE proved to be a reliable method for monitoring structural and clinical changes in SNCCT. Further research, including randomized controlled trials, is recommended to confirm these findings and explore longer-term outcomes.

The Clinical Efficacy of Extracorporeal Shock Wave Therapy Combined with Platelet Rich Plasma and Exercise for Lateral Epicondylitis: Prospective Randomized Sham-Controlled Ultrasonographic Study.

To evaluate the combined effect of two different regenerative therapies, extracorporeal shock wave therapy (ESWT) and platelet-rich plasma (PRP), along with therapeutic exercise, in patients with lateral epicondylitis (LE). Prospective, Randomized, Sham-Controlled Trial. Outpatient clinic. Ninety one patients with LE for >3 months were randomly allocated into 3 groups. Participants were assigned to PRP+ESWT, Sham PRP +ESWT, or ESWT only treatment group. All groups received exercise therapy. The primary outcome was the VAS pain score. Secondary outcomes included handgrip strength, Patient-rated Tennis Elbow Evaluation (PRTEE), Quick Disabilities of the Arm, Shoulder, and Hand (Quick DASH), Short Form 36 (SF-36), ultrasonographic assessments (common extensor tendon [CET] measurement and total ultrasonography scale score [TUSS]), and isokinetic evaluation. Participants were evaluated three times: pre-treatment (T0), after 4 weeks (T1), and after 12 weeks (T2). The PRP group showed superiority over other groups in terms of VAS (activity and night) scores at follow-ups. With regard to the secondary outcomes, in the short term, the PRP group demonstrated a statistically significant difference in the PRTEE-function. In the 12th week, PRP outperformed only against ESWT in all PRTEE parameters, and also showed superior Quick DASH scores to the other groups. In handgrip strength, the PRP group demonstrated superiority over the Sham PRP group at T1 and over both groups at T2. In the isokinetic evaluation, PRP group showed superiority over the Sham PRP group in both wrist flexion/extension peak torque scores during follow-ups. No significant differences were found in any of the ultrasonographic parameters, including CET thickness and TUSS scores, between the groups at the 4th and 12th week. The combined application of ESWT and PRP in the management of LE has demonstrated superior efficacy, as evidenced by significant improvements in clinical parameters.

Comparison of Short-Term Effects of Extracorporeal Shock Wave Therapy, Low-Level Laser Therapy and Pulsed Electromagnetic Field Therapy in Knee Osteoarthritis: A Randomized Controlled Study.

Background: Knee osteoarthritis (OA) is the most prevalent form of osteoarthritis and a leading cause of chronic pain in adults. This study aimed to compare the short-term effects of extracorporeal shock wave therapy (ESWT), low-level laser therapy (LLLT), and pulsed electromagnetic field therapy (PEMF) on pain, function, and quality of life in patients with knee OA. Methods: A hundred and twenty patients with Kellgren-Lawrence grade 2-3 knee OA were randomized into four groups: ESWT (once a week for three sessions), LLLT (twice a week for eight sessions), PEMF (twice a week for eight sessions), and a control group with 30 patients in each group. All participants were instructed in a daily exercise program, including knee joint range of motion, stretching, and strengthening exercises (3 × 10 repetitions). Outcome measures, including the visual analog scale (VAS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Short Form-36 (SF-36), and the Timed Up and Go (TUG) test, were assessed at baseline after treatment and at the third month. Results: There were no significant differences between groups at baseline regarding VAS, WOMAC, SF-36, and TUG scores (p > 0.05). Significant improvements were observed in all parameters post-treatment for all groups (p < 0.001). However, the improvements in the PEMF group were significantly lower than in the ESWT and LLLT groups, particularly for VAS, WOMAC pain, and SF-36 physical function scores (p < 0.05). No significant differences were found between ESWT and LLLT (p > 0.05). Conclusions: In the short-term, ESWT, LLLT, and PEMF effectively reduce pain, improve physical function, and enhance quality of life in patients with knee OA, though PEMF showed less pronounced improvements.

Impact of hydronephrosis on shockwave lithotripsy outcomes for upper ureteral stones.

To investigate the effect of the degree of hydronephrosis on extracorporeal shockwave lithotripsy (SWL) success in patients who underwent SWL due to upper ureteral stones. Medical records of 878 patients who underwent SWL were retrospectively reviewed. Patients with isolated unilateral 6-10mm radiopaque upper ureteral stones above the upper border of the sacroiliac joint were included in the study. The primary endpoint of the study was the relationship between the degree of hydronephrosis with upper ureteral stones and the stone clearance time, number of SWL sessions, and success, while the secondary endpoint was the effect of the presence of severe hydronephrosis (SFU grade 3) on SWL success. The mean age of the patients was 41.3 ± 10.9years. The mean stone size was 8.2 (6-10) mm. Ureteropelvic junction stones were present in 24 (20%) patients. The mean stone clearance time was 14.6 ± 9.7days. One-month SWL success was determined as 85%. SWL success rates decreased as the degree of hydronephrosis increased (p = 0.047). Being 45years of age and older increased the risk of SWL failure by 16.25 times (OR = 16.25, p = 0.017). Increasing the stone clearance time by 1day increased the risk of SWL failure by 1.17 times (OR = 1.17, p = 0.006), and increasing the number of SWL sessions by 1 session increased the risk of SWL failure by 7.69 times (OR = 7.69, p = 0.016). The presence of severe hydronephrosis (grade 3) did not affect SWL success (OR = 5.56, p = 0.071). According to our study results, as the degree of hydronephrosis increases in 6-10mm upper ureteral stones, the number of SWL sessions increases, stone expulsion times prolong, and 1-month success rates decrease.

Therapeutic effects of dry needling for patellofemoral pain syndrome: a systematic review and meta-analysis.

Dry needling has been increasingly used as an adjunctive therapy for patellofemoral pain syndrome in clinical practice. This study aimed to summarize the available evidence about the effects of dry needling in managing patellofemoral pain syndrome. Seven English-language databases and three Chinese-language databases were searched. Two researchers independently screened the literature, extracted data, and assessed the risk of bias using the PEDro scale and the Cochrane Risk of Bias Assessment Tool. The quality of evidence was evaluated using the GRADE approach. A total of 12 studies were included, involving 624 participants. Dry needling significantly improved knee pain (MD=-0.86, 95%CI -1.17 to -0.55) and physical function (MD=5.33, 95%CI 3.88 to 6.78) compared to comparative groups. When combined with exercise therapy, dry needling resulted in large reduction in knee pain(MD=-2.02, 95%CI -2.36 to -1.67) and small improvement in physical function (MD=9.56, 95%CI 7.84 to 11.27) compared to exercise therapy alone. However, negligible or no additional benefits were observed when dry needling was added to extracorporeal shock wave therapy or multimodal interventions. Furthermore, dry needling showed no significant advantage over other trigger point therapies in terms of pain reduction and functional improvement. Dry needling is effective in reducing pain and improving function for patients with patellofemoral pain syndrome, particularly when combined with exercise therapy. However, more high-quality studies are required to draw a definitive conclusion. CRD42023490627 on PROSPERO.

Can Focal Extracorporeal Shock Wave Therapy Promote Bone Consolidation and Improve Pain and Functionality? – A Case Series

Can Focal Extracorporeal Shock Wave Therapy Promote Bone Consolidation and Improve Pain and Functionality? – A Case Series

Endoscopic Management of Benign Pancreaticobiliary Disorders.

Endoscopic management of benign pancreaticobiliary disorders encompasses a range of procedures designed to address complications in gallstone disease, choledocholithiasis, and pancreatic disorders. Acute cholecystitis is typically treated with cholecystectomy or percutaneous drainage (PT-GBD), but for high-risk or future surgical candidates, alternative decompression methods, such as endoscopic transpapillary gallbladder drainage (ETP-GBD), and endoscopic ultrasound (EUS)-guided gallbladder drainage (EUS-GBD), are effective. PT-GBD is associated with significant discomfort as well as variable adverse event rates. EUS-GBD leverages lumen-apposing metal stents (LAMS) for direct access to the gallbladder, providing the ability to treat an inflamed GB internally. Choledocholithiasis is primarily managed with ERCP, utilizing techniques to include balloon extraction, mechanical lithotripsy, or advanced methods such as electrohydraulic or laser lithotripsy in cases of complex stones. Altered anatomy from bariatric procedures like Roux-en-Y gastric bypass may necessitate specialized approaches, including balloon-assisted ERCP or EUS-directed transgastric ERCP (EDGE). Post-operative complications, including bile leaks and strictures, are managed endoscopically using sphincterotomy and stenting. Post-liver transplant anastomotic and non-anastomotic strictures often require repeated stent placements or advanced techniques like magnetic compression anastomosis in refractory cases. In chronic pancreatitis (CP), endoscopic approaches aim to relieve pain and address structural complications like pancreatic duct (PD) strictures and calculi. ERCP with sphincterotomy and stenting, along with extracorporeal shock wave lithotripsy (ESWL), achieves effective ductal clearance for PD stones. When traditional approaches are insufficient, direct visualization with peroral pancreatoscopy-assisted lithotripsy is utilized. EUS-guided interventions, such as cystgastrostomy, pancreaticogastrostomy, and celiac plexus blockade, offer alternative therapeutic options for pain management and drainage of peripancreatic fluid collections. EUS plays a diagnostic and therapeutic role in CP, with procedures tailored for high-risk patients or those with complex anatomy. As techniques evolve, endoscopic management provides minimally invasive alternatives for patients with complex benign pancreaticobiliary conditions, offering high clinical success and fewer complications.

Comparative Study between Ultrasound Guided Anterior and Posterior Approaches of Quadratus Lumborum Block in Extracorporeal Shock Wave Lithotripsy

Comparative Study between Ultrasound Guided Anterior and Posterior Approaches of Quadratus Lumborum Block in Extracorporeal Shock Wave Lithotripsy

Predictive Modeling Is a Reliable Indicator in Determining Excessive Renal Mobility Single-Center Randomized Study.

Purpose: Excessive kidney mobility is an underestimating challenge for surgeons during retrograde intrarenal surgery (RIRS) and extracorporeal shock wave lithotripsy (ESL). There is no technique approved as a gold standard procedure for reducing excessive kidney mobility. The study aimed to uncover predictive factors for determining excessive renal mobility by utilizing clinicodemographic characteristics and noncontrast computed tomography (NCCT) data. Materials and Methods: The patients were categorized into two groups based on the presence of excessive renal mobility. Patients were scanned with a 16-channel, multislice NCCT, and images were captured utilizing a 16 × 1.25 mm collimation, 5 mm slice thickness. Many parameters including the origin angle of the renal artery, renal artery, vein length, diameter, the area and length of the psoas muscle, and perirenal and pararenal fatty tissue were measured on the images and analyzed. The data were analyzed using multivariate logistic regression, and the receiver operating characteristic curve model and we used predictive modeling based on three significant parameters. Results: Between May 2023 and May 2024, a total of 140 patients with and without excessive renal mobility enrolled into study. After multivariate analysis, increasing renal vein length and renal artery origin angle results in higher renal motility (odds ratio [OR]: 0.982; 95% confidence interval [CI]: 0.966-0.998; p = 0.030 and OR: 0.973; 95% CI: 0.948-0.999; p = 0.044; respectively). It also observed that an increase in tidal volume led to a reduction in renal mobility (OR: 1.015; 95% CI: 1.007-1.024; p = 0.001). Predictive modeling was designed based on these outcomes. This predictive modeling accurately estimates the presence of excessive renal mobility with improved 59% specificity and 65% sensitivity (p < 0.001, area under the curve 0.757; CI: 0.671-0.843). Conclusion: Physicians may predict the presence of excessive renal mobility via the predictive modeling mentioned in the current article. They may perform manipulations to reduce kidney mobility prior to ESL and RIRS.

Endoscopic retrograde cholangiopancreatography combined with extracorporeal shock wave lithotripsy for the removal of large gallbladder stones: a pilot study

BackgroundEndoscopic gallbladder-preserving cholecystolithotomy (EGPC) has become an alternative option for treating cholecystolithiasis. However, developing a new method of EGPC in which the gallbladder wall is not damaged remains a challenge. This study introduced a new EGPC method called endoscopic retrograde cholangiopancreatography (ERCP) combined with extracorporeal shock wave lithotripsy (ESWL), which preserves the integrity of the gallbladder wall in the treatment of cholecystolithiasis complicated with choledocholithiasis.MethodsIn total, six patients (aged 23–72 years, 3 males and 3 females, Han ethnicity) who had large gallbladder stones (diameter ≥ 1 cm) complicated with common bile duct (CBD) stones and who underwent ERCP combined with ESWL at the First Affiliated Hospital of Nanchang University from July 2022 to December 2022 were enrolled. The patients’ clinical characteristics, endoscopic treatment and follow-up data were analyzed. A paired t test was performed to compare the differences in the main serological indicators before and after EGPC.ResultsOf the six patients, five completed EGPC, and one failed due to intolerable abdominal pain during ESWL and was subsequently transferred to surgery. With respect to post-EGPC adverse events, one patient developed mild post-ERCP pancreatitis, and no other adverse events occurred. Both the technical success rate and clinical success rate of ERCP combined with ESWL were 83.3% and the incidence of adverse events was 16.7%. The six patients were followed up for an average of 24 months, during which only one patient experienced a recurrence of gallbladder stones at the 3-month follow-up, but no gallbladder stones were found at the 6-month follow-up after oral administration of ursodeoxycholic acid.ConclusionsERCP combined with ESWL is a potentially safe and effective treatment for large gallbladder stones.Trial registrationThis study was registered at the Chinese Clinical Trial Registry site. [Registration number: ChiCTR2200060927 (http://www.chictr.org.cn/); registration date: June 14, 2022].

Ultrasonographic and pedobarographic evaluation of the effectiveness of extracorporeal shock wave therapy in patients with plantar fasciitis

Background Prior studies showing the effectiveness of extracorporeal shock wave therapy (ESWT) in patients with plantar fasciitis are mostly based on patient-reported measurements. Objective The aim of this study was to demonstrate the effectiveness of ESWT with ultrasonographic and pedobarographic measurements. Methods A total of 50 patients were included in the study. All patients were evaluated before and six weeks after ESWT treatment. Pain was evaluated with the Visual Analogue Scale (VAS), functional status with Foot Function Index (FFI), and quality of life with Short Form-36 (SF-36). Plantar pressure measurements were made with a pedobarography device, and plantar fascia thickness was measured with ultrasonography. Results After treatment, VAS-Pain decreased significantly. There was a statistically significant improvement in FFI scores after treatment. Similarly, a statistically significant improvement was seen in SF-36 scores. There was a significant decrease in ultrasonographic measurements of the plantar fascia thickness in the origo and midsection regions. There was a statistically significant decrease only in medial heel pressure measurements. Conclusion The results of this study showed that ESWT provides symptomatic and functional improvements in patients with plantar fasciitis as well as ultrasonographic plantar fascia thickness and pedobarographic medial heel pressure measurements.