Extracorporeal Shock Wave Lithotripsy Group Research Articles

Which Method Is More Effective for the Treatment of 1-2 cm Renal Pelvis Stones in Obese Patients: Extracorporeal Shock Wave Therapy or Flexible Ureterorenoscopy?

This study aimed to compare the clinical outcomes and complications of obese patients who underwent extracorporeal shock wave lithotripsy (ESWL) and flexible ureterorenoscopy (FURS) for treating 1-2 cm renal pelvic stones. This study included 89 patients with a body mass index (BMI) >30 who underwent ESWLand FURSsurgeries for 10-20 mm renal pelvic stones between January 2015 and July 2023. Three months after the treatments, patients underwent full abdominal computed tomography (CT) and were examined for stone-free status and the presence of residual stones. The presence of ≥4 mm residual stones on imaging was considered a failure, and these patients were treated again. Demographic data, stone characteristics, stone-free rate (SFR) three months after the procedure, surgery/procedure time, and complications such as bleeding, urosepsis, and collecting system perforation were compared between the groups. The patients included in the study were divided into two groups: ESWL (n=46) and FURS (n=43). Demographic and clinical data were similar between the groups. Retreatment rates were higher in the ESWL group compared to the FURS group. The mean procedure time was similar between the groups (p=0.085). The three-month SFR was found to be higher in the FURS group (88.3% vs. 73.9%; p=0.043). There was no difference in complication rates between groups. FURS is a more effective treatment method than ESWL in obese patients with stones 1-2 cm in size located in the renal pelvis.

Comparison of outcomes between USG guided ESWL Vs Fluoroscopy guided ESWL – Our institutional Experience

Background: Extracorporeal shockwave lithotripsy (ESWL) is a commonly used non-invasive treatment modality for urolithiasis. While fluoroscopy (FS)-guided ESWL has been the traditional approach, the use of ultrasound (USG) guidance has gained traction due to its potential benefits in terms of reduced radiation exposure and improved stone targeting. Aims and Objectives: The aims and objectives are to study the safety and efficacy of extracorporeal shock wave lithotripsy in the management of renal stones, outcomes of overall stone-free rate (SFR), pain intensity, urinary biochemical variables, mean hospital stay, quality of life, and adverse events. Materials and Methods: Patient data from the period of May 2022 to April 2023 were reviewed, including 20 patients who underwent USG-guided ESWL and 20 patients who underwent FS-guided ESWL. Results: Our analysis revealed that the USG-guided ESWL group demonstrated comparable stone fragmentation rates and SFR (P-value) when compared to the FS-guided group. Moreover, radiation exposure was significantly reduced in the USG-guided ESWL group, with a mean total FS time of [55] s compared to [3005] s in the FS-guided group. No significant differences were observed in terms of complications between the two groups. Conclusion: This study highlights the successful implementation of USG-guided ESWL in our institution’s experience, showing comparable outcomes in terms of stone fragmentation rates and SFR, while significantly reducing radiation exposure, also can be considered an effective and safe alternative for the treatment of urolithiasis.

Comparing the efficacy of extracorporeal shock wave lithotripsy and ureteroscopic lithotripsy in the treatment of proximal ureteral stones in children: A retrospective study.

Ureteroscopic lithotripsy and extracorporeal shock wave lithotripsy methods are commonly used in the treatment of proximal ureteral stones. There are no adequate studies showing which method is more effective in children. In our study, we aimed to evaluate and compare the efficacy of two treatment methods, commonly used for proximal ureteral stones in children. A total of 78 patients who underwent ureteroscopic lithotripsy (n = 38) and extracorporeal shock wave lithotripsy (n = 40) due to stones located in the proximal ureter between 2010 and 2021 were included in the study. Demographic data, clinical characteristics, and treatment outcomes were retrospectively analyzed. Kolmogorov-Smirnov, Chi-square, and Mann-Whitney U tests were used for statistical analysis. There was no statistical difference between the demographic characteristics of the groups, except for the mean age values (p = 0.008). A statistically significant difference was found in favor of the extracorporeal shock wave lithotripsy group in terms of stone-free rates after the first intervention, complication rates requiring intervention, re-intervention rates, and the average number of anesthesia sessions per patient until stone-free status (p = 0.043, p = 0.009, p = 0.017, and p < 0.001, respectively). The results of this retrospective study suggest that extracorporeal shock wave lithotripsy is the primary treatment option for single, non-complicated proximal ureteral stones.

A Comparative Study on Outcomes of Retrograde Intrarenal Surgery (RIRS), Mini Percutaneous Nephrolithotomy (PCNL), and Extracorporeal Shock Wave Lithotripsy (ESWL) for Lower Pole Renal Calculi of &lt; 1.5 cm

Background: Percutaneous nephrolithotomy (PCNL), established in the 1970s, has replaced open surgery for large stones. Extracorporeal shock wave lithotripsy (ESWL), once the preferred first-line treatment for small-to-medium-sized renal stones, has a questionable charm owing to patient reluctance for repeated treatments and hospitalizations since ESWL has a reduced stone-free rate (SFR). Flexible ureterorenoscopy, also referred to as RIRS, originally applied in the management of lower pole stones resistant to ESWL, is increasingly being used as a primary modality to manage lower pole stones, and it may potentially achieve higher SFR than ESWL and lower morbidity than PCNL for patients with low-volume stone diseases. Objectives: Observations were made to compare ESWL, mini PCNL, and RIRS in managing lower pole renal calculi of &lt; 1.5 cm. Methods: This observational study encompassed all patients with lower pole renal stones with &lt; 1.5 cm diameter and &lt; 1000 HU density who underwent mini PCNL, RIRS, or ESWL from January 2020 to July 2021. There were 40, 60, and 60 patients in the RIRS, mini PCNL, and ESWL groups, respectively, for all of whom preoperative CT urogram was performed. The patients were informed of the procedures, and their informed consent was obtained. The stone-free rates of the three modalities were compared, and the outcomes were statistically analyzed. Results: The mean stone sizes in the present study were 12.99 × 3.56 mm in mini PCNL, 10.62 × 2.51 mm in RIRS, and 10.93 × 3.13 mm in ESWL. The mini PCNL group's SFR was significantly higher than those of other groups: 59 (98.3%) in mini PCNL, 34 (85%) in RIRS, and 46 (76.7%) in ESWL (P = 0.002). Out of the 60 patients in the mini PCNL group, only one (1.7%) required an ancillary procedure, while only six (10%) out of 40 patients in the RIRS group and 11 (18.33%) out of 60 patients in the ESWL group required the ancillary procedure (P = 0.031). Conclusions: For lower pole renal calculi &lt; 1.5 cm, mini PCNL has the highest SFR, followed by RIRS and ESWL, in sequence. The ancillary procedure rate was 18.33% in the ESWL group, which was higher than those of mini PCNL (1.7%) and RIRS (10%).

MP70-16 IN PEDIATRIC PATIENTS WITH AN UPPER TRACT URINARY STONE OF LESS THAN 2 CM IN DIAMETER, DOES URETEROSCOPY COMPARED TO SHOCK WAVE LITHOTRIPSY IMPROVE THE STONE-FREE RATE? A SYSTEMATIC REVIEW AND META-ANALYSIS FROM THE EAU UROLITHIASIS PANNEL

You have accessJournal of UrologyCME1 Apr 2023MP70-16 IN PEDIATRIC PATIENTS WITH AN UPPER TRACT URINARY STONE OF LESS THAN 2 CM IN DIAMETER, DOES URETEROSCOPY COMPARED TO SHOCK WAVE LITHOTRIPSY IMPROVE THE STONE-FREE RATE? A SYSTEMATIC REVIEW AND META-ANALYSIS FROM THE EAU UROLITHIASIS PANNEL Robert Geraghty, Riccardo Lombardo, Lazaros Tzelves, Niall F Davis, Andreas Neisius, Ales Petřík, Giovanni Gambaro, Helene Ulrik Jung, Andreas Skolarikos, Thomas Tailly, and Bhaskar Somani Robert GeraghtyRobert Geraghty More articles by this author , Riccardo LombardoRiccardo Lombardo More articles by this author , Lazaros TzelvesLazaros Tzelves More articles by this author , Niall F DavisNiall F Davis More articles by this author , Andreas NeisiusAndreas Neisius More articles by this author , Ales PetříkAles Petřík More articles by this author , Giovanni GambaroGiovanni Gambaro More articles by this author , Helene Ulrik JungHelene Ulrik Jung More articles by this author , Andreas SkolarikosAndreas Skolarikos More articles by this author , Thomas TaillyThomas Tailly More articles by this author , and Bhaskar SomaniBhaskar Somani More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003338.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To determine which treatment between ureteroscopy (RIRS) and shockwave lithotripsy (ESWL) has a better stone free rate in paediatric patients (<18 years) with upper tract stones (<2 cm) METHODS: Using PubMed, Web of Science, and the Cochrane database, we identified studies published until August 2022 reporting surgical outcomes of paediatrics patients undergoing ULT and ESWL with renal stone < 2 cm. Protocol was registered in the PROSPERO database. Only comparative studies were considered for analysis. Stone free rate, operative time and complications were analyzed. Review manager was used for analysis. RESULTS: A total of 7 studies were included in the analysis and out of them three were randomized clinical trials. A total of 786 patients were analyzed. Mean age ranged from 6.5 to 11.5 years. The ESWL group presented a range of stone free rates between 20 and 90% while the RIRS group presented a range of stone free rates between 37 and 97%. The meta-analysis of the three randomized clinical trials favored the RIRS group over the ESWL group in terms of stone-free rate (RR: 0.84; p<0,05) (Figure). Only four studies included complication rate and rates were comparable between both groups. In terms of operative time only four studies included data and most of them favored ESWL over RIRS (Figure). Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1010 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Robert Geraghty More articles by this author Riccardo Lombardo More articles by this author Lazaros Tzelves More articles by this author Niall F Davis More articles by this author Andreas Neisius More articles by this author Ales Petřík More articles by this author Giovanni Gambaro More articles by this author Helene Ulrik Jung More articles by this author Andreas Skolarikos More articles by this author Thomas Tailly More articles by this author Bhaskar Somani More articles by this author Expand All Advertisement PDF downloadLoading ...

Long-term outcomes of pancreatoscopy-guided electrohydraulic lithotripsy for the treatment of obstructive pancreatic duct stones.

Background and study aims Pancreatoscopy-guided electrohydraulic lithotripsy (EHL) has proven to be an effective first-line therapy in symptomatic chronic pancreatitis (CP) patients with obstructing pancreatic duct (PD) stones 1 . However, long-term outcomes of endoscopic EHL remain unknown. The aim of the present study was to evaluate the long-term treatment effects of EHL as first-line therapy and to compare with those obtained in a historical cohort of patients who underwent extracorporeal shockwave lithotripsy (ESWL) as primary treatment. Patients and methods An observational retrospective single-center long-term follow-up study was performed including 19 consecutive patients who previously underwent endoscopic EHL compared to 18 patients who underwent ESWL followed by endoscopic retrograde pancreatography (ERP). The primary endpoint was long-term treatment success after EHL or ESWL defined as no recurrence of symptomatic intraductal stones confirmed on imaging. Secondary endpoints for the EHL-population included long-term clinical success (i. e., a similar or lower Izbicki Pain Score or reduction in opiate usage as compared to 6-month follow-up), quality of life (QoL), pancreatic function and hospital re-admission rate. Results In the EHL group, 37 % of the patients developed recurrent symptomatic PD stones versus 61 % in the ESWL group after a median follow-up of 35.0 and 76.5 months. Of the patients with recurrence, 71 % versus 100 % underwent a reintervention. Median time to recurrence was 12.0 versus 13.0 months. Clinical success sustained in 58 % of the EHL patients. QoL was not significantly different compared with 6-month follow-up and baseline. Conclusions Also at long-term follow-up, endoscopic EHL as first-line treatment is moderately effective for symptomatic CP patients with treatment success rates that seems at least equally effective as ESWL.

Effectiveness of Extracorporeal Shockwave Lithotripsy and Percutaneous Nephrolithotripsy for the Management of Moderate Size Kidney Stone

Aim: To provide a specific guidance in managing renal stones. Study Design: Place and Duration of Study: Pakistan Atomic Energy Commission, General Hospital Islamabad from 1st 2018 to 30th November 2018. Methodology: Eighty two patients were included and divided into two groups. Patients in group A underwent ESWL, while those in group B underwent PCNL. All of the participants underwent thorough diagnostic and therapeutic procedures. As per inclusion and exclusion criteria, patients with renal stones (10-20 mm), detected by CT scan were selected for either ESWL or PCNL. Results: Thirty four patients in the PCNL group and 21 patients in the ESWL group, had post-operative hematuria at the time of presentation (p=0.072). There is a substantial difference between patients between 18-38 years and those in the 60+ years. According to the stone-free rate, 76 individuals had favourable results whereas only 6 had negative ones (p=0.756 and p=0.050). Conclusion: Extracorporeal shockwave lithotripsy and pecutaneous nepthrolithotripsy are both effective technique options for kidney stones. However, since ESWL is non-invasive and has fewer adverse effects than PCNL treatment option, it is more successful in treating medium-sized kidney stones (20 mm or smaller). Keywords: Extracorporeal shockwave lithotripsy, Percutaneous nephrolithotripsy, Kidney stone

A Comparative Study of Stone Re-Treatment after Lithotripsy.

The high recurrence rate has always been a problem associated with urolithiasis. This study aimed to explore the effectiveness of single interventions, combined therapies, and surgical and nonsurgical interventions. Herein, three lithotripsy procedures—extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), and ureteroscopic lithotripsy (URSL)—were assessed and a retrospective cohort was selected in order to further analyze the association with several risk factors. Firstly, a population-based cohort from the Taiwan National Health Insurance Research Database (NHIRD) from 1997 to 2010 was selected. In this study, 350 lithotripsy patients who underwent re-treatment were followed up for at least six years to compare re-treatment rates, with 1400 patients without any lithotripsy treatment being used as the comparison cohort. A Cox proportional hazards regression model was applied. Our results indicate that the risk of repeat urolithiasis treatment was 1.71-fold higher in patients that received lithotripsy when compared to patients that were not treated with lithotripsy (hazard ratio (HR) 1.71; 95% confidence interval (CI) = 1.427−2.048; p < 0.001). Furthermore, a high percentage of repeated treatment was observed in the ESWL group (HR 1.60; 95% CI = 1.292−1.978; p < 0.001). Similarly, the PCNL group was also independently associated with a high chance of repeated treatment (HR 2.32; 95% CI = 1.616−3.329; p < 0.001). Furthermore, age, season, level of care, and Charlson comorbidities index (CCI) should always be taken into consideration as effect factors that are highly correlated with repeated treatment rates.

Outcome of Upper Ureteric Stone Management by in Situ Extracorporeal Shock Wave Lithotripsy and Intracorporeal Pneumatic Lithotripsy

Background: Ureteric stone disease is a common urological problem throughout the world. Treatment of ureteral stones depends on stone size, composition and degree of obstruction, pain, presence of infection, single kidney and abnormal ureteral anatomy. The aim of the present study is to evaluate and compare in situ ESWL and URS with pneumatic lithotripsy in terms of Stone clearance, duration of procedural time, duration of hospital stay and complications (fever, haematuria, ureteral injury, stone migration, stone clearance, steinstrasse, UTI, ureteral perforation). Methods: A total of 80 patients were included in the study. 42 of them enrolled in ESWL group and 38 in pneumatic lithotripsy group. This is a Prospective Observational study. ICPL were done as day case surgery and ESWL were done as outpatient basis. Results: Intracorporeal pneumatic lithotripsy is better than in situ ESWL for the treatment of small non-impacted upper ureteric stone because it has more stone clearance rate and less complication like fever, haematuria, steinstrasse, UTI, ureteral injury and ureteral perforation. Conclusion: At the end of the study, it can be concluded that for the management of upper ureteric stones ICPL is a better option than in situ ESWL considering its greater stone clearance and less complications.

Comparison between Intracorporeal Pneumatic Lithotripsy and Extracorporeal Shock Wave Lithotripsy (ESWL) in terms of efficacy and Safety for Management of Proximal Ureteric Stones

Objective: To compare efficacy and safety of intracorporeal pneumatic lithotripsy versus extracorporeal shock wave lithotripsy (ESWL) in patients of upper ureteric stones having stone size from 10 to 15 mm. Study Design: Randomized control trial Setting: Study was done at department of Urology, Nishtar Hospital Multan. The duration of the study was from January 2021 to January 2022. Methodology: 140 patients were divided into two groups randomly. In group A ureterorenoscopy (URS) with Pneumatic Lithotripsy was used for proximal ureteric stones management. URS was performed under general anesthesia. In group B, ESWL was done for the management of proximal ureteric stones identified by ultrasound and fluoroscopy. SPSS version 23 was used for data analysis. Results: In this study In Intracorporeal Pneumatic Lithotripsy group the stone cleared in 90% patients and in ESWL group the stone cleared in 78.6% patients (p-value=0.595). In Intracorporeal Pneumatic Lithotripsy group the pain was present in 14.3% patients and in ESWL group the pain was present in 18.6% patients (p-value=0.494). In Intracorporeal Pneumatic Lithotripsy group the bleeding was noted in 25.7% patients and in ESWL group the bleeding was noted in 40.0% patients (p-value=0.072). Conclusion: This study concluded that intracorporeal pneumatic lithotripsy is a good alternate of ESWL for the management of upper ureteric stones (having size from 10 to 15mm). Keywords: Urolithiasis, Intracorporeal Pneumatic Lithotripsy, Extracorporeal Shock Wave Lithotripsy, Ureteric Stone

Comparison of variation of renal functions after ESWL and Pyelolithotomy for Kidney Stone

Introduction: The effect of ESWL and pyelolithotomy shows that parameters as serum creatinine, renal plasma flow, GFR, and estimated GFR are disturbed for different duration. Moreover, the time required for assessment can be significant because the acute functional deterioration of kidney may resolve and it is hard to measure the chronic injury. Objectives: To frequency of patients of renal stone that fall in the ESWL range and pyelolithotomy range and also to compare the percentage change in GFR in patients undergoing ESWL versus pyelolithotomy. Materials &amp; Methods: A total of 126 patients with diagnosed as having renal stone on USG KUB, 15 to 65 years of age were included. Patients having nephrolithotomy, post procedural ureteric obstruction and UTI were excluded. Patients falling in ESWL range and pyelolithotomy range were recorded. Patients were called for follow up 3 months after surgery. GFR was measured and percentage change was calculated. Results: In this study, ESWL was done in 39 (30.95%) patients and pyelolithotomy in 87 (69.05%) patients. Mean baseline GFR in ESWL group was 32.49 ± 5.98 and in pyelolithotomy group was 31.17 ± 4.621. Mean GFR after 3 months in ESWL group was 45.13 ± 7.54 and in pyelolithotomy group was 44.25 ± 5.96. Mean percentage change in GFR in ESWL group was 36.82 ± 21.27 and in pyelolithotomy group was 44.05 ± 22.40 with p-value of 0.087. Conclusion: This study concluded that frequency of patients of renal stone that fall in the pyelolithotomy range is higher as compared to ESWL range and also the percentage change in GFR in patients undergoing pyelolithotomy is higher as compared to ESWL. Keywords: renal stone, pyelolithotomy, glomerular filtration rate.

A comparative study between single-operator pancreatoscopy with intraductal lithotripsy and extracorporeal shock wave lithotripsy for the management of large main pancreatic duct stones.

Endoscopic management of large main pancreatic ductal (MPD) stones often require treatment with lithotripsy. Extracorporeal shock wave lithotripsy (ESWL) has been the mainstay therapy, and single-operator pancreatoscopy with intraductal (intracorporeal) lithotripsy (SOPIL) is an emerging technique. However, no comparative studies between these techniques exist. We therefore aimed to compare ESWL to SOPIL for the treatment of large MPD stones. This is a retrospective cohort study comparing patients who were treated with ESWL or SOPIL from September 2013 to September 2019 at a single tertiary center. Logistic regression was performed to identify factors associated with technical success and efficient stone clearance (≤ 2 procedures to clear stones). There were 240 patients who were treated with ESWL and 18 treated with SOPIL. The overall technical success rate of stone clearance was 224/258 (86.8%), which was similar between the ESWL and SOPIL groups (86.7% vs 88.9%, p = 1.000). A SOPIL approach required fewer total procedures (1.6 ± 0.6 vs 3.1 ± 1.5, p < 0.001) and less aggregate procedure time (101.6 ± 68.2 vs 191.8 ± 111.6min, p = 0.001). Adverse event rates were similar between the groups (6.3% vs 5.6%, p = 1.000). The use of SOPIL was independently associated with greater efficiency compared to ESWL (OR 5.241 [1.348-20.369], p = 0.017). Stone size > 10mm was associated with less efficient stone clearance (OR 0.484 [0.256-0.912], p = 0.025). Both ESWL and SOPIL are safe and effective endoscopic adjunct modalities for treating large pancreatic duct stones. SOPIL is an emerging alternative to ESWL that is potentially more efficient for lithotripsy and MPD stone clearance.

MINI PERCUTANEOUS NEPHROLITHOTOMY VERSUS EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY IN TREATMENT OF NON LOWER POLAR HIGH DENSITY RENAL STONE 10-20 MM (A PROSPECTIVE RANDOMIZED STUDY)

Background: The optimal management of medium sized renal stones differs from one patient to another according to different factors. Stone attenuation value (SAV) is one of these factors which affect stone free rate (SFR) after extracorporeal shock wave lithotripsy (ESWL) with limited effect on mini-percutaneous nephrolithotomy (mini-PCNL). Objective: To compare safety and SFR of mini-PCNL and ESWL in the treatment of non-lower pole renal stones with high density and size of 10-20 mm. Patients and Methods: This prospective randomized study was carried out at Sayed Galal, Al Azhar University Hospital, Cairo, Egypt from November 2019 to October 2020 and included 70 patients with non-lower pole renal calculi 10 to 20 mm. Patients were randomly allocated in 2 equal groups: Group A was treated by mini-PCNL and group B was treated by ESWL. The primary end point was SFRs (no stone or residual 3>mm) in ESWL and mini-PCNL in this category of stone. The secondary end points were the complication rate, retreatment rate, and need for auxiliary procedures in each group. Results: The overall operative time was significantly lower in mini-PCNL group (median: 50.00; IQR: 20.00) compared to ESWL group (median: 55.00; IQR: 28.00) (p= 0.001). The overall fluoroscopy time was significantly lower in mini-PCNL than ESWL (3.2 versus 3.6 minutes, p=0.040). In mini-PCNL group, 32 out of 34 (94.1%) patients were stone free. In ESWL group, 10 out of 33 (30.1%) were rendered stone free after the third ESWL session. The SFR was significantly higher in mini-PCNL group (p < 0.001). In mini-PCNL group, none of cases needed a second look PCNL. The 2 failed cases had significant residual fragments that migrated into inaccessible calyx during pneumatic lithotripsy. In ESWL group, all cases had normal hemoglobin (Hb) level at each follow-up visit. In mini-PCNL group, when comparing pre- and post-operative Hb, a very highly significant differences were observed between pre- and post-operative Hb level (p < 0.001). Conclusions: Mini-PCNL is superior to ESWL in treatment of non-lower pole medium sized renal stones of high density with high SFR, and low complication rate as need for re-hospitalization or need for auxiliary procedure.

CLINICAL PROFILE AND COMPARISON OF OUTCOME OF TREATMENT BY EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY AND URETERORENOSCOPY IN THE MANAGEMENT OF UPPER URETERIC CALCULI

Objective: Urinary calculi are the third most common affliction of the urinary tract, exceeded only by urinary tract infections and pathologic conditions of the prostate. This study was carried out to assess the safety, efficacy, and compare structural and functional outcome after treating the patients of the upper ureteric calculus with Extracorporeal Shock Wave Lithotripsy (ESWL) and Ureterorenoscopy (URS).&#x0D; Methods: A prospective study was conducted on patients with the upper ureteric stone of size 0.5–1.5 cm. A total of 50 patients were included in the study by means of systematic random sampling so as to get 25 patients in each category of ESWL and URS for the treatment of their upper ureteric calculi.&#x0D; Results: The age ranged from 15 years to 55 years. There were 36 males and 14 females in the study of 50 patients, 43 (86%) presented with pain, followed by 4 (8%) presented with hematuria. Twenty-eight (56%) of the patients had stone in the range of 0.5–1.0 cm, and 22 (44%) of the patients had stone in the range of 1.0–1.5 cm. Sixteen (32%) patients had stone within 2 cm of the pelvi-ureteric junction, and 13 (26%) had stone within 2 cm of the sacroiliac joint. Twenty-one (42%) patients had stone in between these two. Of the 50, 25 patients (50%) underwent shock wave lithotripsy, 25 patients (50%) underwent URS. In the ESWL group, 21 (84%) patients were stone-free after single sitting of ESWL. Four patients (16%) who required Re ESWL, after repeat ESWL two became stone-free however 2 (8%) patient of 1.0–1.5 cm category required secondary procedure, that is, URS and became stone free. To achieve stone-free 1.24 procedure was required per patients. Of the 25 patients in the ESWL group, 2 (8%) patient (one steinstrass case and one poor fragmentation case) required secondary procedure. They underwent URS. Both the patient belonged to 1.0–1.5 cm group. URS was done using semirigid ureteroscope using pneumatic Lithoclast. In our study, two patients of each 0.5–1.0 cm and 1.0–1.5 cm category did not become stone free. These four patients were subjected to ESWL and became stone free.&#x0D; Conclusion: The management of the ureteral stone should be decided on individual basis, based on stone size, location, symptoms, obstruction, and the availability of the instruments. For stones of 0.5–1.0 cm, ESWL is the treatment of choice for the upper ureteric stones, with very low Re- ESWL (1.12 sittings) without any requirement of ancilliary procedure. URS may be used for the upper ureteric stones but requirement of ancilliary procedure is high 11.11%. For stones between 1.1 cm and 1.5 cm, ESWL is the preferred modality of treatment for the upper ureteric stones.

COMPARATIVE EFFICACY OF EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY AND RETROGRADE INTRARENAL SURGERY IN THE TREATMENT OF CALCIUM OXALATE NEPHROLITHIASIS

Objective To evaluate the results of extracorporeal shockwave lithotripsy (ESWL) versus retrograde intrarenal surgery (RIRS) for the treatment of calcium oxalate nephrolithiasis, as well as the damaging effects on renal function, taking into account the dynamics of blood cystatin C and urine beta2-microglobulin.Material and Methods Of 94 patients with calcium oxalate nephrolithiasis aged 23–78 included in the study, 42 patients were classified as having undergone ESWL (group I) and 52 patients as having undergone RIRS (group II). Group II patients were then stratified into subset 2A (n = 32) as having undergone RIRS through rigid ureteroscope and subset 2B (n = 20) as having undergone RIRS through flexible ureteroscope. We performed plain urography and nephrosonography at 24–48 hours postoperatively and unenhanced computed tomography 4–6 weeks after surgery. We measured concentrations of serum cystatin C and urinary beta2-microglobulin as a marker for kidney damage. In group I, samples of peripheral blood andurine were taken before and after the first, third sessions and 30 days after the last ESWL session. In group II, samples were analyzed before surgery, on the first and 30th postoperative days.Results The average size of calculi in the group with RIRS was 16.91 ± 2.79 mm, in the group with ESWL 12.31 ± 2.27 mm. The need for reoperation after RIRS was 19.2%, which was lower than after ESWL. Stone-free effect (no stones, or residual stones less than 3 mm) was observed in 95% of cases in patients with RIRS, and in 78% with ESWL. Group I patients demonstrated an increase in the blood leukocytes total number more often than subsets 2A (rigid RIRS) and 2B (flexible RIRS) patients. Leukocyturia was also a more common complication in group I. In the RIRS group, there was no statistically significant change in the level of blood cystatin C and urine beta2-microglobulin, on the contrary, a moderate increase in the endogenous marker of cystatin C was noted after one ESWL session. The increase in urine beta2-microglobulin levels in patients after the first and third ESWL sessions was significantly higher than after RIRS.Conclusion Flexible RIRS may be suggested as the preferred procedure for patients requiring additional protection of renal function in the treatment of renal stones less than 20 mm. ESWL of stones less than 20 mm can be used as an alternative treatment, since it is characterized by a rather long period of stone eradication from the urinary tract, a high frequency of residual calculi after the procedure, and also has a damaging effect on the renal tissue.

Comparative Study of Extracorporeal Shock Wave Lithotripsy Versus Mini Percutaneous Nephrolithotomy for the Treatment of Nonlower Calyceal 10–20 mm Size Kidney Stone

Purpose: Urolithiasis is a common medical condition and the treatment is mainly minimally invasive methods. There exists no specific guidelines for the treatment of radio-opaque solitary non lower calyceal kidney stones of 10–20 mm in literature and no head to head study comparing both the procedures. Hence, this study was performed to have a specific guide for the treatment of such stones. Materials and Methods: This study, included all patients aged &gt;18 years, with solitary radiopaque calculi of 10–20 mm size in upper or middle calyx or pelvis of the kidney. A total of 105 patients were assigned to receive extracorporeal shock wave lithotripsy (ESWL) or mini-percutaneous nephrolithotomy (PCNL) for treatment of stone were enrolled in the study and the results were compared in terms of retreatment, stone-free rate (SFR), and complications. Results: The SFR was statistically higher in the mini PCNL group for all locations. The SFR for the ESWL group was low after 1st session; however, it increased with multiple sessions. We had a total of 9 complications in both groups, which was statistically insignificant. Conclusion: This study showed that the mini PCNL is a viable, safe option for the treatment of 10–20 mm non lower calyceal stones, having superior SFRs compared to ESWL with statistically insignificant complications. It can be offered as first-line option for the management of such stones.

Immediate Shockwave Lithotripsy vs Delayed Shockwave Lithotripsy After Urgent Ureteral Stenting in Patients with Ureteral or Pyeloureteral Urolithiasis: A Matched-Pair Analysis.

Introduction: The most common cause of acute renal colic is a ureteral obstruction caused by ureterolithiasis. Urgent intervention is often necessary due to intractable pain. Early extracorporeal shockwave lithotripsy (SWL) as an alternative treatment option to ureteral stenting becomes forgotten in times of rising ureterorenoscopy. However, definitive guidelines are lacking, in which urgent treatment should be preferred in the absence of signs of infection. Therefore, we assessed efficacy and safety of early SWL (eSWL) to secondary SWL (sSWL) after urgent ureteral stenting. Patients and Methods: One hundred four patients treated between January 2015 and November 2017 for obstructive ureterolithiasis were matched regarding stone size, stone localization, and assigned to group eSWL (n = 52) or group sSWL (n = 52). The eSWL group received shock waves (without prior ureteral stenting) and sSWL group ureteral stenting within 48 hours from diagnosis. Thereafter, patients in group sSWL were treated with shock waves for a median of 23 ± 14.6 days after ureteral stenting. Stone-free rates, complication rates, and reintervention rates were assessed. Univariable and multivariable logistic regression was applied to find predictors of outcomes in the two treatment groups. Results: Overall, there was no statistically significant difference between both groups regarding stone-free rate and complication rate. Reinterventions were more often addressed for patients in group sSWL (p = 0.05). eSWL was significantly superior to sSWL regarding stone-free rates for stones between 6 and 9 mm (p = 0.04). At the multivariable multinomial logistic regression none of the two treatment modalities was associated with better outcomes. A body mass index ≥30 was associated with a reduced 6-week stone-free status (p = 0.04), whereas stones ≥8 mm were associated with an increased need of reintervention (p = 0.04). Conclusion: eSWL seems to be an effective and safe emergency procedure compared with sSWL after urgent stenting within 6 weeks and should be considered as a treatment option in patients without absolute indications for immediate ureteral drainage. Clinical trial registration number: 2019-00155.

Is health-related quality of life of patients after single-use flexible ureteroscopy superior to extracorporeal shock wave lithotripsy? A randomised prospective study.

The aims of the study were to compare the change in the Wisconsin Stone Quality of Life (WISQOL) score in patients who underwent retrograde intrarenal surgery (RIRS) single-use ureteroscope or extracorporeal shock wave lithotripsy (ESWL) with a calculation of quality-adjusted life-years (QALYs). 158 patients treated with urinary stone disease were randomly divided into 80 patients in the validation and 78 patients in the intervention arm. Patients in the intervention arm were randomly divided into the RIRS or the ESWL group. Linguistic validation of the WISQOL into the Slovak language was performed using astandardised multistep process. Discriminant validity was assessed by comparing stone-forming patients to an additional 34 healthy individuals. Patients were asked to fill in the WISQOL before and in the 24th week after the intervention. The QALYs were calculated by the formula QALY = weight factor (WF) x time period after intervention. The Cronbach's α of the WISQOL was 0.94, the Pearson's coefficient for test-retest reliability was 0.91, and the discriminant validity confirmed a higher score for healthy individuals (p < 0.001). The median WISQOL score changed from 45.5 to 95.5 vs. 33.9 to 87.1 in the RIRS and ESWL groups, respectively (p < 0.001). Patients from the RIRS group had a good possibility of reaching 19.727 QALYs gained during life expectancy compared to 15.780 for the ESWL group (p < 0.001). RIRS single-use ureteroscope is significantly superior to ESWL in reaching more QALYs gained during life expectancy. The WISQOL Slovak version is valid, reliable and strictly specific for stone-forming patients.

Efficacy of Percutaneous Nephrolithotomy in the Treatment of Renal Calculi of 10 to 20 MM Size: A Comparison With Extracorporeal Shock Wave Lithotripsy

Background: Stones in the urinary tract is a common medical problem in the general population. At present, the great expansion in minimally invasive techniques has led to the decrease in open surgery. Extracorporeal shock wave lithotripsy (ESWL) has been introduced as an alternative approach which disintegrates stones in the kidney and upper urinary tract through the use of shock waves. Nevertheless, as there are limitations with the success rate in ESWL, other minimally invasive modalities for kidney stones such as percutaneous nephrolithotomy (PCNL) is also widely applied. There is a trend of using ESWL for treatment of renal stones smaller than 1 cm and PCNL in those with stones greater than 2 cm. Nevertheless, no consensus regarding treatment of renal stones between 1 to 2 cm stones. The objective of this prospective study was to compare the results of ESWL and PCNL for treatment of 1 to 2 cm renal stones.&#x0D; Method : This is a quasi experimental study. This study was conducted to compare the efficacy and safety of percutaneous nephrolithotomy (PCNL) and extracorporeal shock wave lithotripsy (ESWL) in treating 10 to 20 mm sized renal stone among the Bangladeshi population. This prospective study conducted between the periods of September, 2011 to August, 2012 in the department of urology, Bangabandhu Sheikh Mujib medical university (BSMMU) Hospital. All the patients attending the urology outpatient clinic with 10 to 20mm renal calculi were the study population. A total of 70 subjects were enrolled for this study and they were equally divided into two groups so that each group had 35 subjects. The one group received PCNL whereas the other group received ESWL. Statistical analyses of the results were obtained by using window based computer software devised with Statistical Packages for Social Sciences (SPSS-15).&#x0D; Results: There is no statistically significant difference in regarding age, sex, stone side(lt. or rt.), the distribution of stone (upper, middle and lower calyx) and size between the groups (p&gt;0.05). At 3 month follow up among the patients in ESWL group stone cleared and not cleared were 25(71.4%) and 10(28.6%) respectively and at 3 month follow up among the patients in PCNL group stone cleared and not cleared were 33(94.3%) and 2(5.7%)respectively. There is statistically significant difference in stone clearance rate at 3 month follow up between the groups (p&lt;0.05). All patients in ESWL group developed post procedure haematuria 35(100.0%). Other post procedure complications among the ESWL group pain, fever and steinstrasse were 12(34.3%), 07(20.0%) and 03(08.6%) respectively. Common post procedure complications among the patients of PCNL group pain, haematuria and fever were 11(31.4%), 33(94.3%) and 13(37.1%) respectively. Other post procedure complications in PCNL group were vomiting (8.6%), urinary leakage (5.7%), wound infection (11.4%) and urinary cutaneous fistula (5.7%). There was no statistically significant difference post procedure pain, haematuria and fever between the groups (p&gt;0.05), but statistically significant difference observed in steinstrasse and wound infection between the groups (p&lt;0.05). Mean±SD of hospital stay among the patients of ESWL group and PCNL group was 1.37±0.65 and 4.34±1.43 days respectively. There is statistically significant difference in hospital stay between the groups (p&lt;0.05).&#x0D; Conclusion: Though some specific complications which can be treated conservatively are more in PCNL group it may be concluded that the treatment with PCNL is better option than ESWL among the patients having renal calculi 10 to 20 mm.&#x0D; Bangladesh Journal of Urology, Vol. 21, No. 2, July 2018 p.98-104

Comparative Analysis of Semi Rigid Ureterolithotripsy and Extracorporeal Shock Wave Lithotripsy for the Treatment of Upper Ureteric Calculi

Objectives: To find out the better treatment option between semi rigid ureteroscopy with ICPL and ESWL for upper ureteric calculi. To compare stone free rate, complications and re treatment between ureterolithotripsy and ESWL in upper ureteric calculi.&#x0D; Materials and Method: This prospective comparative study was conducted in the department of urology BSMMU and Kidney and urology hospital, Dhaka from June 2009 to May 2010. Fifty patients were enrolled and 25 on each group as ESWL and ICPL Inclusion criteria was adult patients with single radiopaque stone of 06-15 mm, and no obstruction distal to stone. We exclude Stone size &gt; 1.5cm, PUJ stone, patients with DJ stent and nephrostomies, infection, pregnancy, hemostatic, disorders, and morbid obesity. Identified postoperative urological complications pain, haematuria, fever, stone migration, obstruction, infections, and postoperative hospital stays recorded accordingly. X- ray KUB and in some cases ultrasound of kidney ureter and bladder with prostate with PVR were done. Those with residual calculi sized less than 2 mm were considered stone free. Those patients whom stone not cleared or stone migrated they again sent for ESWL or ureterolithotripsy. Stone free patient of ureterolithotripsy sent for removal of Double J stent under local anesthesia at 4 weeks.&#x0D; Results: Three months postoperatively, 21 out of 25 Patients (85%) in the ureterolithotripsy group were stone free. In ureterolithotripsy group, all failures were due to upward calculus migration. After calculus migration, this was mandated double- J stenting and send for ESWL. These patients were referred for ESWL, all of whom were stone free after this procedure. DJ stent removed under local anesthesia. 22 out of 25 Patients (88%) in the ESWL group were stone free and 10 patients need two sessions. Re-ESWL had done after 3 weeks. All failures in ESWL group were due to hard in constancy and small stone size. Failed cases were referred for ureterolithotripsy and DJ stenting, all of whom were stone free after this procedure. Using statistical data by chi square test and analytical test level of significance as set at 0.05 and p&lt; 0.05 was consider significant.&#x0D; Conclusion: Upper ureteral calculi up to 1.5 cm can be safely and effectively managed by using semi rigid ureteroscopy and pneumatic lithotripsy. However, the ESWL approach has still its role in treating upper ureteric calculi. Finally, postoperative home rest in the ESWL group was more due to the repeated treatment.&#x0D; Bangladesh Journal of Urology, Vol. 20, No. 2, July 2017 p.54-60