Extracorporeal Shock Wave Lithotripsy In Patients Research Articles

Predictive markers for infections after extracorporeal shockwave lithotripsy in patients with kidney stone based on a large prospective cohort.

Infections in patients with kidney stones after extracorporeal shockwave lithotripsy (SWL) is a common clinical issue. However, the associated factors are unclear. Therefore, we aim to develop and validate a predictive model for infections after SWL in patients with kidney stone. Between June 2020 and May 2022, consecutive kidney stone patients were enrolled. Of them, 553 patients comprised the development cohort. One hundred sixty-five patients comprised the validation cohort. The data were prospectively collected. The stepwise selection was applied using the likelihood ratio test with Akaike's information criterion as the stopping rule; A predictive model was constructed through multivariate logistic regression. The performance was evaluated regarding discrimination, calibration, and clinical usefulness. Predictors of infections after SWL in treating kidney stones included older age (OR = 1.026, p = 0.041), female (OR = 2.066, p = 0.039), higher BMI (OR = 1.072, p = 0.039), lower stone density (OR = 0.995, p < 0.001), and higher grade of hydronephrosis (OR = 5.148, p < 0.001). For the validation cohort, the model showed good discrimination with an area under the receiver operating characteristic curve of 0.839 (95% CI 0.736, 0.941) and good calibration. Decision curve analysis demonstrated that the model was also clinically useful. This study indicated that age, gender, BMI, stone density, and hydronephrosis grade were significant predictors of infections after SWL in treating kidney stones. It provided evidence in optimizing prevention and perioperative treatment strategies to reduce the risk of infection after SWL.

The Role of Oral Dissolution Therapy in Increasing the Efficacy of Extracorporeal Shockwave Lithotripsy in Patients with Less Than 2 Centimeters of Renal Stones: A Systematic Review

The prevalence of renal stones is about 15% of the population. The trend is increasing with a high recurrence rate of up to 50% in 5 years, demanding a more sophisticated treatment for renal stones. ESWL is a treatment for less than 2 cm renal stones with good outcomes. Although ESWL is a technique with many advantages, many factors contribute to the outcome of ESWL with size and stones density as the most important factor. Oral dissolution therapy (ODT) has been used for decades and its effect on renal stones is beneficial to dissolve and prevent renal stones recurrence. The combination of ODT and ESWL is not yet recommended by current guidelines. The purpose of this systematic review is to summarize the latest evidence on the role of ODT in increasing the efficacy of ESWL for renal stones. The database used in this study are PubMed and Cochrane using keywords “urolithiasis”, “renal”, “shock wave”, “citrate”, and “oral dissolution therapy”. The outcome of the article sought is stone fragmentation after ESWL. 4 studies were included, and 3 compared the outcome between ESWL alone and ESWL combined with ODT. The outcome of combined therapy shows superior outcomes compared to ESWL alone with fewer sessions required for stone clearance or a higher chance for stone fragmentation. One study in children showed 100% stone clearance after ESWL with ODT, which was higher than the average success rate of ESWL in children with renal stones. Oral dissolution therapy may have a role in increasing the efficacy of extracorporeal shockwave lithotripsy for patients with less than 2 cm renal stones.

Efficacy of Isosorbide in Post Extra Corporeal Shock Wake Lithotripsy Stone-Free Time

Background and Objective: Extracorporeal shockwave lithotripsy (ESWL) is mong the the low-risk treatment methods of treating kidney stones. Specialists are looking for ways to remove small stones caused by ESWL in patients as soon as possible. The present study aimed to determine the effect of isosorbide on the duration of renal pelvis excretion after ESWL. Materials and Methods: In this clinical trial, 176 patients with renal pelvis &lt; 20 mm, who were referred to the ESWL Department of Moradi Hospital, Rafsanjan, Iran, in 2019, were examined. After lithotripsy, the patients were randomly assigned into two intervention groups of receivers of isosorbide 20 mg tablets every 12 hours for two weeks and placebo control for two weeks. The collected data was analyzed using Mann-Whitney and Kruskal-Wallis statistical tests. Results: The success of ESWL was 78.2% in the isosorbide group and 77.5% in the placebo group (P=0.919). The average duration of stone excretion in the isosorbide group was 4.21 ± 1.05 days, and the placebo group was 4.79 ± 1.16 (P=0.001). In the isosorbide group, the duration of stone excretion in patients with stone size 16-20 mm was less than 16 mm (P=0.011). The average duration of stone excretion in patients 36-55 years old (P=0.021) and patients with right-sided stones (P=0.008) in the isosorbide group was less than the placebo group. Conclusion: Isosorbide, accompanied by other treatments, reduced the duration of stone excretion after ESWL. Moreover, although Isosorbide can be used to improve the management of patients with kidney stones, more studies are needed to confirm this finding

Success of Extracorporeal Shockwave Lithotripsy (ESWL) in Relation to Triple D Score

Aim: To determine the frequency of success of ESWL in patients with renal stones and to compare the success of ESWL with different Triple D scores in the same group of patients. Methodology: Descriptive study in the Department of Urology, Sindh Institute of Urology and Transplantation Hospital, Karachi from 29thOctober 2020 to 28th April 2020. One hundred and fifteen patients with renal stone seen as radio opaque shadow on X rays KUB were included. CT was performed and stone diameters were measured. Quadruple D-score was defied because stone location is combined with TrD-S ranging from 0 (worst) to 3 (best) points. KUB was used for evaluation of stone free status after 4-weeks of ESWL sessions. Patient can be regarded stone free if complete stone was removed. Results: The mean age was 48.99±10.67 years, the mean size of the stone was 12.99±3.54mm, and the mean triple D score was 1.70±1.00. There were 75(65.22%) males and 40(34.78%) female patients. The success of ESWL was found in 79(68.70%) patients. On comparison of success of ESWL with triple D score, success of ESWL was found in 04(26.7%) having 0 score, in 19(54.3%) having 01 score, in 27(77.1%) having 02 score, and in 29 (96.7%) having 03 score (P&lt;0.001). Conclusion: The triple D score appears to be a useful predictor of ESWL treatment outcomes. Using the Triple D score may improve the cost-effectiveness of ESWL by limiting its use to patients likely to have favourable outcomes. Key Words: Extracorporeal shockwave lithotripsy (ESWL), Triple D score, Renal stone

Effect of adjunctive drug therapy on early expulsion of distal ureteral calculi after extracorporeal shock wave lithotripsy

Objective: To evaluate the efficacy of ketochromate tromethamine and phloroglucinol combination therapy in early expulsion of ureteral calculi after extracorporeal shockwave lithotripsy (ESWL) in patients with distal ureteral clculi. The clinical and follow-up data of 275 patients with lower ureteral calculi who underwent ESWL were collected retrospectively in Civil Aviation General Hospital from January 1st 2021 to June 30th 2021. According to whether adjunctive medication used before ESWL patients were divided into control group and medication group (with ketochromate tromethamine 30 mg and phloroglucinol 80 mg before ESWL). Primary endpoint is the clearance rate of ureteral calculi after ESWL, secondary endpoint are the other outcomes and drug allergy. There were 138 cases in control group [117 were males and mean age (42±13) years]. Meanwhile, there were 137 cases in medication group [118 were males and mean age (42±12) years]. The clearance rate of ureteral calculi at 24 h (67.88% vs 48.55%, P=0.001)、one week (76.64% vs 57.97%, P=0.001) and four weeks (89.05% vs 76.08%, P=0.005)after ESWL in medication group were significant higher than that in control group. There was a significant difference in the VAS score of pain scale after ESWL (1.77±0.80 vs 2.06±1.04, P=0.012) and re-ESWL rate (8.03% vs 17.39%,P=0.02) between two groups, but no difference with gross hematuria in 6 h after ESWL and drug allergy. Conclusions combination use of ketochromate tromethamine and phloroglucinol significantly improve early expulsion of ureteral calculi after ESWL in patients with distal ureteral calculi, with no side effect.

Development and validation of a predictive model for stone-free failure after extracorporeal shockwave lithotripsy in patients with ureteral stone in a large prospective cohort

To develop and validate a nomogram for predicting stone-free failure after shock wave lithotripsy (SWL) guided by ultrasound in patients with ureteral stones. The development cohort consisted of 1698 patients who underwent SWL guided by ultrasound at our center from June 2020 through August 2021. Multivariate unconditional logistic regression analysis was used for building a predictive nomogram with regression coefficients. An independent validation cohort consisted of 712 consecutive patients from September 2020 through April 2021. The performance of the predictive model was assessed in regard to discrimination, calibration, and clinical usefulness. Predictors of stone-free failure included distal stone location (odds ratio = 1.540, P < 0.001), larger stone size (odds ratio = 1.722, P < 0.001), higher stone density (odds ratio = 1.722, P < 0.001), larger skin to stone distance (SSD) (odds ratio = 1.058, P < 0.001), and higher grade of hydronephrosis (odds ratio = 1.755, P = 0.010). For the validation cohort, the model showed good discrimination with an area under the receiver operating characteristic curve of 0.925 (95% confidence interval, 0.898, 0.953) and good calibration (unreliability test, P = 0.412). Decision curve analysis demonstrated that the model was also clinically useful. This study demonstrated that stone location, stone size, stone density, SSD, and hydronephrosis grade were significant predictors of stone-free failure after SWL guided by ultrasound in patients with ureteral stones. This may guide clinical practice.

Development and validation of a predictive model for major complications after extracorporeal shockwave lithotripsy in patients with ureteral stones: based on a large prospective cohort.

The risk factors of complications after SWL are not well characterized. Therefore, based on a large prospective cohort, we aimed to develop and validate a nomogram for predicting major complications afterextracorporeal shockwave lithotripsy (SWL) in patients with ureteral stones. The development cohort included 1522 patients with ureteral stones who underwent SWL between June 2020 and August 2021 in our hospital. Five hundred and fifty-three patients with ureteral stones participated in the validation cohort from September 2020 to April 2022. The data were prospectively recorded. Backward stepwise selection was applied using the likelihood ratio test with Akaike's information criterion as the stopping rule. The efficacy of this predictive model was assessed concerning its clinical usefulness, calibration, and discrimination. Finally, 7.2% (110/1522) of patients in the development cohort and 8.7% (48/553) of those in the validation cohort suffered from major complications. We identified five predictive factors for major complications: age, gender, stone size, Hounsfield unit of stone, and hydronephrosis. This model showed good discrimination with an area under the receiver operating characteristic curves of 0.885 (0.872-0.940) and good calibration (P = 0.139). The decision curve analysis showed that the model was clinically valuable. In this large prospective cohort, we found that older age, female gender, higher Hounsfield unit, size, and grade of hydronephrosis were risk predictors of major complications after SWL. This nomogram will be helpful in preoperative risk stratification to provide individualized treatment recommendations for each patient. Furthermore, early identification and appropriate management of high-risk patients may decrease postoperative morbidity.

Development and validation of a predictive model for treatment outcome after emergency extracorporeal shockwave lithotripsy in patients with symptomatic ureteral stones during the COVID-19 pandemic: in a large prospective cohort.

The predictors of treatment outcome after emergency extracorporeal shockwave lithotripsy (SWL) are not well characterized. Therefore, based on a large prospective cohort, we aimed to develop and validate a nomogram for predicting treatment outcome after emergency SWL in patients with symptomatic ureteral stones. The development cohort included 358 patients with symptomatic ureteral stones who underwent emergency SWL between June 2020 and August 2021 in our hospital. One hundred and twenty-nine patients with symptomatic ureteral stones participated in the validation cohort from September 2021 to April 2022. The data were prospectively recorded. The backward stepwise selection was applied using the likelihood ratio test with Akaike's information criterion as the stopping rule. The efficacy of this predictive model was assessed concerning its clinical usefulness, calibration, and discrimination. Finally, 15.6% (56/358) of patients in the development cohort and 14.0% (18/129) of those in the validation cohort suffered from stone-free failure after emergency SWL. We identified four predictors for stone-free failure: stone size, stone density, skin to stone distance (SSD), and degree of hydronephrosis. This model showed good discrimination with an area under the receiver operating characteristic (AUROC) curves of 0.935 (0.899-0.971) and good calibration (P = 0.059). The decision curve analysis showed that the model was clinically valuable. In this large prospective cohort, we found that stone size, stone density, SSD, and degree of hydronephrosis were predictors of treatment outcome after emergency SWL. This nomogram will be helpful in preoperative risk stratification to provide individualized treatment recommendations for each patient. Furthermore, early identification and appropriate management of patients may increase the success rate of emergency SWL during the COVID-19 pandemic.

Role of Triple D Score in Eswl: Our Experience at Urology Department Chandka Medical College Hospital Larkana Pakistan

Aim: To detect usefulness of triple D score in ESWL (extracorporeal shock wave lithotripsy) for management of renal stone. Methodology: Retrospective Study was conducted at Urology department, CMCTH) at SMBBMedical University Larkana. 50 patients underwent ESWL from 2018 to 2020. All the related data were taken as well as demographic details, history and risk factor from the patients. Routine investigation carried out including Blood CP ESR, Urine DR, Blood sugar, Renal profile, urine culture sensitivity and CT KUB. The stone density, skin-to-stone distance, and stone size were calculated by a radiologist. Results: ESWL was performed on 50 patients with average age of 30± 8 years and a sex ratio (male female) of 1:0.3. The stone-free percentage after the first treatment session was 40 percent and 90 percent on 2nd sitting, based on the triple D score, which included stone size, skin to stone distance, and stone density (HU). The mean stone size was 15.8 mm, the Skin to Stone Distance was 6.4 cm, and the stone density was 594 HU were established respectively. Conclusion: The Triple D Score is easy to compute and reported by radiologist. The use of the Triple D Score in ESWL patients has been shown to improve overall ESWL success rates. Keywords: Extracorporeal, Shock, Wave, Lithotripsy, Renal stone and Triple D score

No-show after extracorporeal shock wave lithotripsy treatment in endourology clinic: Can we build a typical patient profile?

ObjectivesPatients “no‐show” in outpatient clinics is a worldwide challenge. Healthcare providers and patients suffer from negative impacts that include increased expenditure, clinical management ineffectiveness, and decreased access to care. This study aims to evaluate no‐show rate among extracorporeal shock wave lithotripsy patients visiting endourology clinic and to identify the demographic and clinical predictors of no‐show.MethodsA cross‐sectional and historical cohort study using electronic medical records. We included 790 patients aged >18 years old referred for endourology clinic following shock wave lithotripsy during 2010–2017 at Hadassah Medical Center in Israel. We predicted no‐show rate following shock wave lithotripsy by various patient characteristics by a multivariate logistic regression model.ResultsOverall, 291 (36.8%) patients did not arrive for postoperative clinic. Of these, 91 (11.52%) patients referred to Emergency Department. Patients who were younger in age (odds ratio 1.49, 95% confidence interval 1.08–2.04), patients who underwent hospitalization ≥3 days (odds ratio 1.63, 95% confidence interval 1.11–2.41) and patients who had undergone a stent‐free shock wave lithotripsy (odds ratio 5.71, 95% confidence interval 2.40–13.57) were significantly associated with higher no‐show rate. Larger stone size was associated with reduction in no‐show rate with every millimeter increase of stone diameter was associated with a reduction of 6.1% probability for no‐show (odds ratio 0.94, 95% confidence interval 0.89–0.99).ConclusionsPredicting patients' characteristics and no‐show patterns is necessary to improve clinical management efficiency, access to care, and costs. We showed that patients who were younger, patients who underwent stent‐free shock wave lithotripsy, patients who had a smaller stone, and patients who underwent a longer hospitalization were more prone to miss their appointment. Paying attention to the characteristics of individual patients may assist in implementing intervening program of patient scheduling.

Stenting versus non-stenting before extracorporeal shock wave lithotripsy for proximal ureteric stones: A prospective interventional study

Background: Extracorporeal shock wave lithotripsy (ESWL) has become the first-line treatment for stones in the upper urinary tract measuring &lt;2cm. It is the minor invasive treatment for calculi of the upper urinary tract. Aims and Objectives: This study aims to identify the effect of the presence and absence of a ureteric stent on the outcome of ESWL in patients with proximal ureteric stones. Materials and Methods: This was a prospective cohort study done on 300 patients and wasdivided into two equal groups of 150 each. Group A patients were selected for ESWL with DJ stent, and Group B patients werefor ESWL without DJ stent. Non-contrast CT KUB was done as a functional study along with plainX-ray KUB and ultrasound before the intervention. All treatments were done with Direx Compact XL (electromagnetic generator) device as an outpatient procedure. Patients were followed up radiographically at 15 days, 1 month, 2 months, and in 3 months. Hematuria, steinstrasse, fever, ureteric colic, lower urinary tract symptoms (LUTS), stone clearance, number of ESWL sessions, and secondary procedures were recorded for each group. DJ stent was taken out when the stone disappeared or at the end of 3 months. Variables were compared with Chi-square test. Results: The overall stone-free rate at 3 months was 90.6% (272/300). Clearance after the first sitting, second sitting, and the third sitting wasnot significant between the two groups(P&gt;0.05).There was no significant difference between the two groups in regard to clearance according to the size of the stones. A total of 9.3%(28/300) of patients did not have a successful outcome and were termed as ESWL failures. Post- ESWL complications were significant between the both groups in terms of hematuria and ureteric colic. All the ureteric colic patients had a stone size larger than 13 mm, P=0.0005, which was more in the non-stented (Group B) patients. Most of the lower urinary tract symptoms were seen in stented (Group A) patients, P&lt;0.0001 significant between the two groups, and dysuria was also significant between the two groups with P=0.0033. Conclusion: Pre-ESWL ureteral stenting provides no additional benefit over no stent in situ, although ureteral stents are associated with more irritative symptoms.

The Analgesic Effect of Cryotherapy on Patients Undergoing Extracorporeal Shock Wave Lithotripsy: A Randomized Controlled Trial

Objective: To compare the degree of pain between cryotherapy and standard preoperative care in the treatment of urolithiasis with extracorporeal shock wave lithotripsy (ESWL).Materials and Methods: A total of 180 ESWL patients were randomly assigned to experience the standard preoperative method, or additional cryotherapy (ice pack application on the ESWL site) for 10 minutes before ESWL. The primary outcome was the maximum difference of pain intensity score from baseline during ESWL and the secondary outcomes, which were analgesic consumption, pulse rate, adverse events, stone free rate, and complications that were gathered and analyzed.Results: The maximum change in pain intensity score from baseline during ESWL in the cryotherapy group was significantly lower than in the control group (VAS score 4.0±1.9 vs. 5.2±2.7, p=0.002). The cryotherapy group showed significantly less total fentanyl consumption than the control group (85.3±22.0 mcg vs. 93.6±25.6, p=0.021). We found no significant difference in stone free rate, adverse events or complications in either group.Conclusion: Preoperative cryotherapy using ice packs for 10 minutes can provide an effective analgesic for ESWL. Adequate pain control with cryotherapy should be an option of pain management during ESWL.

The reasons of unsatisfactory results of extracorporeal shock wave lithotripsy in patients with ureterolithiasis

The article dedicate to the problem of failure of extracorporeal shockwave lithotripsy in patients with ureterolithiasis and reveal the changes which appear in the ureter in the location of the stone.The aim. Analysis of the results of treatment in patients, suffering ureteric stones, using the ureterolithotripsy procedure after failure extracorporeal shockwave lithotripsy.&#x0D; Materials and methods. In 137 patients with ureteric stones, whom ureterolithotripsy procedure after failure extracorporeal shockwave lithotripsy was conducted, the symptoms of the disease, the diagnostic methods value, efficacy of surgical treatment and reasons of the failure of previous method of treatment were analyzed.&#x0D; Results. In 135 patients endoscopic removal of stones has been succeeded, in 2 patients because of total obliteration of the ureter, uretero-ureteral anastomosis has been performed. If the symptoms, with are characteristic of ureterolithiasis, persists up to one week stones don’t cause significant macroscopic changes to the ureter wall. If the stone persists in the ureter longer than a week we identified local appearing of oedema. Long–term (more than two months) ureteric stone persistence increase the risk of intramucosal “ingrowth” of the calculi greatly.&#x0D; Conclusion. The URS and ESWL are high effective and minimal invasive methods of surgical intervention for patients with ureterolithiasis, guaranteeing high level of postoperative “stone free rate”. Prolongation of the stone insertion time in the ureter causes the ureteric wall changes, complicating performance of minimal invasive interventions (ureterolithotripsy and extracorporeal shock–wave lithotripsy) and reduce its efficacy.

The effect of the phytocomplex Renotineх® on postoperative period after external shock wave lithotripsy in patients with urolithiasis

INTRODUCTION: Phytopreparations are one of the leading medicines used as preoperative preparation and postoperative management in patients with urolithiasis.&#x0D; THE AIM of the study was to evaluate the nephroprotective effect of Renotinex in patients with urolithiasis after extracorporeal shock wave lithotripsy (ESWL).&#x0D; MATERIALS AND METHODS: The study included 86 patients (43 in the main and the comparison group) with urolithiasis with localization of the stone in the renal pelvis without disturbing the outflow of urine. All patients underwent extracorporeal shock wave lithotripsy (ESWL). After ESWL patients in both groups received spasmodic, anti-inflammatory, antibacterial therapy. Patients of the main group additionally received Renotinex 2 capsules 3 times a day for 14 days before and 14 days after surgery.&#x0D; RESULTS: During the observation a more effective discharge of calculus fragments was noted in patients of the main group while taking the phytocomplex Renotinex, as well as less pronounced damage and faster recovery of the renal parenchyma after ESWL according to the level of enzimuria.&#x0D; CONCLUSION: The results of the study indicate the feasibility of prescribing the phytocomplex Renotinex for nephroprotective and lithokinetic therapy in patients after ESWL.

Effect of media distraction (audio-visual and music) for pain and anxiety control in patients undergoing shock-wave lithotripsy: A systematic review and meta-analysis.

Audio-visual (AV) or music distraction may be used to reduce pain during several healthcare procedures. The present manuscript is a systematic review and meta-analysis to assess the effectiveness of media distraction in reducing pain and anxiety in extracorporeal shock wave lithotripsy (ESWL) patients. The PubMed, Embase, Scopus, BioMed Central, Ovoid and CENTRAL (Cochrane Central Register of Controlled Trials) databases were screened for studies assessing the role of media distraction (music/AV media) in reducing pain and anxiety of ESWL patients. Data were summarized using the mean difference (MD) with 95% confidence intervals (CI). A total of 11 randomized controlled trials were included. Pooled analysis indicated a statistically significant difference in pain outcomes with media distraction [mean difference (MD): -1.18; 95% CI: -2.35, -0.01; I2=96.8%)]. Subgroup analysis indicated that both AV media (MD: -2.94; 95% CI: -4.70, -1.17; I2=79.2%) and music (MD: -0.86; 95% CI: -1.37, -0.35; I2=62.5%), led to significant reduction in pain outcomes. Pooled analysis indicated a statistically significant reduction of anxiety scores with the use of media distraction (MD: -3.91; 95% CI: -6.44, -1.38; I2=77.7%). To conclude, the present review suggests that media distraction in the form of AV media or music may be beneficial in reducing the pain and anxiety of patients undergoing ESWL. Evidence is, however, weak considering the small effect size, confidence intervals being close to zero, and instability of the results on sensitivity analysis. In clinical practice, media distraction may be used during ESWL as a nursing intervention, but a clinically important reduction of pain and anxiety may not be expected.

The Outcomes of Extracorporeal Shock Wave Lithotripsy for High-Density Renal Stone on Non-Contrast Computed Tomography.

IntroductionUrinary lithiasis is usually managed by extracorporeal shock wave lithotripsy (ESWL). Patients are examined using non-contrast computed tomography (NCCT) in order to evaluate the feasibility of ESWL, according to where the stone is located and how big is its size. The objective of this study is to determine the outcomes of ESWL in patients having high-density renal stone, evaluated using NCCT.Materials and methodsA descriptive case series study was conducted in the Department of Urology, Sindh Institute of Urology & Transplantation, Karachi for six months. Patients of either gender aged between 25-50 years, who presented with solitary renal and ureteric calculi of 0.5-2 cm in diameter and high-density renal stones [>750 hounsfield units (HU)] were enrolled. ESWL was performed and a satisfactory outcome was defined as complete stone clearance in less than or equal to three ESWL sessions. Statistical Package for Social Sciences (SPSS) (IBM Corp., Armonk, NY) was used to analyze frequencies and percentages of the number of ESWL sessions, complete renal stone clearances, and satisfactory outcomes at the end of 12 weeks. A p-value of <0.05 was considered significant.ResultsThe mean age of the patient was reported to be 34.08 ± 9.53 years. 51.6% male preponderance was noticed. Renal and ureteric stones were found in 69.7% and 30.3% of patients, respectively. 21.3% of patients showed stone clearance after two ESWL sessions, 27% of patients after three ESWL sessions, and 51.6% of patients after four ESWL sessions. Stone clearance was found in 58.2% of patients and a satisfactory outcome was found in 42.6% of patients.ConclusionsOur results signify a satisfactory outcome of extracorporeal shock wave lithotripsy for high-density renal stone on non-contrast computed tomography. Further studies on a larger scale are needed to validate these results.

Extracorporeal shock wave lithotripsy as treatment for staghorn stones. Analysis of our case series, spanning 20 years

Objective: To evaluate the effectiveness and complications of treatment with extracorporeal shock wave lithotripsy (ESWL) for staghorn stones.&#x0D; Design: A retrospective observational study on staghorn stones treated with ESWL at the Hospital Regional Universitario de Málaga, between 1990 and 2010.&#x0D; Results: The study included 157 patients (136 women and 21 men) that underwent ESWL for staghorn stones. Mean number of sessions for fragmentation was 3.39± 1.94, mean number of waves was 10,066.67±6,182.96, mean intensity was 16.24±12.37, mean accumulated energy was 402.69±182.07, and mean resolution time was 7.59±7.97 months. Of the patients analyzed, 106 were stone-free and 51 had small residual fragments. Only 12 patients had stone recurrence. The mortality rate was 0%. Ten percent of the patients had type IIIb Clavien-Dindo complications, 18% had type IIIa, and 3.31% had type II. The effectiveness quotient (Clayman et al.) was 0.49, if needing more than one session was considered retreatment, and 0.71, if all sessions were considered a single treatment.&#x0D; Study limitations: Given the retrospective, observational study design, the conclusions were relative, due to the heterogeneity between patients regarding urinary tract morphology, stone size, and stone composition.&#x0D; Originality or value: ESWL in patients with multiple comorbidities is an alternative to surgery.&#x0D; Conclusions: Even though ESWL is not the treatment of choice for staghorn stones, it is a valid option in selected cases, depending on availability at the center and/or experience of the urologist.

Tratamiento de la litiasis coraliforme con Litroticia extracorpórea por ondas de choque. Análisis de nuestra serie en 20 años

Objetivo: Evaluar la efectividad y las complicaciones del tratamiento con litotricia extracorpórea por ondas de choque (LEOC) en litiasis coraliformes.&#x0D; Diseño: Estudio observacional retrospectivo de litiasis coraliformes tratadas con LEOC en el Hospital Regional Universitario de Málaga entre los años 1990 y 2010.&#x0D; Resultados: Se incluyeron 157 pacientes sometidos a LEOC de litiasis coraliforme, 136 mujeres y 21 hombres. El número medio de sesiones para la fragmentación fue de 3,39± 1.94, el número de ondas de 10066.67±6182.96, la intensidad media de 16,24±12.37, la energía acumulada media de 402.69±182.07 y el tiempo de resolución de 7.59±7.97 meses. De los pacientes analizados, 106 quedaron libres de litiasis y 51 presentaron fragmentos residuales pequeños; sólo 12 tuvieron recidiva litiásica. La mortalidad fue del 0%. Las complicaciones según Clavien-Dindo fueron un 10% de tipo IIIb, 18% tipo IIIa y 3,31% tipo II. El coeficiente de efectividad de Clayman fue de 0,49 si consideramos retratamiento cuando se necesita más de una sesión y 0,71 si se consideran todas las sesiones como un único tratamiento.&#x0D; Limitaciones del estudio: Al tratarse de un estudio observacional retrospectivo, las conclusiones obtenidas son relativas, dado que existe heterogeneidad entre pacientes, en lo referente a morfología de la vía urinaria, tamaño y composición de las litiasis.&#x0D; Originalidad o valor: LEOC en pacientes con múltiples comorbilidades, es una alternativa a la cirugía.&#x0D; Conclusiones: Aunque la LEOC no es el tratamiento de elección para los cálculos coraliformes, es una opción válida en casos determinados, siempre en función de la disponibilidad del centro y/o experiencia del urólogo.

Success of extracorporeal shock wave lithotripsy and ERCP in symptomatic pancreatic duct stones: a systematic review and meta-analysis.

Background and study aims Pain is the most frequent and dominant symptom of chronic pancreatitis. Currently, these patients are treated using a step-up approach, including analgesics and lifestyle adjustments, endoscopic, and eventually surgical treatment. Extracorporeal shock wave lithotripsy (ESWL) is indicated after failure of the first step in patients with symptomatic intraductal stones larger than 5 mm in the head or body of the pancreas. To assess the complete ductal clearance rate and pain relief after ESWL in patients with symptomatic chronic pancreatitis with pancreatic duct stones, a systematic review and meta-analysis was performed. Patients and methods A systematic literature search from January 2000 to December 2018 was performed in PubMed, the Cochrane Library, and EMBASE for studies on ductal clearance rate of ESWL in patients with symptomatic chronic pancreatitis with pancreatic duct stones. Results After screening 486 studies, 22 studies with 3868 patients with chronic pancreatitis undergoing ESWL for pancreatic duct stones were included. The pooled proportion of patients with complete ductal clearance was 69.8 % (95 % CI 63.8–75.5). The pooled proportion of complete absence of pain during follow-up was 64.2 % (95 % CI 57.5–70.6). Complete stone fragmentation was 86.3 % (95 % CI 76.0–94.0). Post-procedural pancreatitis and cholangitis occurred in 4.0 % (95 % CI 2.5–5.8) and 0.5 % (95 % CI 0.2–0.9), respectively. Conclusion Treatment with ESWL results in complete ductal clearance rate in a majority of patients, resulting in absence of pain during follow up in over half of patients with symptomatic chronic pancreatitis caused by obstructing pancreatic duct stones.

Efficacy of extracorporeal shockwave lithotripsy with furosemide and hydration in renal stone management: A randomised controlled trial

ABSTRACTObjective: To assess the effect of diuretics (furosemide) administered before extracorporeal shockwave lithotripsy (ESWL) followed by continuous infusion of 0.9% NaCl during the ESWL in patients with renal stones.Patients and methods: A tertiary care teaching hospital-based prospective randomised controlled trial was conducted from July 2015 to June 2017, including 714 patients who underwent ESWL. The patients were randomised in two groups: in Group-A, patients received 40 mg furosemide 30 min before each ESWL session and 1000 mL 0.9% NaCl intravenous hydration during the procedure. In Group-B, the patients only received 0.9% NaCl. All patients were followed-up every 2 weeks for 3 months with X-ray and ultrasonography of the kidney, ureter and bladder. Patients without a radio-opaque stone at follow-up were classified as successes.Results: After 2 months, the stone-free rate (SFR) was much higher in Group-A, at 77.0% vs 65.3% (P < 0.001). Further, for patients aged ≤40 years, the SFR was significantly higher in Group-A than Group-B, at 89.2% vs 71.4% (P < 0.001). The mean (SD) age of the patients was 34.4 (8.23) years. Amongst them, 441 (61.8%) were male and 273 (38.2%) were female. The mean (SD) stone size was 1.42 (0.21) cm in Group-A and 1.40 (0.20) cm in Group-B.Conclusion: We conclude that the efficacy of diuretics (furosemide) along with hydration is superior to hydration alone during ESWL for renal stone clearance.Abbreviations: BMI: body mass index; KUB: kidney, ureter and bladder; OPD: Outpatient Department; ESWL: extracorporeal shockwave lithotripsy; SFR, stone-free rate.