Extracorporeal Shock Wave Lithotripsy In Patients Research Articles

Patient information leaflets for extracorporeal shock wave lithotripsy: questionnaire survey

ObjectivesTo compare the level of information provided in extracorporeal shock wave lithotripsy (ESWL) patient information leaflets in the London and East of England DeaneriesDesignAll trusts in the London and East of England Deanery who offer an ESWL service were contacted and leaflets were comparedSettingLondon and East of England DeaneryParticipantsAlan Askari, Iqbal ShergillMain outcome measuresExamination of key information that was communicated to ESWL patients via leafletsResults12 trusts responded across the two deaneries. There was significant variation in the amount of information provided in the leaflets with some leaflets not containing an adequate level of instruction or information to patientsConclusionsThe authors propose that a national standardised information leaflet should be incorporated with the British Association of Urological Surgeons (BAUS) procedure specific information leaflet for ESWL procedures

Lithotripsie extracorporelle et obésité avec un IMC supérieur à 35

The treatment of urinary stones in morbidly obese patients is associated with higher morbidity. Extra corporeal shock wave lithotripsy (ESWL) is one of the options to achieve urinary stone clearance with minimal morbidity of these patients. The purpose of this study was to evaluate the outcomes and efficiency of ESWL in patients with body mass index (BMI) upper 35 Kg/m(2). We retrospectively reviewed the records of 98 patients with BMI more than 35 and urinary stones who were treated using ESWL from October 2002 to January 2008. Evaluation of efficiency was based on radiological examinations using abdominal radiography, echography or CT scan. It was mode during as consultation with the urologist surgeon four or six weeks after the last session. Ninety-eight patients, 53 men and 45 women, mean BMI 37.74 presented 133 urinary stones of mean size 10.38 mm. Their location was 83% renal, with 42.11% low caliceal. The number of ESWL is 219, without analgesics safe three under neuroleptanalgesics. Fifty-four cystoscopics stents have been pose (40.6%). The overall stone free was 56.3%, residual fragment of 37.5% and failure of 6.2%. The efficiency was bound to the BMI in a significant way. For the complications: five renal colics, three obstructive pyelonephritis with cystosccopic stent. We conclude that ESWL is an effective and mini invasive treatment, which can be proposed, in the first intention in the treatment of urinary stones to obese patients.

MP-19.14: Urgent Extracorporeal Shockwave Lithotripsy in Patients with Obstruction Solitary or Both Kidneys

MP-19.14: Urgent Extracorporeal Shockwave Lithotripsy in Patients with Obstruction Solitary or Both Kidneys

Estudio prospectivo que compara la litotricia extracorpórea y la ureteroscopia en el tratamiento de la litiasis de uréter distal

Purpose To compare the efficacy of ureteroscopy and extracorporeal shock wave lithotripsy (ESWL) in treating distal ureteral calculi and evaluate the best treatment alternative for this disease. Material and methods A total of 104 patients with distal ureteral calculi requiring surgical intervention were enrolled and observed in a prospective follow-up. For ESWL, a Modulix SLX Storz lithotriptor was used and for ureteroscopy, a Storz 33 cm semi-rigid ureteroscope with a diameter of 7,5 to 9,5 french and a 6-degree optic. Out of the patient total, 54 patients underwent ESWL and 50 underwent ureteroscopy. 62 patients were men and 42 women; mean age in the ESWL group was 49.72, and in the ureteroscopy group, 52,16. Mean calculus size for ESWL was 8.29mm and 8,96 mm for ureteroscopy. A P<.05 was considered statistically significant. Results Mean procedure time for ESWL was 55 minutes in men and 45 minutes in women. For ureteroscopy, procedure time was 80 minutes for men and 55 minutes for women. For ESWL, the mean hospital stay was 4.8 hours (same-day discharge for all patients). Mean hospital stay for ureteroscopy patients was 22 hours. 7% of ESWL patients experienced complications compared with 7.9% of those undergoing ureteroscopy. At the 30-day follow up, 74.3% of ESWL patients were stone free, while 92,3% of the ureteroscopy patients were stone free ( P<.05). Conclusions Based on the results of this study, ureteroscopy is a better method for treating distal ureteral calculi because of its stone free rates and because the difference in complication rates was not significant.

Extracorporeal shock wave lithotripsy as a first-line therapy for ureteral calculi with impaired renal function due to hydronephrosis

In their recent article on extracorporeal shock wave litho-tripsy (ESWL) as a first-line single therapy for obstructiveureteral stones, Chiara and colleagues indicated that ESWLis an effective therapy for obstructive ureteral calculi,varying degrees of hydronephrosis, and impaired renalfunction [1]. The present article adds further support to thefeasibility and safety of ESWL for calculus clearance andrecovery of renal function [1]. It is evident that ESWL hasbecome standardized and can guarantee acceptable peri-operative morbidity, yielding reproducible results fortreatment of ureteral calculi. Although some authors con-sider that ESWL is clearly indicated in the presence ofhydronephrosis, others consider hydronephrosis to be anindicator of successful outcome after ESWL. Consistentwith the findings of Chiara et al., El-Assmy et al. [2] foundthat the degree of urinary obstruction caused by calculusdid not affect the success of calculus clearance. However, atendency for repeat treatment and a prolonged period forstone clearance were associated with the degree of hydro-nephrosis [2]. Chang et al. conducted a prospective,randomized study of patients with hydronephrosis whosestones were located above the level of L5 [3]. Theyreported that hydronephrosis had a major impact on theoutcome of ESWL, because more stone-free patients werefound among those with mild, than among those withsevere, hydronephrosis, and ancillary procedures wereneeded in 16.9% of all patients [3]. Although ESWL hascertain limitations, its indications are expanding and nowinclude all types of urinary tract calculi. Deliveliotis et al.evaluated the use of ESWL in patients with impactedureteral stones that had remained in the same location for atleast 2 months, and found that 85.7% were rendered stone-free without the need for an open procedure, concludingthat ESWL should be attempted as an initial approach forthe treatment of impacted stones [4]. The use of ESWL,which is minimally invasive compared any other surgicalmethod known currently, should be promoted wheneverpossible for patients with ureteral stones.References

The use of tamsulozin as adjunctive treatment after ESWL in patients with distal ureteral stone: do we really need it?

Our study aimed to define the position of tamsulosin as adjunctive therapy in patients with stones of the distal ureter who had undergone extracorporeal shock wave lithotripsy (ESWL). In total, 61 consecutive patients (38 men and 23 women) with single distal radiopaque ureteral stone of > or =6 mm of diameter were enrolled. After ESWL patients were randomized in two groups. Non-steroidal anti-inflammatory drug (supp. diclofenac 50 mg) was given to both groups upon demand. In group B, all patients (30) received additionally tamsulozin 0.4 mg every day. Follow-up visits were performed 1, 2, 3 and 4 weeks after ESWL. Evaluation included a KUB plain film and an ultrasound examination. Efficacy was evaluated in terms of success rate, stone-free rate, expulsion time of the fragments and use of diclofenac. Two patients from the tamsulosin group experienced dizziness and one was withdrawn. The success rate was 58.06 and 66.66% for the control and the tamsulosin group, respectively, while the corresponding values for stone-free rate were 51.6 and 63.33%, respectively. The mean expulsion time of the fragments was 13.22 days for group A and 12.95 days for group B. These results did not achieve statistically significant difference (P > 0.05). The mean diclofenac dose was 118.9 mg in group A and 56.9 mg in group B. This difference was statistically significant (P = 0.02). Despite the relatively small number of patients, our data indicate that the use of tamsulosin after ESWL in this specific subgroup of patients does not result in improved success and stone-free rate and expulsion time. In contrast, a significantly reduced need for analgesics was found.

Rapid Extracorporeal Shock Wave Lithotripsy for Proximal Ureteral Calculi in Colic versus Noncolic Patients

ObjectivesIn delayed extracorporeal shock wave lithotripsy (ESWL) treatment, increasing stone impaction is associated with delayed stone clearance. Whether colic patients treated by rapid ESWL have the same time to stone clearance as noncolic patients, which supports the thesis that stones in both groups are nonimpacted, has not been investigated yet, and was the objective of this study. MethodsA total of 82 patients were prospectively enrolled and treated with piezoelectric ESWL for a solitary proximal ureteral stone. Of these, 56 patients experienced at least one colic episode compared with 26 noncolic patients. Hydronephrosis has been assessed with the use of ultrasound and intravenous urography (IVU). Time to stone clearance after the first ESWL and stone-free rates after a follow-up period of 3 mo were recorded. ResultsIn colic and noncolic patients, mean stone size was 7.8mm (p=0.7). Ultrasound-detected hydronephrosis was present in 88% versus 39% (p<0.0001), whereas IVU-detected hydronephrosis was present in 60% versus 7.7% (p=0.0001). Mean number of impulses applied was 8000±4000 versus 6700±3400 (p=0.1). Mean time to stone clearance was 9.5±12.1 d versus 4.6±3.8 d (p=0.1). Colic and noncolic patients were considered as treatment success in 83% and 81% after 3 mo of follow-up (p=0.9). ConclusionsTreatment outcome and time to stone clearance after rapid ESWL in colic patients compared with noncolic patients is comparable and independent of concomitant hydronephrosis. This finding suggests an absence of significant impaction in proximal ureteral stones treated within 24h after a first colic episode, enforcing the concept of performing rapid ESWL in patients harbouring proximal ureteral stones.

Extracorporeal shock-wave lithotripsy or ureteroscopy as primary treatment for ureteric stones: a retrospective study comparing two different treatment strategies

Our extracorporeal shock-wave lithotripsy (ESWL) lithotripter with ultrasound localization technique was replaced in 1999 by a Storz SLX-MX lithotripter with both X-ray and ultrasound detection possibilities. Before replacing our lithotripter, most ureteric stones were treated with ureteroscopy (URS); subsequently, almost all patients underwent ESWL as primary treatment. The aim of this retrospective study was to compare the results of these two treatment strategies in all consecutive patients attending our hospital in 1998 and 2000 for ureteric stone treatment. The medical records of all patients treated for ureteric stones in 1998 and 2000 were reviewed. In 1998, 173 ureteric stones were treated. Primary treatment was URS in 124 patients, push back/ESWL in 24, ESWL in 21 and open surgery in four. In 2000, 176 ureteric stones were treated: 158 with ESWL and 18 with URS. ESWL or URS monotherapy was defined as ESWL or URS, respectively as the only stone-treatment therapy, with or without the use of a ureteric catheter or nephrostomy tube. Treatment success was defined as a stone-free ureter. In 1998, the success rate for URS monotherapy was 95%, with a retreatment rate (sessions per stone situation) of 1.06. Corresponding figures for ESWL monotherapy in 2000 were 90% and 1.69. All URS patients received general anaesthesia; ESWL patients received opiods. Complication rates were 6% for URS and 3% for ESWL. In the URS group, 4/8 complications were considered to be major. ESWL should be considered the first-line treatment for ureteric stones because of its non-invasive nature, lack of a requirement for general anaesthesia and low complication rates.

1893: Extracorporeal Shockwave Lithotripsy in Patients with Spinal Cord Injury

You have accessJournal of UrologyDiscussed Poster, Wednesday, May 12, 2004, 8:00am- 12:00 pm1 Apr 20041893: Extracorporeal Shockwave Lithotripsy in Patients with Spinal Cord Injury Joshua A. Perkel, Baruch Mayer Grab, Harry P. Koo, Robert H. Hackler, Vernon Orton, and Meena Midha Joshua A. PerkelJoshua A. Perkel More articles by this author , Baruch Mayer GrabBaruch Mayer Grab More articles by this author , Harry P. KooHarry P. Koo More articles by this author , Robert H. HacklerRobert H. Hackler More articles by this author , Vernon OrtonVernon Orton More articles by this author , and Meena MidhaMeena Midha More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)39085-2AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "1893: Extracorporeal Shockwave Lithotripsy in Patients with Spinal Cord Injury." The Journal of Urology, 171(4S), p. 500 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 171Issue 4SApril 2004Page: 500 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Joshua A. Perkel More articles by this author Baruch Mayer Grab More articles by this author Harry P. Koo More articles by this author Robert H. Hackler More articles by this author Vernon Orton More articles by this author Meena Midha More articles by this author Expand All Advertisement PDF downloadLoading ...

Early changes of oxalate and calcium urine excretion in those with calcium oxalate stone formation after extracorporeal shock wave lithotripsy

Objectives To determine the extent of transient changes of tubular function in idiopathic calcium-oxalate (CaOx) stone-bearing patients after extracorporeal shock wave lithotripsy (ESWL), calcium and oxalate excretion were measured before and after ESWL. Methods In 22 patients with renal CaOx stones, the plasma values and urine excretion of creatinine, calcium, oxalate, magnesium, and citrate were measured before and on days 1 and 2 after ESWL under conditions of a standardized diet. Overnight urine collection for an 8-hour period was used to measure the urine excretion, and the values were extrapolated to a 24-hour period. For calculation of the urine ion activity, the AP(CaOx) index EQ(s) and the CaOx risk index were used. Results After ESWL, hyperoxaluria was noted in 10 patients compared with 2 before ESWL. Hypercalciuria was seen in 11 patients after ESWL compared with 3 before. Combined hyperoxaluria and hypercalciuria was found in 7 patients after ESWL compared with 1 before. Both the oxalate/creatinine and calcium/creatinine ratios were significantly increased after ESWL. The AP(CaOx) index EQ(s) and the CaOx risk index were significantly increased after ESWL in patients with increased post-ESWL calcium and/or oxalate excretion. Conclusions Increased calcium and/or oxalate excretion can be seen in patients with CaOx stones early after ESWL. This increased excretion of lithogenic substances represents an increased risk of fragment apposition after ESWL for the group with a significantly increased AP(CaOx) index EQ(s) and CaOx risk index. Therefore, prophylactic measures in patients at risk early after ESWL might be warranted to prevent possible recurrent stone formation.

Screening for Significant Bacteriuria in Patients with Upper Tract Calculi Using Dipstick Urine Analysis

Screening for Significant Bacteriuria in Patients with Upper Tract Calculi Using Dipstick Urine Analysis

Extracorporeal Shock Wave Lithotripsy in Children

Extracorporeal Shock Wave Lithotripsy in Children

MECHANICAL PERCUSSION, INVERSION AND DIURESIS FOR RESIDUAL LOWER POLE FRAGMENTS AFTER SHOCK WAVE LITHOTRIPSY: A PROSPECTIVE, SINGLE BLIND, RANDOMIZED CONTROLLED TRIAL

We compare the effectiveness of mechanical percussion and inversion with observation for eliminating lower caliceal fragments 3 months after shock wave lithotripsy. At 3 months after shock wave lithotripsy 69 patients with residual lower caliceal fragments 4 mm. or less were randomized to receive either mechanical percussion and inversion or observation for 1 month. The observation group then received crossover mechanical percussion and inversion if fragments persisted. All patients were followed with plain film of the kidneys, ureters and bladder to assess the stone area and stone-free status, and renal tomography or noncontrast spiral computerized tomography to confirm stone-free status. A blinded radiologist reviewed all films. Patients were treated with a mechanical chest percussor applied to the flank while inverted to greater than 60 degrees after receiving 20 mg. furosemide. A total of 35 patients were randomized to receive immediate mechanical percussion and inversion therapy and 34 observation. Of the patients in the observation group 28 subsequently received mechanical percussion and inversion after completing the observation period. The groups were not different in gender, body mass index, side affected, stone location or renal anatomical features. The mechanical percussion and inversion group had a substantially higher stone-free rate than the observation group (40% versus 3%, respectively, p <0.001). The mechanical percussion and inversion group also had a greater improvement in total stone area than controls (-63.3% versus +2.7%, respectively, p <0.001). No significant adverse effects were noted in the mechanical percussion and inversion group. Mechanical percussion and inversion is a safe and effective treatment option for residual lower caliceal fragments 3 months after shock wave lithotripsy. Nearly 50% of patients become stone-free, and stone burden is decreased by 50% in the remainder.

Ultrasound-guided piezoelectric extracorporeal shock wave lithotripsy of parotid gland calculi.

The introduction of piezoelectric extracorporeal shock wave lithotripsy (ESWL) has changed therapy for salivary calculi. This method seems especially suitable for treating calculi in the parotid gland. The purpose of this study was to evaluate ESWL in patients with such calculi. From November 1990 to November 1999, all patients with sialolithiasis of the parotid gland were treated with piezoelectric ESWL. Three different lithotriptors were used over the 9-year study period. Results were analyzed according to both the patients' clinical status and follow-up sonograms. In total, 42 patients (21 women, 21 men; mean age, 59 years) were treated with ESWL. The mean follow-up period for all patients was 63 months (range, 7-96 months). After ESWL had been performed, 71% of the patients were completely free of symptoms, and 21% had marked improvement of their symptoms. Sixty-seven percent were completely free of calculi, and 27% had a marked reduction in the size of their calculi. Adverse effects of ESWL included temporary glandular swelling (4 patients), blood-tinged salivary secretions (9 patients), petechiae on the skin surface (3 patients), and parotid abscess (1 patient). ESWL is an outpatient procedure that can be performed without anesthesia and with scarcely any discomfort for patients. Conventional surgical procedures such as subtotal parotidectomy may be almost entirely replaced by ESWL because of the excellent treatment results and a very low rate of complications associated with ESWL. ESWL should be considered the treatment of choice for parotid calculi.

Extracorporeal shockwave lithotripsy in patients treated with antithrombotic agents.

Between January 1996 and December 1999, 749 patients underwent electromagnetic SWL. Among them, 23 patients, 19 with renal and 4 with ureteral stones, were receiving antithrombotic drugs (aspirin, ticlopidine, dipyridamole). According to the cardiologist and hematologist, we divided these patients into two groups: Group 1 had a low thromboembolic risk (previous myocardial infarction), and Group 2 had a high thromboembolic risk (aortocoronary bypass, atrial fibrillation, cerebrovascular disease, peripheral occlusive arterial disease). Group 1 patients discontinued their antiplatelet therapy 8 days prior to SWL to permit a sufficient number of functioning platelets to remain. Group 2 patients suspended antiplatelet therapy, and unfractioned heparin 5000 IU tid (8 a.m., 4 p.m., and 12 p.m.) was administered for the 8 days prior to SWL. On the ninth day of withdrawal, SWL was performed in all patients. Close follow-up was performed during the postoperative period (hemoglobin, hematocrit, kidney ultrasonography, plain abdominal film). The antithrombotic therapy was restored in all patients within 10 to 14 days of withdrawal. Hematomas and thromboembolic events were not observed. At 3 months' follow-up, 14 patients (61%) were stone free, 3 (13%) had <4-mm fragments, and 6 (26%) had >4-mm residual fragments. Our schedules for the suspension or substitution of antithrombotic therapy, although tested in a small number of patients, allowed us to perform SWL without hemorrhagic or thromboembolic complications.

Effect of vibration massage therapy after extracorporeal shockwave lithotripsy in patients with lower caliceal stones.

To determine whether vibration massage influences the results of extracorporeal shockwave lithotripsy (SWL) in patients with lower caliceal stones. One hundred three patients with lower caliceal stones were entered in the study. Patients were divided into two groups that received either SWL alone (Group A, N = 52) or with vibration massage (Group B, N = 51). There was no statistically significant difference between the two groups in stone size, duration of follow-up, or patient age. The complication, stone-free, and stone recurrence rates of the groups were compared. There was no statistically significant difference between the groups in the number of shockwaves, number of SWL sessions, or shockwave energy. The renal colic rate was higher in Group B than in Group A (P = 0.03). The stone-free rates in Group A and Group B were 60% and 80%, respectively (P = 0.003). The stone recurrence rate was higher in Group A than in Group B (P = 0.0006). This retrospective study demonstrates that SWL with vibration massage appears to have a beneficial effect on the passage of fragments in patients with lower caliceal stones.

Randomized study of intracorporeal laser lithotripsy versus extracorporeal shock-wave lithotripsy for difficult bile duct stones

Background: Endoscopic treatment modalities are well established for the removal of bile duct stones. For the small percentage of stones that are difficult or impossible to extract by conventional means, more sophisticated endoscopic techniques or associated modalities such as intracorporeal laser lithotripsy (ILL) and extracorporeal shock wave lithotripsy (ESWL) have to be applied. Little is known, however, about the relative value of these different techniques. We therefore compared endoscopic ILL with ESWL in patients with difficult bile duct stones in a prospective randomized study. Methods: The study included 60 patients (35 women; mean age 70 ± 15 years) with bile duct stones in whom standard extraction failed (n = 33) or in whom the papilla was not accessible, thus requiring percutaneous access (n = 27). They were randomized to receive ESWL under fluoroscopic targeting (maximum discharge number per session: 6000) or ILL using a pulsed dye laser with an automatic stone recognition system, which was mostly performed (28 of 30 cases) under cholangioscopic control. Endoscopic removal of fragments was attempted within the subsequent (ESWL) or the same (ILL) session. Failure was defined as failure to remove all ductal stones/fragments after a maximum of three lithotripsy sessions. Results: There were no statistical differences in background variables between the two groups. Bile duct clearance was achieved in 22 of 30 patients (73%) in the ESWL group and in 29 of 30 patients (97%) in the ILL group (p < 0.05). The number of treatment sessions (ESWL 3.0 ± 1.3; ILL 1.2 ± 0.4; p < 0.001) and the duration of treatment (ESWL 3.9 ± 3.5 days; ILL 0.9 ± 2.3 days; p < 0.001) were also significantly different in favor of ILL. Two minor complications occurred in each group; there was no 30-day mortality. Crossover therapy to ILL led to stone removal in seven of the eight cases in which ESWL failed, whereas ESWL fragmented the stone in the single patient in whom ILL failed. Conclusions: ILL is more effective in the treatment of difficult bile duct stones than ESWL in terms of stone clearance rate and treatment duration. (Gastrointest Endosc 1998;47:88344-34.)

Single Stones of the Lower Pole of the Kidney

Objective: To assess the effectiveness of extracorporeal shock wave lithotripsy (ESWL) and percutaneous nephrolithotomy (PCN) as a treatment for stones of the lower pole of the kidney and to compare their morbidity according to the stone size. Methods: We retrospectively studied 739 patients treated for a single stone of the lower pole. Group I consisted of 666 patients treated by ESWL and group II consisted of 73 patients treated by PCN. Results: These were assessed at 3 months for 587 ESWL patients (88%) and at day 1 for all PCN patients on renal tomography or ultrasonography. Respectively in groups I and II, 335 patients (57%) and 53 patients (72.6%) were stone-free (p = 0.01). For medium-size (10–20 mm) stone patients, stone-free represented 102 patients (44%) and 29 patients (72.5%) in groups I and II respectively (p = 0.001). For smaller stones (<10 mm), stone-free represented 231 patients (69%) and 21 patients (84%) in groups I and II respectively (p = 0.12). Morbidity rate was less with ESWL than with PCN. Conclusions: PCN achieves better results than ESWL for single stone of the lower pole with statistical significance for middle-size stones but with higher morbidity.

Bacteriuria Following Extracorporeal Shock-Wave Lithotripsy in Patients Whose Urine Was Sterile Before the Procedure

During 10 months at our hospital, 413 patients underwent extracorporeal shock-wave lithotripsy (ESWL). The occurrence of complications was examined in the 126 (30.5%) of these patients who had sterile urine before the procedure and who had neither indwelling catheters nor stents. No patient received prophylactic antibiotics. After ESWL, nine patients (7%) developed bacteriuria, which was usually transient and required no therapy. Seven of the nine cases developed within 2 weeks of ESWL. In no case did other complications follow bacteriuria. Patients in whom bacteriuria was suspected because of fever all proved to have sterile urine. Our results indicate that patients whose urine is sterile before ESWL do not need antimicrobial prophylaxis.

S100a0 protein as a marker for tissue damage related to extracorporeal shock wave lithotripsy.

We assayed serum and urine S100a0 protein levels in patients with renal stones (n = 21) or ureteral stones (n = 18), before and after extracorporeal shock wave lithotripsy (ESWL) to evaluate tissue injury. Serum S100a0 protein levels increased significantly immediately after, and at 2 and 24 h after ESWL in patients with renal stones, and at 2 and 24 h after ESWL in patients with ureteral stones. Significant increases in urine S100a0 protein levels were observed immediately and 2 h after ESWL in both groups of patients. The patients receiving a higher number of shock waves had a more pronounced increase in serum S100a0 protein especially in the case of more than 3,500 shock waves. Because S100a0 protein exists at relatively high concentrations in the proximal renal tubules and skeletal muscles, serum and urine S100a0 protein levels appear to be useful markers of tissue injury, including damage in the kidney and skeletal muscles, in the early post-ESWL phase.