Extracorporeal Shock Wave Lithotripsy Procedure Research Articles

Community-Acquired Infection among the Hospitalized Renal Stone Patients

Abstract Background One of the most prevalent long-term kidney disorders in high-blood-pressure patients is nephrolithiasis. This study involves collecting urine and renal stones from patients with urinary tract infection (UTI) to analyze how hospitalized patients with UTI contract community infections. The samples were collected at the Sulaimaniyah Surgical Teaching Hospital urology and extracorporeal shock wave lithotripsy (ESWL) staff. It is understood that UTIs contribute to the formation of kidney stones. Methods Screened and cultured urine requires careful collection, transport, and interpretation. Urine samples were collected from the patients with UTI at the Sulaimaniyah teaching hospital for culturing. Urine cultures containing pyuria and bacteria indicate UTIs. Microorganisms were studied, inoculated on blood, MacConkey, and mannitol salt agar, and biochemically identified. A bacterial and microbiological examination of kidney stones was conducted at the Sulaymaniyah Surgical Teaching Hospital's ESWL and urology departments. Clean renal stone samples with ethanol for 1 minute, crush using sterile tongs, then culture in 37°C thioglycolate broth for 48 hours. Specimens inoculated on blood, MacConkey, and mannitol salt agars resulted in isolation of staphylococci, streptococci, and Staphylococcus spp. Results In this study, 17 of 48 samples showed microbial growth. Each of Enterococcus and Micrococcus spp. comprised 12.5% of eight renal intact stone samples. Three of 14 renal intact stone samples showed microbial growth with 7 and 14% for Enterococcus and Escherichia coli, respectively. From eight urine samples before and after ESWL procedure, E. coli isolation incidents doubled from 12.5 to 25%, while Staphylococcus spp. remained the same at 12.5%. Out of 10 UTI urine samples, 20% Staphylococcus spp., E. coli, and 10% Pseudomonas spp. were isolated. Conclusion This study related renal stones to E. coli, enterococci, Micrococcus luteus, and staphylococci. After ESWL, the urine samples revealed E. coli growth, whereas comparable urine samples before ESWL did not. Thus, urinary infections can cause kidney stones. Eighteen of 48 kidney stone samples tested positive for E. coli, 22 for staphylococci, 11 for enterococci, 5 for Pseudomonas, 5 for Proteus, and 5 for micrococci.

EUS-guided laser lithotripsy for pancreatic duct stones after failed conventional pancreatic endotherapy.

The central dogma of pain in patients with chronic pancreatitis revolves around the pathophysiology of ductal hypertension owing to stones that obstruct the pancreatic duct. Conventional modalities available to decompress the pancreatic duct are occasionally limited by failed selective pancreatic duct cannulation during endoscopic retrograde cholangiopancreatography. We describe a novel endoscopic approach of EUS-guided laser lithotripsy to assist in pancreatic duct (PD) stone fragmentation in two symptomatic patients with underlying chronic pancreatitis who had failed PD cannulation and extracorporeal shock wave lithotripsy (ESWL). In both cases, a 365-micrometer LightTrail TracTip Holmium laser fiber was advanced within a 19G endoscopic ultrasound aspiration needle (Expect Slimline (SL), Boston Scientific, Marlborough, Massachusetts, United States) under endoscopic ultrasound (EUS) guidance to fragment the PD stones. There were no procedure-related complications encountered and follow-up after 1 month of the procedure revealed significant reduction in abdominal pain scores. To the best of our knowledge, these are the first reported cases of EUS-guided laser lithotripsy performed for PD stones. Our approach of performing laser lithotripsy under EUS guidance obviates the need for an ESWL procedure; however, it is technically more challenging and requires precision to avoid injury to the pancreas. Further prospective studies are required to evaluate the safety and efficacy of this novel approach and its applicability as either a rescue procedure or in tandem with conventional pancreatic endotherapy modalities.

A systematic review and meta-analysis on the outcomes of extracorporeal shock wave compared to ureteroscopic lithotripsy for the treatment of ureteral stones

ObjectivesIn this systematic review and meta-analysis, we sought to identify whether extracorporeal shockwave lithotripsy (ESWL) or ureteroscopic lithotripsy (URSL) is the most appropriate method for treating ureteral stones. MethodsWe identified relevant literature by searching the Google Scholar and PubMed databases in accordance with PRISMA guidelines. We focused on the outcomes of extracorporeal shockwave lithotripsy and ureteroscopic lithotripsy. For each method, we compared complications, hematuria, perforation, failure, stone clearance, initial stone-free, operating time, stone size, auxiliary procedures, and overall stone-free outcomes. Our analysis involved meta-analysis, heterogeneity testing, subgroup analysis, meta-regression sensitivity analyses, Egger's tests, Smoothed Variance Egger's (SVE) testing, and Smoothed Variance Thomson (SVT) testing. In addition, we detected publication bias for all outcomes related to the two procedures. ResultsBased on ten eligible studies, we conducted a meta-analysis on a total of 1509 patients. Extracorporeal shockwave lithotripsy was used to treat 677 patients; the remaining 832 patients were treated by the ureteroscopic lithotripsy procedure. Considering the meta-analysis statistical parameters including odds ratio (OR), standardized mean difference (SMD), Q, I2 and their p-values, the overall stone-free, operating time, stone size outcomes were identified with significant OR, SMD, and Q values. The hematuria, failure, and stone clearance outcomes were determined to have significant Q values. The perforation and initial stone free outcomes had significant OR values. And, complications and auxiliary urinary procedures were not significant in terms of OR and Q values. ConclusionsAnalysis indicated that ESWL and URSL procedures are essential for the treatment of ureteral stones, even though the perforation rate is higher for URSL than for ESWL. Overall stone-free rates were better for the URSL procedure.

Effectivity of Extracorporeal Shock Wave Lithotripsy and Stenting vs Stenting Only for Difficult Common Biliary Duct Stones: A Retrospective Analysis

Background: This study is conducted to investigate the effectiveness of extracorporeal shockwave lithotripsy (ESWL) after biliary stent placement compared to biliary stent placement alone in difficult common bile duct stones.Method: This is a retrospective cohort study using medical record data from the Gastrointestinal Endoscopy Center Registry of Dr. Cipto Mangunkusumo General National Hospital. We retrospectively evaluated 126 subjects with difficult bile stones. The subjects were divided into two groups: subjects subjected to biliary stent placement only and subjects who underwent ESWL procedure after the biliary stent placement. The effectiveness of the procedures was measured in the form of total clearance of bile stones.Results: A total of 126 subjects were included in this study, including 72 subjects who underwent ESWL procedure after biliary stent placement and 54 subjects who underwent biliary stent placement only. The effectiveness of ESWL after biliary stent placement in achieving total clearance was 69.1%, and the effectiveness of biliary stent placement in achieving total clearance was 64.8%. The ESWL procedure as adjuvant therapy after biliary stent placement did not provide a statistically significant difference (p = 0.703; 95% CI: 0.816–1.351). Normal body mass index was a factor that influences the effectiveness of ESWL after biliary stent placement (p = 0.002).Conclusion: The ESWL procedure as adjuvant therapy after biliary stent placement has the same level of effectiveness as biliary stent placement alone.

The Use of a Virtual Reality Device (HypnoVR) During Extracorporeal Shockwave Lithotripsy for Treatment of Urinary Stones: Initial Results of a Clinical Protocol

To assess the impact of a Virtual Reality Device (VRD, HypnoVR, Strasbourg, France) on patient-reported pain and anxiety during extracorporeal shockwave lithotripsy (ESWL). We enrolled 30 patients submitted to ESWL for urinary stones. Patients with either epilepsy or migraine were excluded. ESWL procedures were performed using the same lithotripter (Lithoskop; Siemens, AG Healthcare, Munich, Germany) at a frequency of 1 Hz delivering 3000 shock waves per procedure. The VRD was installed and started 10 minutes before the procedure. Tolerability of pain and treatment-related anxiety represented the primary efficacy outcomes and were evaluated using: (1) a visual analogue scale (VAS), (2) the short version of the McGill pain questionnaire (MPQ), and (3) the short version of the surgical fear questionnaire (SFQ). Secondary outcomes were VRD ease of use and patient satisfaction. Median (IQR) age was 57 (51-60) years and body mass index (BMI) was 23 (22-27) kg/m2. Median (IQR) stone size was 7 (6-12) mm with a median (IQR) density of 870 (800-1100) HU. Stone location was kidney in 22 (73%), and ureter in 8 (27%) patients. Median (IQR) extra time for installation was 6.5 (4-8) minutes. Overall, 20 (67%) patients were at their first ESWL treatment. Side effects were experienced by only 1 patient. Comprehensively, 28 (93%) patients would recommend and would use VRD again during ESWL. VRD application during ESWL is safe and feasible. The initial report from patients is positive in terms of pain and anxiety tolerance. Further comparative studies are needed.

Value of Music and Nitrous Oxide for Pain Control during Extracorporeal Shock Wave Lithotripsy (ESWL).

To compare the efficacy of 4 different analgesic regimens that include music and nitrous oxide during the treatment of renal lithiasis with ambulatory extracorporeal shock wave lithotripsy (ESWL). A single-centre, longitudinal, prospective, randomized, open and parallel group study was conducted. Patients with renal lithiasis were included and were randomized to Group A (basal analgesia: midazolam (1 mg), fentanyl (0.05 mg) and dexketoprofen (50 mg)), Group B (basal analgesia and nitrous oxide), Group C (basal analgesia and music) and Group D (basal analgesia, nitrous oxide and music). For the measurement of pain, a visual analogue scale ranging from 0 (no pain) to 100 (maximum pain imaginable) was used. Patient satisfaction was assessed using a Likert questionnaire. The epidemiological data of the patients in terms of lithiasis, previous clinical and ESWL sessions, and pain measured with the VAS before, during (maximum) at the end of the session and at discharge were recorded. Data on complications were also collected, as was the patients' subjective evaluation of the treatment and their satisfaction. The ESWL procedure was performed with a Storz Modulith SLX-F2® lithotripter. A maximum of 4000 waves were applied at a frequency of 1.5 Hz. Eighty patients were included (20 per group). None of the analgesia guidelines proved to be superior to the others for pain control during the ESWL session. Patients younger than 50 years had significantly higher values for the maximum VAS. Only 13.75% of patients required rescue analgesia. A total of 77.5% described their experience as good, very good or excellent, regardless of the assigned group. The addition of nitrous oxide and/or music did not result in a statistically significant improvement over the basal analgesia regimen of midazolam, fentanyl and dexketoprofen; however, the degree of patient satisfaction was very high.

Diagnostic value of multidetector computed tomography for detection of complication after extracorporeal shock-wave lithotripsy

Background Urolithiasis represents one of the most common urogenital disorders. Extracorporeal shock-wave lithotripsy (ESWL) has changed the management of urolithiasis. ESWL has many complications, including cardiac dysrhythmia, bacteriuria, bleeding, steinstrasse, renal colic, and urosepsis. Multidetector computed tomography (MDCT) allows reliable detection and quantification of post-ESWL complications. Aims The aim of this work was to evaluate post-ESWL sequel by CT and to rule out complications. Patients and methods In total, 30 patients with renal stones received treatment with ESWL. Patients came after undergoing ESWL procedure and suffering from clinical complaints to the Department of Diagnostic Radiology in Tanta University Hospital examination center. Results All patients included in our study were evaluated by MDCT to detect complications after ESWL. We found that 10 cases had multiple stone fragments along the course of the ureter that was called steinstrasse. Urinary-tract infections in six (20%) cases. Two cases had signs of inflammation with steinstrasse. Six cases had renal hematoma. We found a significant value. No significant value between the incidence of complications and systolic blood pressure and also diastolic blood pressure. We found significant differences between the incidence of complications and high fasting blood sugar, especially urinary-tract infection. MDCT-diagnosed pyelonephritis has high white blood cell count in urine more than 100. Red blood cell significantly increased in urine analysis of cases with renal hematoma and pyelonephritis. Conclusion MDCT is considered the most accurate noninvasive imaging tool not only for diagnosis of urinary-tract stone but also detection of complications after ESWL.

The effect of stone size on the results of extracorporeal shockwave lithotripsy versus semi-rigid ureteroscopic lithotripsy in the management of upper ureteric stones

ABSTRACT Objectives To evaluate the role of stone size on the efficacy and safety of extracorporeal shockwave lithotripsy (ESWL) monotherapy vs ureteroscopy (URS) for managing upper ureteric stones. Patients and methods The study design was a randomised prospective study of a total cohort of 180 patients with upper ureteric single stones of 0.5–1.5 cm. Half of the patients were managed by ESWL monotherapy, while the other half underwent URS with stone fragmentation using an ultrasound lithotripter (URSL). The success rate, re-treatment rate, auxiliary procedure (AP) rate, efficacy quotient, and complications were compared between the two groups. Results After single URSL and ESWL procedures 70/90 (77.8%) and 35/90 (38.9%) of the stones were successfully cleared, respectively (P < 0.001). The re-treatment rate after ESWL was significantly higher than in the URSL group (38.9% vs 11.1%, P < 0.001). Requiring an AP was not significantly different following ESWL (22.2%) and URSL (24.4%) treatment. The overall stone-free rate (SFR) at 3 months was significantly superior in the URSL group (88.9% vs 77.8%); however, both procedures had excellent results with no significant difference for stones of <1 cm (95.5% vs 92.9%, P > 0.05), compared to better results following URSL for stones of >1 cm (82.6% vs 64.6%, P < 0.05). Conclusion Our present study supports that ESWL is recommended as a first-line non-invasive monotherapy for upper ureteric opaque stones of <1 cm, while URSL is recommended as a first-line treatment for stones of >1 cm. The results for URSL were superior with lower a re-treatment rate, rapid stone clearance in a very short time, and less radiation exposure. Therefore, stone size is an important factor for the final decision of the initial management of upper ureteric stones because it has a direct relation to the efficacy of ESWL, but it has no effect on the results of URSL.

Is pain perception different in pediatric and adult patients undergoing stone crushing procedure after the application of multimodal analgesia?

Aim: Extracorporeal shock wave lithotripsy (ESWL) is an important modality in the treatment of urinary system stone disease in children and adults. However, ESWL may be painful and stressful procedure. We aimed to examine the differences between pain perception felt during ESWL in children and adult patients after the application of multimodal analgesia. Method: Patients who underwent the stone crushing procedure under multimodal analgesia at the ESWL unit of Mersin University Hospital Urology Clinic between May 2010 and December 2010, were divided into two groups as pediatric and adult. Using the VAS form, the adult patients’ and pediatric patients' pain perception felt during ESWL, were scored and compared. Results: The difference between the mean scores of pain perception felt during ESWL were not significant for all three sessions in both groups. But the difference between the mean scores of pain perception felt during all ESWL sessions between the pediatric and adult groups were significant for all three sessions. The success rate for SWL was calculated as 83.3% for the pediatric group and 80% for the adult group. Conclusion: ESWL is a painful procedure. Our ESWL success rate is compatible with the literature. The pediatric and adult patients successfully completed the ESWL procedure with multimodal analgesia. The pain perception felt during ESWL score was higher in pediatric cases.

Effect of Implementing Evidence- Based Guidelines on Lifestyle Modification for Adult Patients with Renal Stone Undergoing ESWL Procedure

Introduction: Renal stone disease is one of the major health problems among urological patients, mainly the third most common urological disorder. Lifestyle modification and Extracorporeal Shock-Wave Lithotripsy (ESWL) is the first line of intervention for of upper urinary tract stones smaller than 2cm and ureter stones from 1 to 1.5 cm diameter. Aim: The aim of this study was to examine the effect of implementing evidence- based guidelines on lifestyle modification for adult patients with renal stone undergoing ESWL procedure. Methods: Random sample of Seventy patients in the age group ranging from 21-60 years old, recruited from the Urology department at the Alexandria main University Hospital, and Elnokba center for Urology in Damanhur City. Tools used for all patients underwent full history and physical examination including age, gender, family history of renal stones, past history of recurrent stone and any current medical diseases. In addition to assessing patients' knowledge regarding renal stone disease and ESWL procedure and lifestyle pattern regarding renal stones and prevention of its recurrence. Pre -Post test for patients' knowledge conducted before and after ESWL procedure with follow up for lifestyle modification within 1- and 3-months following implementation of lifestyle modifications guidelines sessions. Results: Results showed that both groups had poor knowledge level and lifestyle pattern, while after implementation all studied patients had fair knowledge and lifestyle pattern level. Results showed highly positive correlation between knowledge, and lifestyle pattern among the study group with P 0.001. Evidence based lifestyle guidelines enhance renal stone patient’s knowledge, lifestyle pattern of study group. The nurses should be trained to conduct evidence based educational lifestyle guidelines. Conclusion: Renal stone patients attending the lifestyle modification guidelines sessions demonstrated a positive significant improvement in their knowledge, as well as modifications in their lifestyle practices, all dimensions of health behaviors than those patients not attending the sessions. Therefore, a lifestyle modification guideline is considered as an effective nonpharmacological intervention in renal stone treatment and recurrence prevention. So, this study may provide a practice framework for the future development of other nursing evidence-based practice.

Factors influencing extracorporeal shock wave lithotripsy efficiency for optimal patient selection.

IntroductionCurrent literature suggests various predictors related to the stone and patient, which could influence stone fragmentation and clearance rates.AimTo establish clinical characteristics of stone disease for patients undergoing extracorporeal shockwave lithotripsy (ESWL) which may predict the success of the procedure.Material and methodsOne hundred and nine patients with renal stone disease diagnosed by non-contrast computed tomography (NCCT) who underwent ESWL between January 2015 and December 2019 were included in the study. Endpoints: patient being stone free (SF) or when < 4 mm fragments were detected. Age, gender, location, skin-to-stone distance, maximum stone length, stone volume, stone surface area, mean stone Hounsfield units (HU) and highest HU score were explored in uni- and multivariate regression analysis.ResultsStone size revealed the highest prognostic power for ESWL failure, where OR for stone volume and stone surface area were 1.06 (1.03–1.10) and 1.04 (1.02–1.06), respectively (all p < 0.01) while a tendency was observed for skin-to-stone distance 1.02 (1.00–1.03). The amount of energy applied during the procedure to one cubic millimeter of stone volume (SMLI/stone volume) was predictive for treatment success (OR = 0.60, 95% CI: 0.41–0.87, p < 0.01). Stone volume (OR = 1.06, 95% CI: 1.00–1.14, p = 0.01) and stone surface area (OR = 1.03, 95% CI: 1.01–1.06, p = 0.02) remained as statistically significant prognostic factors for treatment failure.ConclusionsBoth greater stone volume and stone surface area, as well as lower power delivered per stone volume unit during the ESWL procedure, were found to be significant factors and could be useful to predict treatment failure.

Proposal of Optimal Vasoconstrictive Drugs to Protect Against Extracorporeal Shockwave Lithotripsy Induced Renal Injury

PurposeSince the 1980s, extracorporeal shockwave lithotripsy (ESWL) has been the first‐line therapy for non‐invasive removal of kidney stones. However, in recent years it has become apparent that acute injury and hemorrhage from ESWL can precipitate chronic conditions such as hypertension and diabetes. In 2006, a paper by Willis et al. suggested that pretreating of the kidney with a low energy shockwave before the ESWL procedure decreased lithotripsy induced renal injury in a porcine model. It is proposed that the protective mechanism of pretreatment is due to the renal artery vasoconstrictive effects of ESWL decreasing renal perfusion and therefore mechanical vascular insult.MethodsA literature search was performed from 1985 to 2020 on the effects of various drugs (epinephrine, NSAIDs, adenosine, synthetic human angiotensin II), which were reviewed by available data on strength and duration of effect, as well as side effects that may affect procedure prognosis. Drugs with a rapid onset of action and a half life that did not extend beyond the duration of the procedure were preferred over those with slower effects and longer half‐lives. Finally, drugs were assessed for effects adverse to ESWL, such as anticoagulation and hypertension, which could decrease the procedure prognosis.ResultsThe literature review done in the present search elucidates human synthetic angiotensin II and epinephrine as potential drugs for experimental protective vasoconstriction in EWSL. Both drugs had short half lives between 5 and 30 minutes with limited potential for side effects when administered locally.DiscussionESWL studies measuring the renal protective effects of pretreatment shock wave are currently performed in porcine and human trials. These studies have shown a decrease in renal resistive index, suggesting renal arterial vasoconstriction and decreased renal perfusion as the protective mechanism. The present work suggests pharmacologic agents that could induce similar renal protective effects prior to ESWL treatment. In selecting a drug for ESWL priming, vasoconstrictive drugs were chosen based on speed of onset, duration of effect, and potential side effects. Effect duration was particularly scrutinized as ESWL procedures generally last under 60 minutes, and any vasoconstriction beyond the time course of the procedure may precipitate vascular damage of intrarenal vessels and tubular necrosis, both of which cause decreased GFR. The primary advantage of ESWL pretreatment is in shifting vasoconstriction from after to during the ESWL. This suggests that drug effects may not have to last the entire procedure duration, but rather up to the point that mechanically‐induced vasoconstriction commences. As angiotensin II (15–30 min) and epinephrine (5 min) have short half lives, IV administration of these drugs could be titrated against the genesis of ESWL vasoconstriction.ConclusionThis literature review lays the foundation for further experimentation by proposing angiotensin II and epinephrine as optimal renal protective agents for ESWL.Support or Funding InformationNone

Less painful ESWL with ultrasound-guided quadratus lumborum block: a prospective randomized controlled study

Objectives: Extracorporeal shock wave lithotripsy (ESWL) has been widely used for the treatment of urinary tract stones and is usually administered as an outpatient procedure, although the vast majority of patients do not tolerate it without sedoanalgesia. The quadratus lumborum block (QLB) is a newly-defined technique for abdominal surgery. The aim of this study was to evaluate the analgesic efficacy of ultrasound-guided QLB in ESWL.Materials and methods: Forty patients, aged 18–65, with ASA physical status I–II and scheduled for ESWL were randomly assigned to Group C (control group) and Group QLB (treatment group). Group QLB received single-shot USG-guided transmuscular QLB with 10 ml of 0.5% bupivacaine and 10 ml of 2% lidocaine before a 20-min ESWL procedure. No intervention was performed on Group C. Visual analogue scale (VAS) scores, opioid consumption, patient satisfaction, ESWL and stone details were recorded.Results: VAS scores were significantly lower in Group QLB at all time intervals (p < 0.05). Fentanyl consumption during ESWL was significantly lower in Group QLB than in Group C (p < 0.001). The fragmentation success rate was significantly higher in Group QLB than in Group C (19/20 vs 14/20, respectively, p = 0.046). Patient satisfaction was also higher in Group QLB (p = 0.011).Conclusions: This study shows that QLB provided adequate analgesia for ESWL and that it reduced extra opioid consumption significantly compared to the control group.

THE EFFECTIVITY OF EUTECTIC MIXTURE OF LOCAL ANESTHETICS CREAM AS EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY ADJUVANT ANALGESIA IN SOETOMO GENERAL HOSPITAL

Objective: The Extracorporeal Shockwave Lithotripsy (ESWL) procedure is the first choice for kidney stone therapy with the size ≤20mm. One of the complications of ESWL is the pain. Pain control during ESWL is essential to maintain the focus point of ESWL and give enough time to achieve complete stone fragmentation. Until now there is still no data about the effectiveness of Eutectic Mixture of Local Anesthetics (EMLA) cream as an adjuvant analgesic for ESWL procedure in Soetomo Hospital Surabaya. To compare the onset of pain and ESWL Wong-Baker Pain Scale (WBPS) between the EMLA group and placebo group. Material &amp; Methods: The design of this study was a single-blind randomized control trial comparing the onset of pain and Wong Baker pain scale between the patient in EMLA group and placebo one. WBPS is assessed in minute 15, 30, 45, and 60 of ESWL sessions and 60 minutes post ESWL procedure. The results were analyzed with SPSS. Pain onset and differences of WBPS were tested by using independent T-test if the data is normally distributed and using Mann-Whitney test if the data is not normally distributed. Results: 10 patients were obtained in each group. The mean onset of pain in the EMLA group was longer than the mean onset of pain in the placebo group but statistically not significant (p&gt;0.05). The WBPS in the EMLA group was significantly lower compared with the placebo group in the 30, 45, and 60 minutes of ESWL (p&lt;0.05). Conclusion: EMLA cream application before ESWL was effective and safe as an adjuvant analgesic to reduce pain during ESWL.

Re: Comparison of Ketamine with Midazolam versus Ketamine with Fentanyl for Pediatric Extracorporeal Shock Wave Lithotripsy Procedure: A Randomized Controlled Study.

Re: Comparison of Ketamine with Midazolam versus Ketamine with Fentanyl for Pediatric Extracorporeal Shock Wave Lithotripsy Procedure: A Randomized Controlled Study.

A large series of extracorporeal shockwave lithotripsy in the very elderly.

Background:The incidence of urinary lithiasis has been increasing in recent decades at all ages, including the elderly. In parallel, the world population is aging and there is a paucity of data on treatment of urinary stones in very elderly people. Our main objective was to evaluate the effects of extracorporeal shockwave lithotripsy (ESWL) in patients older than 75 years, and the characteristics of this population. Complications and mortality rates after this procedure in octogenarians were also described.Methods:We retrospectively evaluated very elderly patients who underwent ESWL at our institution from 1998 to 2015, through chart review, telephone interviews, and consultation with the municipal mortality information program. Measured outcomes included demographic and clinical data, ESWL characteristics and complications, interval between ESWL and death, and cause of death.Results:Demographic and treatment characteristics were similar between very elderly and younger patients who underwent ESWL during the same period. No severe complications occurred among older patients. Octogenarians treated in our cohort had a significant life expectancy when ESWL procedures were performed. Even though 38.9% of the patients passed away during the studied period, mortality occurred on average 4.38 years after the ESWL session.Conclusions:In conclusion, ESWL has been used by urologists as a first-line treatment for uncomplicated urinary calculi in very elderly patients. Despite changes associated with aging, and the high prevalence of comorbidities, this procedure seems to be safe and well tolerated in elderly people.

Evaluation of the Efficacy of Canephron® N Herbal Medicine in the Complex Treatment of Urolithiasis Patients Using Remote Shock-wave Lithotripsy

The study objective was to analyse the effect of the herbal drug Canephron N, namely, its ability to potentiate the efficacy of extracorporeal shock wave lithotripsy (ESWL) in the treatment of patients with urolithiasis (UL) and prevent recurrence of stone formation.Aim. To сheck the hypothesis that treatment with Canephron N can potentiate lithotripsy and reduce the risk of re-stone formation.Methodology. Patients at the age of 18 to 65 years had calcium oxalate urolithiasis with the size of the stone from 0.8 to1.3 cm in the kidneys and from 0.5 to0.9 cm. in ureters who underwent ESWL procedure. They were randomized into 2 equal groups of 30 people. The treatment group received general recommendations on the management of the patient with UL following ESWL and the herbal drug Canephron N for 6 months. The control group received only general recommendations. Moreover, according to condition, both groups received painkillers and spasmolytics if pain occurred during elimination of fragments. The following parameters were evaluated: the period of elimination of fragments after stone disintegration by ESWL method; the percentage of complete elimination of fragments; the presence of pain syndrome and leukocyturia in the postoperative period; the rate of recurrence of stone formation during one year after the procedure.Results. More complete and rapid elimination of fragments was observed in the treatment group. Thus, up to day 14 elimination of stone fragments was observed in 96.6 % of patients in the treatment group versus 76.6 % in the control group. Fewer cases of pain syndrome during elimination of stone fragments (23 % in the treatment group and 43 % in the control group) and rare cases of leukocyturia within 14 days (10 % versus 23 %, respectively) were observed in the treatment group. Recurrent stone formation within the year was not observed in patients of the treatment group, in the control group – in 23 % of patients. However, because of the small size of the groups, one may talk about a tendency but not about statistically significant patterns.Conclusion. Canephron N is an effective and safe drug in the treatment of patients with urolithiasis who underwent extracorporeal shock wave lithotripsy. Its use contributes to more rapid and safe elimination of fragments of destructed calculi and reduces risk of recurrent stone formation.

EFFICACY EVALUATION OF THE PHYTOTHERAPEUTIC DRUG CANEPHRON N IN THE COMPLEX TREATMENT OF PATIENTS WITH UROLITHIASIS USING EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY

The study objective was to analyse the effect of the herbal drug Canephron N, namely, its ability to potentiate the efficacy of extracorporeal shock wave lithotripsy (ESWL) in the treatment of patients with urolithiasis (UL) and prevent recurrence of stone formation. Aim. To сheck the hypothesis that treatment with Canephron N can potentiate lithotripsy and reduce the risk of re-stone formation. Methodology. Patients at the age of 18 to 65 years had calcium oxalate urolithiasis with the size of the stone from 0.8 to 1.3 cm in the kidneys and from 0.5 to 0.9 cm. in ureters who underwent ESWL procedure. They were randomized into 2 equal groups of 30 people. The treatment group received general recommendations on the management of the patient with UL following ESWL and the herbal drug Canephron N for 6 months. The control group received only general recommendations. Moreover, according to condition, both groups received painkillers and spasmolytics if pain occurred during elimination of fragments. The following parameters were evaluated: the period of elimination of fragments after stone disintegration by ESWL method; the percentage of complete elimination of fragments; the presence of pain syndrome and leukocyturia in the postoperative period; the rate of recurrence of stone formation during one year after the procedure. Results. More complete and rapid elimination of fragments was observed in the treatment group. Thus, up to day 14 elimination of stone fragments was observed in 96.6 % of patients in the treatment group versus 76.6 % in the control group. Fewer cases of pain syndrome during elimination of stone fragments (23 % in the treatment group and 43 % in the control group) and rare cases of leukocyturia within 14 days (10 % versus 23 %, respectively) were observed in the treatment group. Recurrent stone formation within the year was not observed in patients of the treatment group, in the control group – in 23 % of patients. However, because of the small size of the groups, one may talk about a tendency but not about statistically significant patterns. Conclusion. Canephron N is an effective and safe drug in the treatment of patients with urolithiasis who underwent extracorporeal shock wave lithotripsy. Its use contributes to more rapid and safe elimination of fragments of destructed calculi and reduces risk of recurrent stone formation.

Extracorporeal shock wave lithotripsy for pancreatic duct stones: an observational study

Introduction: Previous studies suggest that fragmentation of pancreatic duct stones (PDS) using extracorporeal shock wave lithotripsy (ESWL) is associated with pain relief. However, the treatment may not be effective in certain subgroups.Aim: To evaluate predictors of pain relief after ESWL in patients with chronic pancreatitis and PDS.Methods: Retrospective study including patients with chronic pancreatitis undergoing ESWL for painful PDS. Analgesic use before and after the ESWL procedure was registered. We defined adequate pain relief after ESWL as ‘pain-free without analgesics or with use of weak analgesics as needed’. The study was approved by the Danish Data Protection Agency (approval number: AHH-2017-048).Results: We included 81 patients (median age 58 years; 63% men; 68% alcoholic pancreatitis). Patients underwent one to seven ESWL procedures (mean 1.7). A concurrent ERCP was performed in 17%. All patients used analgesics before the ESWL procedure (68 used opioids). After ESWL, 43 still used opioids. Thirty-two patients achieved adequate pain relief. Univariable regression analysis showed that older age predicted adequate pain relief (OR 1.09;1.03–1.16; p = .002) as did location of the stone in the head or neck (OR 2.59;1.04–6.45; p = .041). In multivariable analysis, we found that the only two predictors of adequate pain relief were age (p = .002) and the location of the stones (p = .039).Conclusion: After the ESWL, about four out of ten patients are pain-free without medication or able to manage their pain with weak analgesics. Age and the location of the stones may be considered when evaluating if patients are eligible for referral to ESWL.

Early complications of extracorporeal shockwave lithotripsy in the records of the Department of Paediatrics, Nephrology and Allergology of the Military Institute of Medicine - preliminary results.

The aim of the study was to analyse the frequency and type of early complications of extracorporeal shock wave lithotripsy (ESWL) and to assess the safety of the procedure among paediatric patients. The study is a retrospective analysis of all ESWL procedures carried out due to urolithiasis in 2009-2015 in the Department of Paediatrics, Nephrology and Allergology of the Military Institute of Medicine. Medical records of 170 children were analysed: 94 girls (55.3%) and 76 boys (44.7%) aged 1 to 18 years. Out of the 272 procedures performed, 247 were included in the study. Among 233 effective ESWL treatments, complications were noted in 35 (15.02%) procedures: among 10 girls (40%) and 15 boys (60%). In 25 cases (10.73%) surgical intervention was necessary due to urinary obstruction caused by a fragment of a disintegrated stone. Urinary tract infection was present among 3 patients (1.29%) who required surgical treatment. Nonsurgical complications included 7 urinary tract infections (3%) and 3 cases of severe abdominal pain (1.29%). Complications such as perirenal haematoma, subcapsular haematoma or ureteral perforation were not observed. The vast majority of complications observed in the study were associated with urinary obstruction caused by partial blockage of the ureter with kidney stone fragments (“steinstrasse”). Despite the complications that were documented, ESWL should be considered a safe procedure.