Extracorporeal Shock Wave Lithotripsy Treatment Research Articles

Effect of acupressure on pain intensity and physiological indices in patients undergoing extracorporeal shock wave lithotripsy: a randomized double-blind sham-controlled clinical trial

BackgroundDespite the widespread use of extracorporeal shock wave lithotripsy (ESWL) as a treatment for kidney stones, it is essential to apply methods to control pain and improve patient comfort during this procedure. Therefore, this study aimed to investigate the effect of acupressure at the Qiu point on pain intensity and physiological indices in patients undergoing ESWL.MethodsThis randomized, sham-controlled clinical trial was conducted at the Shahid Beheshti Educational-medical Center in Hamadan City (western Iran) from May to August 2023. Seventy-four eligible patients were split into intervention (n = 37) and sham (n = 37) groups. Ten minutes before lithotripsy, the intervention group received acupressure at the Qiu point, while the sham group received touch at a neutral point. The primary outcomes were pain intensity measured by the Visual Analog Scale (VAS) and physiological indices such as blood pressure and heart rate at baseline, 1, 10, 20, 30, 40, and 50 min after the intervention. The secondary outcomes included lithotripsy success and satisfaction with acupressure application.ResultsThe analysis of 70 patients showed no significant differences in the demographic and clinical information of the patients across the two groups before the study (P > 0.05). Generalized estimating equations revealed that the interaction effects of time and group in pain and heart rate were significant at 30 and 40 min (P < 0.05). The results of this analysis for systolic blood pressure revealed a significant interaction at 30 min (P = 0.035). However, no significant interaction effects were found for diastolic blood pressure changes (P > 0.05).ConclusionsAcupressure at the Qiu point positively impacts pain in patients undergoing ESWL treatment and increases their satisfaction. However, these results for physiological indices require further studies. Thus, acupressure can be considered a simple, easy, and effective option for pain management in patients during this procedure.Trial registration[https://en.irct.ir/trial/69117], identifier [IRCT20190524043687N4].

AI prediction of extracorporeal shock wave lithotripsy outcomes for ureteral stones by machine learning-based analysis with a variety of stone and patient characteristics.

We propose an artificial intelligence prediction method for extracorporeal shock wave lithotripsy treatment outcomes by analysis of a wide variety of variables. We retrospectively reviewed the records of 171 patients from between January 2009 and November 2019 that underwent shock wave lithotripsy at Wakayama Medical University, Japan, for ureteral stones shown on preoperative non-contrast computed tomography. This prediction method consisted of stone area extraction, stone analyzing factor extraction from non-contrast computed tomography images, and shock wave lithotripsy treatment result prediction by a non-linear support vector machine for analysis of 15 input and automatic measurement factors. Input factors included patient age, skin-to-stone distance, and maximum ureteral wall thickness, and the automatic measurement factors included 11 non-contrast computed tomography image texture factors in the stone area and stone volume. Permutation feature importance was also applied to the artificial intelligence prediction results to analyze the importance of each factor relating to estimate decision grounds. The prediction performance was evaluated by five-fold cross-validation, it obtained 0.742 of the mean area under the receiver operating characteristic curve. The proposed method is shown by these results to have robust data diversity and effective clinical application. As a result of permutation feature importance, some factors that showed high p-values in the significant difference tests were thought to have a high contribution to the proposed prediction method. Future issues include validation using a larger volume of high-resolution clinical non-contrast computed tomography image data and the application of deep learning.

Extracorporeal shock wave lithotripsy: Prematurely falling out of favour? A 7year retrospective study from an Australian high-volume centre.

The aim of this study is to audit 7years of data with a 3year follow up from a high-volume stone centre performing extracorporeal shock wave lithotripsy (ESWL) to evaluate efficacy in stone clearance compared to existing knowledge and understand reasons for this performance. Patients who received ESWL treatment for renal or proximal ureteric stones at a single centre between January 2012 and January 2019 (to allow minimum 3year follow up) were retrieved. A retrospective analysis was performed cross referencing for stone size, location, treatment and need for further procedures. Ethical approval was granted through Metro North HHS HREC, Queensland, Australia. A total of 1930 patients met inclusion criteria. Fifty-seven percent (n = 1100) underwent left-sided ESWL, compared to 43% (n = 830) on the right. Stone size and location were both statistically significant to treatment outcome. Small stones (<1cm) had an overall clearance rate of 81.9%, medium stones (1-2cm) had a clearance rate of 60.6% and stones (>2cm) had a clearance rate of 31.3%. Small stones in an upper calyx had the highest clearance rate (87.5%, n = 120). Allowing for two procedures, 89% of stones were treated successfully. ESWL remains a legitimate option for the treatment of small and medium sized renal calculi. ESWL stone clearance rates at our centre are higher than published elsewhere and serve as proof to its efficacy. X-ray imaging on the day of the procedure, heavy consultant input and frequent intra-operative imaging are cited as key reasons for success. Further research is warranted to elucidate factors affecting stone clearance rate and to enable more standardised outcomes. Further investment may be required into ESWL provisions in most Australian states and especially in Queensland to enable its continued use in contrast to developing endourological techniques.

Effectiveness of extracorporeal shock wave lithotripsy in urolithiasis patients under 2 years of age.

In this study, we present our extracorporeal shock wave lithotripsy (ESWL) outcomes in urolithiasis patients under the age of two. The procedure was performed with patients < 2 years of age sedated, under anesthesia using ketamine and Dormicum (midazolam), in the supine position. Fragmentation was evaluated by fluoroscopy after the procedure. A total of 74 procedures were performed on 65 kidneys. One patient with bilateral stones had two sessions of ESWL on the right side; three sessions of ESWL were performed in one patient with a unilateral stone, and two sessions were performed in seven patients with unilateral stones. All other patients underwent one session of ESWL. As post-procedural complications, hematuria was observed in 14 patients (12 mild and 2 significant), and vomiting occurred in 1 patient. Ureterorenoscopy was performed in 5 patients, and percutaneous nephrolithotomy in 6 patients due to a failed procedure. As a result, ESWL treatment is effective and has advantages such as a short hospitalization time, good reproducibility, cost-effectiveness, and a low rate of complications. Therefore, we recommend ESWL as the first-line treatment for renal and proximal ureteral stones in infants < 2 years of age.

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 external physical vibration lithecbole in obese patients with lower pole stones

To investigate the efficacy and safety of external physical vibration lithecbole (EPVL) in obese patients with <15 mm lower pole stones following extracorporeal shock wave lithotripsy (ESWL). Two hundred and ninety-nine obese patients with BMI greater than 30 kg/m2 and lower pole stones smaller than 15 mm were prospectively randomized into two groups. While ESWL was the only option in the control group, patients in the treatment group accepted EPVL after receiving ESWL. Imaging tests were used to compare the stone expulsion status on day 1 and the stone-free rates (SFR) on the first, second, and fourth weekends. All 299 obese patients were randomly divided into two groups, with 152 patients assigned to the treatment group and 147 assigned to the control group. EPVL was effective in facilitating the expulsion of stone fragments. The treatment group's stone expulsion rate on the first day following EPVL was significantly greater than the control group's (66.4% vs. 51.7%, p = 0.009). Stone clearance rates in the treatment and control groups were 63.2 and 55.1% at 1 week (p = 0.041), 84.9 and 70.7% at 2 weeks (p = 0.011), and 90.8 and 79.6% at 4 weeks (p = 0.017), respectively. The complications (hematuria, lumbago, and fever) between the groups did not show any significance (p > 0.05). Patients in the treatment group received an average of 5.2 sessions. EPVL is an efficient and secure procedure that facilitates lower pole stone discharge in obese patients following ESWL treatment. To support the aforementioned conclusions, additional large-scale multi-center prospective studies are required.

Automated Measurement of Stone Heterogeneity Index and Variation Coefficient of Stone Density on CT Image

Heterogeneity is a key feature of stone density as Hounsfield Unit (HU) on computer tomography (CT) for extracorporeal shock-wave lithotripsy (ESWL) outcomes predicting in urinary calculi patients. The goal of this study is to develop the modified 2D and 3D automate stone heterogeneity index and variation coefficient of stone density estimation program to predict ESWL treatment. For 2D, the proposed program was selected the largest slice of the stone in the whole input slice and then stone related variables, stone heterogeneity index and variation coefficient of stone density were calculated by using the average HU and the number of voxels of the stone. For these variables, it was also developed 3D automate system by using all slices including the stone. Moreover, the 2D schematic diagram was produced to show the internal structure of stone in order to estimate the compositional heterogeneity of stone. All processes of this study were established without manual process. And then, the result of the proposed study is presented compared with the manual measurements. The described methods can provide to assist the prediction of ESWL treatment success and urinary stone diagnosis.

The Lifetime History of the First Italian Public Extra-Corporeal Shock Wave Lithotripsy (ESWL) Lithotripter as a Mirror of the Evolution of Endourology over the Last Decade

Extracorporeal shockwave lithotripsy (ESWL) is the only non-invasive treatment for kidney stones. It does not require an operating room, anesthesia, or hospital stay. Its role evolved over the years and nowadays ESWL is slowly disappearing from many stone centers and urologic departments. We present the history and the role of ESWL treatment since its birth in 1959 and its development through the following years. We also present details of its application and impact on the first Italian stone center in 1985. ESWL has had different roles over the centuries: in the early years it was a great alternative to open surgery and percutaneous nephrolithotripsy (PCNL), then it had its decline with the introduction of the miniscopes. Currently, although ESWL is not considered a treatment of excellence, newer models are emerging. With the application of new technologies and artificial intelligence, this technique can become a good option alongside endourologic treatments.

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.

Extracorporeal Shock Wave Lithotripsy (ESWL): An Evaluation of Success in Low, Medium and High Stone Density

Objective: To find the frequency of patients of renal calculi with different stone densities and to evaluate the success rate of ESWL treatment in selected groups of patients i.e. low, medium and high stone density. Methodology: In this descriptive case series, at Department of Urology, Services Hospital, Lahore was conducted and enrolled a 100 cases with single, radiopaque renal stone of 1-2 cm (10 to 20 mm), between 15-80 years of either gender whereas those with calculus in nonfunctioning kidney (GFR less than 15 ml/min), calculus in Pyonephrotic kidney, presence of JJ stent and having previous surgery for stone on same side or radiolucent stones were excluded from this study. All sessions of ESWL were performed following departmental protocol. 3 weeks after the ESWL session, the outcome was evaluated by plain X-ray KUB and USG KUB. In this analysis, ESWL success was defined as either total stone clearance or the presence of clinically insignificant residual fragments (CIRFs) (4 mm, peripheral, not producing renal colic, with no infection or extensive hematuria). Results: Stone density was in the range of 335-1900 HU with a mean density of 851.1 (±418) HU. Patients with medium density group (500-1000HU) were significantly greater than other two groups. MDG had frequency of 51% followed by LDG (25%) and HDG (24%). Overall, ESWL success rate was 82% in all the 100 patients of renal calculi. Success rate was greatest in LDG i.e. 100%. MDG had a success rate of 90% and only 45.8% of the patients in HDG had succees after ESWL treatment. Success rate decreased as the stone density increased. Conclusion: the stone density has a significant impact on success of ESWL. NCCT stone characteristics like mean density in HU and demographic characteristics are potential predictors for evaluation of success of ESWL. Keywords: Kidney stones, ESWL, Stone density

Renal stone density on native CT-scan as a predictor of treatment outcomes in shock wave lithotripsy.

Extracorporeal shock wave lithotripsy (ESWL) is considered a standard treatment for nephrolith or kidney stones measuring less than 20 mm. Anatomical, machine-related, and stone factors play pivotal roles in treatment outcomes, the latter being the leading role. This paper examined the relationship between stone density on native CT scans and ESWL treatment to remove renal stones concerning several treatments. One hundred and twenty patients (64 males and 56 females) were enrolled and completed the study from April 2019 to September 2020. Inclusion criteria were a single renal pelvis stone of 5-20 mm to be treated for the first time in adult patients with no urinary or musculoskeletal anatomical abnormalities. We assessed patients' renal function and obtained stone characteristics using a native CT scan. Patients were then scheduled for ESWL by the same machine and operator under fluoroscopy, with two-week intervals between treatment sessions when more than one treatment session was required. Before each new session, a new KUB-US was performed to reevaluate the stone. One hundred and twenty patient records were analyzed, 64 (53.3%) males and 56 (46.7%) females, with a mean age of 38.6 years and a mean stone size of 13.15 mm. Treatment with ESWL cleared stones in 76 (63.3%) patients, while 44 (36.7%) failed the treatment. The mean stone density in patients whose stones were cleared was significantly lower (661 vs. 1001) (P<0.001). Estimating renal calculus (or kidney stone) density on a native CT scan might help prognosticate ESWL treatment outcomes regarding stone clearance rates and the number of sessions required to clear a stone.

Effect of Precision Health Education on Compliance Behavior after Extracorporeal Shock Wave Lithotripsy.

Objective The aim of this study was to investigate the effects of precision health education on patients' compliance behavior and lithotripsy efficacy after extracorporeal shock wave lithotripsy (ESWL). Methods From June 2018 to September 2018, 104 patients with upper urinary tract calculi who underwent ESWL at Anhui No.2 Provincial People's Hospital were randomly divided into two groups. The observation group (n = 53) was given precision health education guidance after ESWL treatment, while the control group (n = 51) was only informed of precautions after lithotripsy. Postoperative compliance behavior, stone expulsion time, and complications were recorded in both groups. Results The clinical baseline data of the two groups were similar in age, gender, number of stones, size of stones, location of stones, complications, number of lithotripsies, and voltage of lithotripsy between the two groups (P > 0.05). However, compared with the control group, the observation group had better compliance behavior of patients. Furthermore, we divided the patients into three groups based on whether they complied with medical advice. Compared with the noncompliance group (n = 17) and the partial compliance group (n = 23), the stone expulsion time in the complete compliance group (n = 64) was significantly shorter. Also, the number of patients with nausea and vomiting, lacrimation, and cold sweat in the complete compliance group was significantly lower than that in the other groups. Conclusion Precision health education for patients treated with ESWL can significantly enhance the compliance behavior of patients, thereby accelerating the expulsion of stones, improving the efficacy and relieving pain. Precision health education and good compliance behavior complement and reinforce each other.

Extracorporeal shock wave lithotripsy for urinary tract stones in pediatric patients: Our 11 years of experience

Background/Aim: Urinary system stone disease creates a significant burden on the health system. Many treatment methods are available, including extracorporeal shock wave lithotripsy (ESWL), endourological procedures, and open and laparoscopic procedures. In recent years, in parallel with technological developments, endourological devices have become more usable in the renal system. For this reason, urologists are opting for endourological procedures more frequently. ESWL is the least invasive procedure for urinary system stone disease, and it has a higher success rate in pediatric patients than in adults. In this retrospective cohort study, we analyzed the data from the pediatric cases in which we used ESWL treatment in our clinic. We aimed to reveal the effectiveness of ESWL and the factors that will increase the success rate of this procedure in light of the current literature. Methods: The files of patients aged 16 years and under who underwent ESWL at the Urology Clinic of University of Health Sciences Sanliurfa Mehmet Akif Inan Training and Research Hospital between January 2010 and December 2021 were retrospectively reviewed. Age, gender, stone area, stone localization, number of sessions, energy and frequency used, complete stone-free status, and secondary intervention requirement were recorded. The absence of stone fragments or the presence of fragments smaller than 3 mm only in imaging after ESWL was considered a success. Results: This study included 433 pediatric patients. The mean age of the patients was calculated as 12.02 (4.67) (range: 1–16) years. The most important factors affecting the number of residual stones were stone localization (P = 0.045) and size (P &lt; 0.001). When stone localization was compared according to patient age, the older patients were found to have a significantly higher rate of stones in the proximal ureter than in the lower calyx of the kidney (P = 0.045) and renal pelvis (P = 0.048). Conclusion: Although there are continual advances in other minimally invasive surgical methods today, ESWL is a treatment method that can be safely applied in pediatric patients. Stone size and stone localization are the two most important factors affecting its success rate.

Complications Post Extracorporeal Shock Wave Lithotripsy: Literature Review Study

Since its introduction in 1980, Extracorporeal Shock Wave Lithotripsy (ESWL) has completely changed how urolithiasis is treated. A recognised, secure and efficient therapeutic alternative to surgical urolithiasis treatment is Electroshock Wave Therapy (ESWL). A tiny percentage of individuals do experience ESWL complications and when they do, the kidney is frequently involved. The important literature on extracorporeal Shock Wave Lithotripsy (SWL) treatment and complications was examined and reviewed in order to pinpoint potential issues following SWL. The development and transit of fragments, infections, effects on renal and non-renal tissues and impacts on kidney function are the main causes of complications after SWL. Each of these risks can be avoided by taking the proper precautions, such as adhering to the contraindications, identifying and treating concurrent disorders or infections and using the SWL in the safest and most effective manner possible while personalising the treatment for each patient. In conclusion, SWL is a successful and largely non-invasive method of treating kidney stones. There are various contraindications and potential consequences, just like with any other sort of therapy, though. The danger of the emergence of others might be significantly reduced by strict adherence to the first; however, this must be completely understood in order to put every preventive step at our disposal into action. Different studies mentioning different cases and statistics related to the complications post ESWL were considered and reviewed for this document.

Music for Health: From Ear to Kidney.

Music for Health: From Ear to Kidney.

Are there any changes in serum renal parameters in patients undergoing ESWL therapy?

Purpose: The goal of this research was to explain the effects of ESWL on renal function (Extracorporeal Shock Wave Lithotripsy). Materials and Methods: This study was carried out retrospectively between November 2019 and October 2020, with 50 adult patients scheduled to perform an ESWL treatment because of a diagnosis of kidney stone and to completed the study protocol. In all of these patients, there was no urogenital abnormality, and none had a solitary kidney. Patients' mean age was 37.2 (between 26 and 67 years of age). Of patients, 31 (62%) were male and 19 (38%) were female. Three ESWL sessions were carried out in the patients and the time between sessions was set at 7 days. The routines collected one day before the ESWL (Routine I) protocol were repeated one day after the first session (Routine II) and one day after the end of all ESWL (Routine III) sessions. Results: There wasn’t any statistically significant difference among routines in terms of the ratio of serum electrolytes, serum creatinine, GFR and spot urine/protein. Conclusion: The findings indicate that the renal function tests do not need to assess whether ESWL leads to a tubular functional dysfunction in patients when treating upper urinary system stone disease. Keywords: Extracorporeal Shock Wave Lithotripsy (ESWL), renal stone, renal function and glomerular filtration rate (GFR)

Robotic Partial Nephrectomy in the Treatment of a Posterior Excluded Caliceal Diverticulum with a Renal Calculus

Clinical History: A 64-year-old woman with a history of nephrolithiasis presented with intermittent severe left flank pain. CT scan showed a 1-cm left renal calculus within the periphery of the kidney. The renal parenchyma eroded around the calculus, suggesting a caliceal diverticulum (CD). Shockwave lithotripsy treatment of stone within the CD was ineffective. Owing to the supracostal location and averse to nephrostomy tube and ureteral stent, the patient opted for a partial nephrectomy (PN). Physical Examination: NAD, AAOx3. Abdomen was soft, nontender, and nondistended. No costovertebral tenderness. Diagnosis: Right CD with kidney stones. Intervention: Robot-assisted laparoscopic right PN with intraoperative ultrasonography was performed. The CD was noted with stones within, and extracted without incident. Warm ischemia time was 15 minutes with excellent hemostasis and repair. There were no intraoperative complications and the patient was stable after the procedure. Follow-Up/Outcomes: Patient had an uncomplicated hospital course and was discharged home on postoperative day 1. Pathology analysis was consistent with an excluded diverticulum with renal calculi. Postoperative noncontrast CT of abdomen/pelvis showed complete treatment of the stone burden and CD. Patient was symptom free at 1-, 3-, 6-, and 12-month follow-up visits and no stones were seen on imaging. Our series of patients includes the aforementioned patient who underwent a retroperitoneal PN and another patient who underwent transperitoneal PN for large upper pole CD. The second patient reported history of recurrent urinary tract infections, which have since resolved. Her 3-month CT was unremarkable and she is symptom free. Both patients were refractory to extracorporeal shockwave lithotripsy treatment done previously. No competing financial interests exist. Author(s) have received and archived patient consent for video recording/publication in advance of video recording of procedure. Runtime of video: 4 mins 59 secs

Factors influencing stone-free rate of Extracorporeal Shock Wave Lithotripsy (ESWL); a cohort study

Objective To evaluate the success rate of Extracorporeal Shock Wave Lithotripsy (ESWL) therapy and identify relevant treatment-specific factors affecting stone-free rate (SFR) after ESWL. Materials and methods All ESWL treatments in the years 2016–2019, in Ängelholm Hospital, Skåne, Sweden were analysed retrospectively. Primary outcome was stone-free rate (SFR) at 3 months. Univariate logistic regression was used followed by multivariable regression. Lasso analysis was made to adjust for treatment-specific factors such as age, stone size, skin-to-stone distance (SSD), stone attenuation, number of treatments, stone location and presence of a urinary stent. Results Factors affecting successful ESWL treatment were lower age (p < 0.001), smaller stone size and volume (both p = 0.001). SSD, stone attenuation, sex, laterality and drainage did not have an effect on SFR in this study. After the first ESWL treatment session, 46.7% of the patients were stone-free. Conclusion Results indicate that stone size and age are the most predictive factors for ESWL outcome. Based on this, we present a simple model for prediction of SFR after ESWL, to be used when counseling patients before ESWL treatment.

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.

Böbrek taşı hastalarda ESWL’ ye bağlı renal hasar üzerine nar suyunun önleyici etkisi

Objective: We aimed to show whether the antioxidant properties of pomegranate juice (PJ) show a protective effect against renal damage associated with oxidative stress caused by Extracorporeal Shock Wave Lithotripsy (ESWL) in patients who have undergone ESWL for kidney stones. Material and Methods: Ninety patients who were to undergo ESWL for kidney stones were included in the study and were divided into 3 groups with 30 patients each ESWL. Group 1 (control group) patients received only ESWL treatment. Group 2 (study group) patients were recommended to take 30 ml/kg/day pomegranate juice mixture orally for 2 days before ESWL. Group 3 (placebo group) patients were recommended to take 30 mg/kg/day water orally for 2 days before ESWL. All ESWL-treated patients received 2000 to 2500 shock waves at 18 to 24 in order to measure lipid peroxidation markers showing the DNA lesion associated with oxidative stress and to show tubular damage after ESWL, Results: There was a statistically significant mean increase of 52.39± 10.49 in 8-Hydroxy deoxyguanosine (8-OHdG) levels after treatment compared to pre-treatment levels in Group 1 (p&lt;0.01). There was a statistically significant mean increase of 13.16±7.71 and 33.24±12.82 in Groups 2 and 3, respectively (p&lt;0.01; p&lt;0.01, respectively) There was a statistically significant mean increase of 19.20±5.21 in N-acetyl-beta-D-glucosaminidase (NAG) levels after treatment compared to pre-treatment levels in Group 1 (p&lt;0.01). There was a statistically significant mean increase of 3.44±5.21 and 13.07±5.50 in Groups 2 and 3, respectively (p&lt;0.01; p&lt;0.01, respectively). Conclusion: Our study concluded that pomegranate juice (PJ) has protective effects against ESWL-related renal damage. Keywords: Antioxidant, kidney stones, lithotripsy, pomegranate juice.