Extracorporeal Shock Wave Lithotripsy Research Articles

Radial extracorporeal shock wave therapy for the management of spasticity in cerebral palsy: study protocol for a randomized controlled trial.

Spasticity is the most common motor disorder in cerebral palsy (CP), and its management is complex, posing a significant challenge for the rehabilitation team. Radial extracorporeal shock wave therapy (rESWT) has emerged in recent years as an effective, non-invasive, and low-risk alternative for the management of spasticity in CP patients, with only minor side effects such as small bruises or discomfort during application. There is great variability in rESWT administration protocols, ranging from a single session up to the 12 sessions. The most extensively studied protocol involves 3 rESWT sessions with a one-week interval between session. According to current literature, the effect of rESWT has not been investigated by extending the time interval between sessions beyond 1 week to determine if therapeutic effects on spasticity can be prolonged over time. Following a power calculation using the minimal clinical important difference of our primary outcome (R2 of Modified Tardieu Scale), 72 patients will be included in the study. Enrolment is based upon inclusion/exclusion criteria outlined in the Methods section. Participants will be randomized in 3 groups. Each patient will receive 2000 impulses in the Triceps Sural muscle (distributed by all the plantar flexor muscles: soleus and gastrocnemius), at a 2.2 Bars pressure and a frequency of 8 Hz. The Control Group will receive 3 rESWT sessions with a time interval of 1 week between each session. The Experimental Group A will receive 3 rESTW sessions with a time interval of 2 weeks between each session and the Experimental Group B will receive 3 rESTW sessions with a time interval of 4 weeks between each session. This study will provide further information regarding the effect of rESWT on spasticity in patients with CP. If an increase in the time interval between rESWT sessions allows for the prolongation of therapeutic benefits on spasticity, it will be clinically relevant fact. With the same treatment dosage, patients will be able to benefit from its effects for a longer period of time. ClinicalTrials.gov, identifier NCT05702606.

Recurrent Urinary Stone Formers: Imaging Assessment and Endoscopic Treatment Strategies: A Systematic Search and Review.

Background/Objectives: Nephrolithiasis is a heterogeneous disease with a high prevalence and recurrence rate. Although there has been much progress regarding the surgical treatment of stones, a standardized follow-up, especially in recurrent stone formers (SFs), has yet to be decided. This fact leads to the overuse of computed tomography (CT) scans and many reoperations in patients, thus increasing their morbidity and the financial burden on the health systems. This review systematically searched the literature for original articles regarding imaging strategies and endoscopic treatment for patients with recurrent urolithiasis, aiming to identify optimal strategies to deal with these patients. Methods: We systematically searched the Medline database (accessed on 1 April 2024) for articles regarding imaging modalities and endoscopic treatment for patients with recurrent urinary tract lithiasis. Results: No specific follow-up or endoscopic treatment strategy exists for patients with recurrent urolithiasis. CT scan was the imaging modality most used in the studies, followed by X-ray, ultrasonography, and digital tomosynthesis. A transparent algorithm could not be identified. Percutaneous nephrolithotomy (PCNL), retrograde intrarenal surgery (RIRS), and ureteroscopy (URS) were used in the studies for endoscopic treatment. PCNL showed the best stone-free (SFr) rate and lowest hazard ratio (HR) for reoperation. RIRS showed superiority over extracorporeal shockwave lithotripsy for recurrent SFs, but fragments over 4 mm increased the recurrent rate. URS has an increased HR for reoperation for bilateral stones. Conclusions: The heterogeneity of urolithiasis leaves urologists without a standardized plan for recurrent SFs. Thus, each patient's follow-up should be planned individually and holistically. Pre-stenting is not to be avoided, especially in high-risk patients, and SFr status needs to be the aim. Finally, CT scans should not be generally overused but should be part of a patient's treatment plan. Prospective studies are required to define SFr status, the size of significant residual fragments, and the modalities of intervention and follow-up.

Multimodal treatments based on Tadalafil during acute phase of Peyronie's disease: experience at two referral academic centers.

The purpose of this study is to identify the clinical outcomes of patients during acute phase of Peyronie's disease (PD) treated with daily Tadalafil 5mg associated with non-surgical treatments such as intra-plaque verapamil injections (IVI), vacuum erection devices (VED) or extra corporeal shockwave therapy (ESWT). 445 patients with PD in acute stage were treated as it follows: Group 1(G1) 117 men with only Tadalafil 5mg once a day for 3months; Group 2(G2) 106 men with IVI plus Tadalafil 5mg for a period of 12weeks; Group 3(G3) 124 men that received ESWT for 6weeks plus Tadalafil with the same protocol of G1; Group 4(G4) 98 men with VED plus Tadalafil 5mg for 3months. There were assessed at baseline and follow-up: Erectile dysfunction (ED), presence and severity of painful erections, penile plaque size and penile curvature degree. The results were evaluated at baseline and 3,6,12months. Not statistically significant differences emerged between the two groups at baseline, except for higher presence of patients with ED in in G3(7.4%) vs other groups(p < 0.001). Three months after the treatment in G3 men had a significant reduction of penile curvature degrees after 1year by treatments, whereas pain in an erection or during intercourse was resolved completely in 75% of the patients. Our study highlights that multimodal therapy has beneficial long-term effects not only in the decrease of ED symptoms, but also in the relief of the penile curvature and the quality of life.

Effects of radial extracorporeal shock wave therapy on flexor spasticity of the upper limb in post-stroke patients: A randomized controlled trial

Objective This study aimed to assess the efficacy of radial extracorporeal shock wave therapy in treating upper limb spasticity after a stroke. Design Randomized controlled trial. Setting Zhujiang Hospital of Southern Medical University. Subjects This study included 95 people with stroke. Intervention The active (n = 47) and sham-placebo (n = 48) radial extracorporeal shockwave therapy groups received three treatment sessions (every third day). Main measures The Modified Ashworth Scale, Hmax/Mmax ratio, root mean square, co-contraction ratio, mechanical parameters of the muscle and temperature were measured at baseline and days 2, 5 and 8. Results Among the 135 potential participants screened, 100 were enrolled and allocated randomly, with 95 participants ultimately being included in the intent-to-treat analysis dataset. The active group showed significantly better improvements in upper limb spasticity and muscle function than did the sham-placebo group. Greater improvements in the Modified Ashworth Scale were observed in the active group than in the sham-placebo group (difference, −0.45; 95% CI, −0.69 to −0.22; P < 0.001). Moreover, significant differences in root mean square, co-contraction ratio and Hmax/Mmax ratio were observed between the two groups (all P < 0.001). The mechanical parameters of the biceps muscle were significantly better in the active group than in the sham-placebo group (P < 0.001). The active group had a higher temperature than the sham-placebo group, although the difference was not significant (P = 0.070). Conclusions This study revealed that the treatment with extracorporeal shockwave therapy can relieve upper limb spasticity in people with stroke.

Dent's Disease: A Cause of Monogenic Kidney Stones and Nephrocalcinosis.

Kidney stones are becoming increasingly common, affecting up to 10% of adults. A small percentage are of monogenic origin, such as Dent's disease (DD). DD is a syndrome that causes low-molecular-weight proteinuria, hypercalciuria, nephrolithiasis, and nephrocalcinosis. It is X-linked, and most patients have mutations in the CLCN5 gene. We performed a review of the literature and evaluated the case series (n = 6) of a single center in Spain, reviewing the natural evolution of kidney stones, clinical implications, laboratory analyses, radiological development, and treatment. All patients had a genetically confirmed diagnosis, with the CLCN5 mutation being the most frequent (66%). All patients had proteinuria and albuminuria, while only two and three presented hypercalciuria and phosphate abnormalities, respectively. Only one patient did not develop lithiasis, with most (60%) requiring extracorporeal shock wave lithotripsy or surgery during follow-up. Most of the patients are under nephrological follow-up, and two have either received a renal transplant or are awaiting one. The management of these patients is similar to that with lithiasis of non-monogenic origin, with the difference that early genetic diagnosis can help avoid unnecessary treatments, genetic counseling can be provided, and some monogenic kidney stones may benefit from targeted treatments.

Commentary on: Preliminary study: efficacy of focused shockwave therapy in patients with moderate-to-severe carpal tunnel syndrome.

Commentary on: Preliminary study: efficacy of focused shockwave therapy in patients with moderate-to-severe carpal tunnel syndrome.

Revolutionizing Urolithiasis Management: A Paradigm Shift through Nutraceutical Interventions, Fluid Therapy and pH Maintenance - A Comprehensive Review

Urolithiasis is characterized by the formation of mineral stones within the urinary tract, is a significant global health concern impacting millions worldwide. This review article examines the multifaceted nature of urolithiasis, encompassing its epidemiology, etiology, diagnosis, and management strategies. Key factors influencing stone formation include biochemical changes, dietary habits, hydration levels, genetic predispositions, and environmental factors. Diagnostic imaging methods such as ultrasonography and computed tomography aids in accurate diagnosis, while treatment options range from extracorporeal shock wave lithotripsy to dietary modifications and fluid therapy. Nutraceuticals, particularly phytoconstituents rich in polyphenols and alkaloids, offer promising avenues for managing urolithiasis by inhibiting crystal formation and supporting kidney function. Moreover, optimizing fluid intake and maintaining urinary pH levels play pivotal role in preventing stone recurrence. Prospects lie in the refinement of nutraceutical formulations, the integration of wearable technology for monitoring, and comprehensive clinical investigations to establish safety and efficacy. Ultimately, this review underscores the importance of holistic approaches to mitigating the burden of urolithiasis and improving patient outcomes. Keywords: Extracorporeal Shock Wave Lithotripsy, Epidemiology, Fluid Therapy, Nutraceuticals, Urolithiasis.

Extracorporeal shockwave therapy in treatment of chronic prostatitis/chronic pelvic pain syndrome: Systematic review and meta-analyses.

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) prevalence varies from 8.4% to 25% of the male population and is associated with diminished health-related quality of life. Managing CP/CPPS remains challenging and there is not any common option to treat all patients effectively because of the complex disease nature. The currently available data for the extracorporeal shockwave therapy (eSWT) effect on pain relief and well-being were analyzed in the present study. We adhered to PRISMA 2022 guidelines for reporting the quantitative and qualitative data synthesis. A literature search was conducted in March 2023 using PubMed/Medline, Scopus, and Google Scholar. Randomized prospective studies of eSWT alone or eSWT plus conventional medicinal treatment were included. The risk of bias was estimated using the RoB 2.0. Primary outcomes were self-reported scores, including the NIH-CPSI questionnaire and VAS, at 1 month or 2, 3, and 6, months follow-up. The CP/CPPS patients who receive eSWT have more pronounced pain relief and improvement of other subjective NIH-CPSI scores compared with control groups that received placebo or medication therapy. The effect of eSWT seems to be long-lasting and was confirmed in the 6-month follow-up (p < 0.01). Based on the meta-analysis of accessible studies, we receive the equivalence eSWT applicability for the CP/CPPS treatment and can be offered to patients because of its noninvasiveness, high level of safety, and successful clinical results demonstrated in this analysis.

ESWL EFFICACY FOR VARIOUS DENSITY STONES (HU) ON PLAIN CT SCAN

Extracorporeal Shock Wave Lithotripsy (ESWL) is a keystone in the harmless management of urinary tract stones, offering a viable alternative to surgical mediation for patients pained by urolithiasis. Objectives: The study aims to find the ESWL efficacy for various density stones (HU) on plain CT scans. Methods: This observational study was conducted at CMH Lahore from February 17, 2024, to May 16, 2024. Data were collected from 180 patients suffering from renal stones. Males represented 60% (108 patients), while females 40% (72 patients). Predominantly, stones were located in the renal pelvis (45%), followed by the upper ureter (30%) and lower ureter (25%). The mean stone size was 10 mm, ranging from 5 to 20 mm, with a corresponding mean stone density of 900 Hounsfield Units (HU) as measured on Plain CT Scan. Results: Data were collected from 180 patients. The mean age of the patients was 50.98±2.34 years. There were 60% male and 40% female patients. According to stone location, 45% are located at the renal pelvis, 30 at the upper ureter and 25% at the lower ureter. A mean reduction in the stone size of 65% post-treatment underscores the procedure's ability to facilitate stone disintegration. Stone-free rates varied based on stone density, with higher rates observed for stones with lower densities: 85% for stones ≤ 700 HU, 75% for stones &gt; 700 HU and ≤ 1000 HU, and 65% for stones &gt; 1000 HU. Conclusion: It is concluded that an accurate assessment of stone density and ESWL score is vital in directing treatment decisions and upgrading outcomes for patients going through ESWL for urinary stones. These findings highlight the importance of personalised treatment approaches and the potential of the ESWL score as an essential tool in clinical practice.

Safety and efficacy of extracorporeal shockwave therapy on chronic prostatitis/chronic pelvic pain syndrome: a prospective, randomized, double-blind, placebo-controlled study

PurposeThis study aimed to investigate the efficacy and safety of extracorporeal shock wave therapy (ESWT) over an 8-week period in individuals diagnosed with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) compared to a control group. Materials and methodsThis prospective, double-blind, placebo-controlled study enrolled 46 participants diagnosed with CP/CPPS, who were randomly assigned to either the treatment group or the control group in a 2:1 ratio. In the treatment group, ESWT was administered at the perineum once a week for 8 weeks. CP/CPPS-related symptoms were assessed using the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH–CPSI). Pain and erectile function were measured using the Visual Analogue Scale (VAS) and the International Index of Erectile Function-Erectile Function (IIEF-EF). ResultsThe primary efficacy assessment variable, the change in NIH–CPSI total score at 4 weeks after the end of the 8-week treatment compared to baseline, was significantly improved (P = 0.0225) in the treatment group (−11.27 ± 8.39) compared to the control group (−5.44 ± 5.73). Regarding the secondary efficacy assessment variables, the treatment group showed significant decreases compared to the control group in change in NIH–CPSI total score (P = 0.0055) at the end of the 8-week treatment compared to baseline, along with significant decreases in pain and quality of life scores, as well as VAS assessments at the end of the 8-week treatment and 4 weeks after the end of treatment (P < 0.05). Moreover, in the evaluation conducted to assess improvement in sexual function, the treatment group showed a significant increase compared to baseline than the control group in the IIEF total score at 4 weeks after the end of the treatment (P = 0.0364). No patients experienced severe side effects related to ESWT during the therapeutic period or the follow-up duration. ConclusionsThe efficacy assessment in this clinical trial indicates that extracorporeal shock wave therapy is expected to have a symptomic improvement effect on CP/CPPS.

Extracorporeal Shock-Wave Lithotripsy and Endoscopy for the Treatment of Pain in Chronic Pancreatitis : A Sham-Controlled, Randomized Trial.

No randomized controlled trials have substantiated endoscopic decompression of the pancreatic duct in patients with painful chronic pancreatitis. To investigate the pain-relieving effect of pancreatic duct decompression in patients with chronic pancreatitis and intraductal stones. 24-week, parallel-group, randomized controlled trial (ClinicalTrials.gov: NCT03966781). Asian Institute of Gastroenterology in India from February 2021 to July 2022. 106 patients with chronic pancreatitis. Combined extracorporeal shock-wave lithotripsy (ESWL) and endoscopic retrograde pancreatography (ERP) compared with sham procedures. The primary end point was pain relief on a 0- to 10-point visual analog scale (VAS) at 12 weeks. Secondary outcomes were assessed after 12 and 24 weeks and included 30% pain relief, opioid use, pain-free days, questionaries, and complications to interventions. 52 patients in the ESWL/ERP group and 54 in the sham group were included. At 12 weeks, the ESWL/ERP group showed better pain relief compared with the sham group (mean difference in change, -0.7 [95% CI, -1.3 to 0] on the VAS; P = 0.039). The difference between groups was not sustained at the 24-week follow-up, and no differences were seen for 30% pain relief at 12- or 24-week follow-up. The number of pain-free days was increased (median difference, 16.2 days [CI, 3.9 to 28.5 days]), and the number of days using opioids was reduced (median difference, -5.4 days [CI, -9.9 to -0.9 days]) in the ESWL/ERP group compared with the sham group at 12-week follow-up. Safety outcomes were similar between groups. Single-center study and limited duration of follow-up. In patients with chronic pancreatitis and intraductal stones, ESWL with ERP provided modest short-term pain relief. Asian Institute of Gastroenterology and Aalborg University Hospital.

Staying in the Game: Interventions for Managing Achilles Tendinopathy in the In-Season Athlete.

Achilles tendinopathy is a common overuse injury that is traditionally managed with activity modification and a progressive eccentric strengthening program. This narrative review describes the available evidence for adjunctive procedural interventions in the management of midportion and insertional AT, specifically in the athletic population. Safety and efficacy data from available literature on extracorporeal shockwave therapy, platelet-rich plasma, high-volume injectate with or without tendon scraping, and percutaneous needle tenotomy are used to propose an algorithm for treatment of Achilles tendinopathy for the in-season athlete.

Efficacy of music therapy for pain control of extracorporeal shock wave lithotripsy: A meta-analysis of randomized controlled studies.

Music therapy may have some potential in the pain control of extracorporeal shock wave lithotripsy, and this meta-analysis aims to study the analgesic efficacy of music therapy for extracorporeal shock wave lithotripsy. We have searched several databases including PubMed, EMbase, Web of Science, EBSCO and Cochrane Library databases, and selected the randomized controlled trials (RCTs) comparing the efficacy of music therapy for pain control of extracorporeal shock wave lithotripsy. This meta-analysis was conducted using the random-effect or fixed-effect model based on the heterogeneity. Ten RCTs and 879 patients were included in this meta-analysis. Compared with routine care for extracorporeal shockwave lithotripsy, music therapy was associated with substantially reduced pain scores (standard mean difference [SMD] = -1.00; 95% CI = -1.57 to -0.42; P = .0007), improved patient satisfaction (SMD = 1.61; 95% CI = 0.45 to 2.77; P = .006) and willingness to repeat (SMD = 2.06; 95% CI = 0.40 to 3.72; P = .01), but had no influence on analgesic consumption (SMD = -3.11; 95% CI = -7.07 to 0.85; P = .12) or adverse events (OR = 1.66; 95% CI = 0.20 to 14.10; P = .64). Music therapy was effective to control the pain of extracorporeal shock wave lithotripsy.

Assessment of the nephroprotective efficacy of steroid therapy by analyzing concentrations of new markers of the renal damage at the extracorporeal remote shock wave lithotripsy in children

Assessment of the nephroprotective efficacy of steroid therapy by analyzing concentrations of new markers of the renal damage at the extracorporeal remote shock wave lithotripsy in children

Bibliometric Analysis of Extracorporeal Shock Wave Lithotripsy Research from 1991 to 2013

Bibliometric Analysis of Extracorporeal Shock Wave Lithotripsy Research from 1991 to 2013

Prospective Evaluation of Extracorporeal Shockwave Lithotripsy in Renal and Upper Ureteric Stone Treatment: Clinical Assessment and Results.

Extracorporeal shockwave lithotripsy (ESWL) is a widely accepted non-invasive treatment for renal and upper ureteric stones smaller than 2 cm due to its safety and efficacy. Despite advancements in minimally invasive techniques, extracorporeal shockwave lithotripsy remains an important modality. This prospective observational study aimed to evaluate the outcomes of ESWLin managing renal and upper ureteric stones measuring less than 2 cm in terms of stone clearance. In a study conducted at a university-affiliated tertiary care hospital, 119 patients with renal and upper ureteric stones underwent extracorporeal shockwave lithotripsy over a 12-month period. Data on patient demographics, stone characteristics, treatment procedures, and complications were collected. Follow-up assessments were performed at two-week intervals for up to two months post-treatment. The mean age of patients was 39.78 years, with a mean stone size of 1.2 cm. Right kidney stones were more prevalent (61.3% [n=76]). Complications included fever (19.3% [n=23]), gross haematuria (24.3% [n=29]), and steinstrasse (21.8% [n=26]). The success rate of extracorporeal shockwave lithotripsy was 81.5% (n=97), with 18.5% (n=22) of patients requiring surgical intervention due to incomplete fragmentation or residual fragments >4 mm. Stone size and density played significant roles in treatment success. Despite advancements in minimally invasive techniques, ESWLretains its significance as a noninvasive and effective treatment option for renal and upper ureteric stones smaller than 2 cm. Its success depends on various factors, including the stone site, size, and composition. ESWL offers advantages such as minimal morbidity, shorter hospital stays, and better patient compliance. Complications such as steinstrasse are manageable with conservative measures or ancillary procedures. While ESWL may be losing ground in some cases, its noninvasive nature and favourable outcomes make it a valuable option in the armamentarium for stone management.

Predictive Prognostic Factors in Non-Calcific Supraspinatus Tendinopathy Treated with Focused Extracorporeal Shock Wave Therapy: An Artificial Neural Network Approach.

The supraspinatus tendon is one of the most involved tendons in the development of shoulder pain. Extracorporeal shockwave therapy (ESWT) has been recognized as a valid and safe treatment. Sometimes the symptoms cannot be relieved, or a relapse develops, affecting the patient's quality of life. Therefore, a prediction protocol could be a powerful tool aiding our clinical decisions. An artificial neural network was run, in particular a multilayer perceptron model incorporating input information such as the VAS and Constant-Murley score, administered at T0 and at T1 after six months. It showed a model sensitivity of 80.7%, and the area under the ROC curve was 0.701, which demonstrates good discrimination. The aim of our study was to identify predictive factors for minimal clinically successful therapy (MCST), defined as a reduction of ≥40% in VAS score at T1 following ESWT for chronic non-calcific supraspinatus tendinopathy (SNCCT). From the male gender, we expect greater and more frequent clinical success. The more severe the patient's initial condition, the greater the possibility that clinical success will decrease. The Constant and Murley score, Roles and Maudsley score, and VAS are not just evaluation tools to verify an improvement; they are also prognostic factors to be taken into consideration in the assessment of achieving clinical success. Due to the lower clinical improvement observed in older patients and those with worse clinical and functional scales, it would be preferable to also provide these patients with the possibility of combined treatments. The ANN predictive model is reasonable and accurate in studying the influence of prognostic factors and achieving clinical success in patients with chronic non-calcific tendinopathy of the supraspinatus treated with ESWT.

Clinical efficacy of mini-percutaneous nephrolithotomy versus retrograde intrarenal surgery for the management of upper urinary tract calculus (1–2.5 cm) in children ≤10 years of age

With improvements in endoscopic surgery, open surgical procedures for urinary system stones have cleared the path for the use of less invasive treatment modalities in patients with pediatric kidney stone disease. Extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), and retrograde intrarenal surgery (RIRS) are among the treatment options available. To prospectively evaluate the outcomes of mini-percutaneous nephrolithotomy and retrograde intrarenal surgery (RIRS) for children ≤10 years of age with upper urinary tract calculus (1-2.5cm). Sixty pediatric patients with single or multiple renal stones (1-2.5cm in diameter) were collected prospectively and equally divided into two groups to undergo RIRS or mini-PCNL. The operative and postoperative outcomes of both groups were analyzed. The groups' mean ages and genders were comparable. The mean stone size for the RIRS group was 1.86cm and 1.69cm for the PCNL group (P=0.449). The PCNL group had statistically longer mean fluoroscopy and hospitalization times. The stone-free rates (SFRs) after a single procedure were 27 (90%) in the PCNL group and 25 (83.33%) in the RIRS group (P=0.706). The UAS was placed in 13 (43.33%) patients in the RIRS group. In the RIRS group, 14 (46.67%) children required preoperative DJ stent application to passively dilate the ureteric orifice. As regard post DJ stenting, 13 (46%) cases applied DJ in the mini PCNL group. major complications were observed in either group. Minor complication (Clavien 1-3) rates were 16.66% and 13.33% for the PCNL and RIRS groups, respectively. There were no differences found between the RIRS and mini-PCNL groups regarding operative time. The mean cost of RIRS was $703.96 and $537.03 for the mini-PCNL. According to the results of this study, mini-PCNL and RIRS are effective procedures for treating renal stones in children up to 2.5cm with comparable success and complication rates. Hospital stay, radiation exposure, and fluoroscopy time are significantly lower in RIRS than in the mini PCNL technique. Although RIRS is effective, a major disadvantage is the greater requirement for JJ stent insertion either before or after the procedure and the consequent need for a second procedure for removal.

COMPARISON OF SUCCESS OF EXTRACORPOREAL LITHOTRIPSY (ESWL) AND LASER URETERORENOSCOPY IN PROXIMAL URETERIC STONES

Managing ureteral stones to achieve complete stone clearance with minimal patient morbidity involves several therapeutic approaches. The commonly used methods include extracorporeal shock wave lithotripsy (ESWL), ureteroscopy (URS), percutaneous nephrolithotripsy, laparoscopic ureterolithotomy, and open ureterolithotomy. However, definitive evidence-based options for managing large proximal ureteral stones are lacking. Objective: To compare extracorporeal shock wave lithotripsy (ESWL) and laser ureterorenoscopy (URS) success rates in treating proximal ureteric stones. Methods: This randomized controlled trial was conducted in the Department of Urology &amp; Renal Transplantation at Bahawal Victoria Hospital, Bahawalpur, from January 1, 2020, to May 31, 2021. One hundred four patients, aged 20 to 60, with single proximal ureteric stones measuring 8-15 mm, were included. Patients with pyonephrosis, sepsis, bleeding disorders, solitary kidney, previous open ureterolithotomy, chronic renal failure, proteinuria, recurrent urinary tract infections, congenital urinary tract obstruction, bladder outflow obstruction, chronic liver disease, or a history of chronic drug usage were excluded. Patients were randomized into two groups: Group A underwent URS lithotripsy with DJ stent placement, while Group B underwent ESWL with DJ stent placement. A single surgeon performed all procedures. Pre-operative antibiotics and analgesics were administered to all patients. Stone clearance was assessed two weeks post-procedure. Statistical analysis was performed using appropriate methods, with a p-value ≤ 0.05 considered significant. Results: The mean age of patients in Group A was 37.52 ± 11.20 years, and in Group B was 36.73 ± 10.57 years. Most patients (75, 72.12%) were between 20 and 40. Out of the 104 patients, 63 (60.58%) were male, and 41 (39.42%) were female, with a male-to-female ratio of 1.7:1. Complete stone clearance was achieved in 44 (84.62%) patients in Group A (URS group) and 30 (57.69%) patients in Group B (ESWL group), with a statistically significant p-value of 0.002. The study concluded that the stone clearance rate after laser ureterorenoscopy (URS) is significantly higher than extracorporeal shock wave lithotripsy (ESWL) for proximal ureteric stones.

Сurrent medical rehabilitation methods for patients after carpal tunnel syndrome surgical treatment: a review

INTRODUCTION. Carpal tunnel syndrome is one of the most common tunnel syndromes types and ranks sixth in the all-occupational diseases’ registry. The high interest in this pathology and its’ postoperative management peculiarities study is due to the disease widespread prevalence, social significance, often unsatisfactory surgical treatment results and a long hand function restoration period. The purpose of this work was to study modern concepts of postoperative rehabilitation of patients with carpal tunnel syndrome. SOURCE SEARCH METHODOLOGY. When preparing the review, open electronic databases of scientific literature were used: PubMed, ClinicalTrials.gov, eLibrary.ru. The search for medical literature data was carried out using the following keywords: “rehabilitation”, “carpal tunnel syndrome”, “carpal tunnel syndrome”, “median nerve”, “compressive neuropathy”. The criteria for inclusion in the analysis of literature sources were: randomized controlled clinical trials, systematic reviews and meta-analyses. Preference was given to publications over the past 5–10 years. DISCUSSION. The article presents the most commonly used techniques in the postoperative management of patients with carpal tunnel syndrome, discusses the mechanisms of their action and prospects for the development of this area. The review discussed the following rehabilitation methods: a wide range of methods of hardware physiotherapy, manual therapy, kinesiotaping, manual lymphatic drainage, as well as the possibilities of physical therapy and robotic mechanotherapy. Despite the high level of development of medicine, the long process of rehabilitation of these patients remains an important problem, while the clinical effectiveness of a wider range of proposed techniques still remains poorly understood. Some of the most promising methods of rehabilitation of patients after surgical treatment for carpal tunnel syndrome are methods of robotic mechanotherapy and extracorporeal shock wave therapy. CONCLUSION. For the effective use of the described techniques as part of the postoperative rehabilitation of patients with carpal tunnel syndrome in clinical practice, further research and study of their long-term effects, as well as comparison of their effectiveness with the aim of the most complete and rapid restoration of the function of the affected hand, is necessary.