Extracorporeal Shock Wave Lithotripsy In Patients Research Articles

Factors predictive of shockwave lithotripsy failure for ureteral stones: why we need to hurry.

The aims of this study are to evaluate the prognostic factors of extracorporeal shockwave lithotripsy in patients with ureteric stones, and to identify which patients might directly benefit of an endoscopic treatment. We performed a prospective study from January 2013 and July 2016 on patients with single ureteric stone and undergoing extracorporeal shockwave lithotripsy (SWL). We divided patients into two groups: first group (success group) included cases resolved with SWL only, and a second group (failure group) including patients with stone not resolved by SWL and requiring an endoscopic treatment. We evaluated age, weight, height, body mass index, stone size, hydronephrosis, laterality, location, days elapsed from onset of symptoms to SWL and stone density when computed tomography was performed. In case of stone fragments >4 mm, the procedure was repeated up to a maximum of three times. SWL was considered as failed if patients had a residual stone of any size after a follow-up of 3 months or if a complication occurred. 274 patients completed follow-up and were enrolled in the study. Mean age was 53.22 years (standard deviation: 13.98). SWL overall success rate was 84.3% (231 patients successfully treated with shockwaves) and failure rate was 15.7% (43 patients underwent auxiliary endoscopic procedure). At the univariate analysis, we observed a statistically significant difference for hydronephrosis (P=0.006), time elapsed from symptoms onset (P=0.013), patients' age (P=0.06) and mean stone density (0.023). In the multivariate logistic regression, patients' age (OR: 1.517), and time elapsed from obstruction to SWL (OR: 3.005) were independent predictive factors for SWL failure. Furthermore, moderate and severe hydronephrosis seemed to be independent predictive factors for SWL failure, presenting an OR of 2.451 and 4.207 respectively. High stone density resulted to be a predictive factor for SWL failure (OR: 2.293 if density was higher than 1100 Hounsfield Units). We report a large series of patients undergone primary SWL for ureteric stones. Our data demonstrated the role of hydronephrosis, time elapsed from obstruction onset to treatment and stone density as independent predictive factors of SWL failure.

Amikacin as the Most Potent Antibiotic Locally, is it Required Prior to Extracorporeal Shock Wave Lithotripsy (ESWL) in Patients with Double J Stents?

Objective: To assess the efficacy of Amikacin as the anti-biotic of least recorded resistance locally in preventing urinary infective episodes following ESWL (Extracorporeal Shock Wave Lithotripsy) in patients with DJ stents in-situ. Materials and methods: A retrospective review of a cohort of 60 adult patients with upper urinary tract calculi and DJ stent in-situ, who received one dose of Amikacin intravenously immediately before ESWL was carried out. All patients had a documented negative urine culture prior to ESWL. The incidence rate of post ESWL bacteriuria was calculated and compared to the published incidence rates of bacteruria patients who did not receive any prophylaxis. Results: A total number of 60 adult patients with DJ stent in-situ, who received Amikacin prophylaxis, underwent ESWL between the 1st of January 2017 and the 31st of December 2017. All of the 60 patients had a documented negative urine culture pre-ESL. Two patients were found to have positive urine culture post ESWL with an incidence rate of 3.33. This was not statistically different to the published percentage of patients who received no prophylaxis in the compared studies that showed incidence rates of 3.08 and 2.17 respectively (Chi-square=0.704, p=0.703). Conclusion: Intravenous Amikacin prophylaxis was not efficacious in reducing UTI and urinary sepsis following ESWL in patients with DJ stents in-situ, despite being the antibiotic of least resistance locally.

Is extracorporeal shockwave lithotripsy a risk factor for the development of diabetes mellitus? A population-based study.

To determine if patients treated with extracorporeal shockwave lithotripsy (ESWL) are at a greater risk of developing diabetes mellitus (DM) than those treated with ureteroscopy (URS). A retrospective population-based cohort study was performed of all ESWL and URS stone treatments done in Ontario between January 1994 and March 2014, utilising linked encoded healthcare databases. The primary outcome was the development of DM >90days after treatment. TheKaplan-Meier method was used for unadjusted survivalanalysis and multivariable analysis with Cox proportional hazards regression was used to assess the risk of DM between the ESWL and URS groups whilst controlling for age, gender, region of residence, income quintile, year of treatment, and comorbidity index. A sensitivity analysis with a subset of ESWL patients treatedfor left renal or proximal ureteric stones was completed. We identified 106963 patients who underwent ESWL or URS over the study period with a median follow-up of 6.6years (ESWL 8.5years, URS 5.6years). Unadjusted survival analysis showed an increased risk of developing DM in the ESWL group compared to the URS group (P<0.001); however, multivariable analysis showed no increased risk of DM in the ESWL cohort (hazard ratio [HR] 0.97, 95% confidence interval [CI] 0.91-1.02; P=0.25). Similarly, sensitivity analysis showed no increased risk of DM in the left renal/proximal ureteric stone ESWL cohort compared to the URS cohort (HR 1.04, 95% CI 0.96-1.13; P=0.35). Our population-based cohort study demonstrated no increased risk of DM in patients undergoing ESWL compared to URS.

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.

Single extracorporeal shock-wave lithotripsy for proximal ureter stones: Can CT texture analysis technique help predict the therapeutic effect?

PurposeTo explore whether the computed tomography texture analysis (CTTA) technique can help predict the curative effects of a single extracorporeal shock-wave lithotripsy (ESWL) for proximal ureteral stones. Materials and methodsIn all, 100 patients with proximal ureteral stone underwent non-enhanced multi-detector computed tomography (MDCT) before ESWL. The patients were divided into success and failure groups. Success of ESWL was defined as the patients being stone-free or having residual stone fragments of ≤2 mm. Traditional characteristics, such as stone size, body mass index (BMI), and skin-to-stone distance (SSD), and CTTA metrics, such as the mean Hounsfield unit (HU) density, entropy, kurtosis, and skewness, were analyzed and compared between two groups by univariate and multivariate logistic regression analyses. Receiver operating characteristic (ROC) curves were generated to determine Youden index-based cutoff values. ResultFailure of stone removal was observed in 36 patients (36%). Stone height, stone cross-sectional diameter, largest cross-sectional area, stone volume, stone density (mean HU), and CTTA metrics (kurtosis and entropy) were the significant independent predictors of ESWL success on univariate analysis (p < 0.05). On multivariate analysis, mean HU, skewness, and kurtosis were shown to be significant predictors of ESWL success (p < 0.05). In subgroup analysis based on the cutoff value of mean stone density (HU = 857), the only significant independent factor associated with both subgroups was kurtosis (p < 0.05). ConclusionsAs a quantitative analysis method, CTTA may be helpful in selecting appropriate ESWL patients. High kurtosis and low mean HU values simultaneously indicate a relatively higher ESWL success rate.

A systematic review of advanced endoscopy-assisted lithotripsy for retained biliary tract stones: laser, electrohydraulic or extracorporeal shock wave.

When conventional endoscopic treatment of bile duct stones is impossible or fails, advanced endoscopy-assisted lithotripsy can be performed by electrohydraulic lithotripsy (EHL), laser lithotripsy, or extracorporeal shock wave lithotripsy (ESWL). No systematic review has compared efficacy and safety between these techniques. A systematic search was performed in PubMed, the Cochrane Library, and EMBASE for studies investigating EHL, laser lithotripsy, and ESWL in patients with retained biliary tract stones. After screening 795 studies, 32 studies with 1969 patients undergoing EHL (n = 277), laser lithotripsy (n = 426) or ESWL (n = 1266) were included. No randomized studies were available. Although each advanced lithotripsy technique appeared to be highly effective, laser lithotripsy had a higher complete ductal clearance rate (95.1 %) than EHL (88.4 %) and ESWL (84.5 %; P < 0.001). In addition, a higher stone fragmentation rate was reported for laser lithotripsy (92.5 %) than for EHL (75.5 %) and ESWL (89.3 %; P < 0.001). The post-procedural complication rate was significantly higher for patients treated with EHL (13.8 %) than for patients treated with ESWL (8.4 %) or laser lithotripsy (9.6 %; P = 0.04). Data on the recurrence rate of the biliary tract stones were lacking. This systematic review revealed that laser lithotripsy appeared to be the most successful advanced endoscopy-assisted lithotripsy technique for retained biliary tract stones, although randomized studies are lacking.

Prevalence of hypertension and diabetes after exposure to extracorporeal shock-wave lithotripsy in patients with renal calculi: a retrospective non-randomized data analysis

PurposeTo evaluate the association of shock-wave lithotripsy (SWL) for kidney stones and hypertension or diabetes.MethodsPatients with urolithiasis treated by SWL were retrospectively identified. To assess whether shock-wave application to the kidney is associated with long-term adverse effects, patients after SWL for kidney stones were selected as the main group of interest. Patients treated with shock waves for distal ureter stones only were chosen as a comparison group. A questionnaire was sent to all patients to assess the prevalence of hypertension and diabetes. The Swiss Health Survey (SHS) dataset was used as an additional comparison group.ResultsAfter a median follow-up of 13.7 years, the odds ratio (OR) to report hypertension [OR 1.30 (95% CI 1.10–1.95)] or diabetes [OR 1.54 (95% CI 1.21–1.97)] was significantly higher in patients treated with SWL compared to the SHS dataset. In comparison with the kidney group, participants in the SHS had a significantly lower OR to report hypertension at follow-up [OR 0.79 (95% CI 0.65–0.95)], while the OR to report hypertension [1.16 (95% CI 0.79–1.70)] was not significantly different in the distal ureter group. For diabetes, a significantly lower [OR 0.60 (95% CI 0.46–0.78)] in the SHS group and a non-significantly lower [OR 0.68 (95% CI 0.38–1.22)] in the ureter group was noted compared to the kidney group.ConclusionCompared to the SHS data set SWL was in general associated with hypertension and diabetes. However, no clear difference between patients after SWL to the kidney compared to SWL to the distal ureter was seen and thus the data do not support a causal relationship.

STONE FREE RATES OF KIDNEY STONE WAS LOWER THAN THE ONE OF URETER STONE PATIENTS MANAGED BY ESWL AND THE ONE OF URETER STONE MANAGED BY URETEROLITHOTRIPSY

Objective: To evaluate the stone free rates of kidney and ureter stone patients managed by Extracorporeal Shockwave Lithotripsy (ESWL), and the ureter stone free rate managed by ureterolithotripsy. Material &amp; method: We reviewed the medical records of kidney and ureter stone patients managed by ESWL and ureter stone patients managed by ureterolithotripsy in Arifin Achmad Regional General Hospital Pekanbaru Riau Province, Indonesia, from January 2010 - December 2016. ESWL and ureterolithotripsy stone free rates were examined by the control of KUB röngents. Results: There were 891 kidney and ureter stone patients consisting of 325 (36.5%) were kidney stone patients and 566 (63.5%) were ureter stone patients. The pyelum stones were the most (78.2%) in kidney stones and the lower ureter stones were the most (57.2%) in ureter stones. There were more male patients than the female ones in which most of the patients were in the group age of 49-59 years. The amount of patients increased each year. The kidney stone free rate managed by ESWL was lower (71.7%) than ureter stone free rate (84.1%) by ESWL, while the stone free rate of ureter stone patients managed by ureterolithotripsy was 100%. Conclusion: The ESWL stone free rate of the kidney stone patients was lower than the one in ureter stone patients while the ureterolithotripsy stone free rate was 100%.

Antibiotic prophylaxis in the prevention of urinary tract infection in patients with sterile urine before extracorporeal shock wave lithotripsy.

Background:One of the lithotripsy complications is urinary tract infection (UTI) and sepsis after extracorporeal shock wave lithotripsy (ESWL). The aim was to study the prophylactic effect of antibiotics on UTI after ESWL.Methods: This randomized double-blind clinical trial was carried out on 600 patients admitted to Babol Clinic hospital in 2014-2015. Patients were randomly divided into treatment group (receiving 200 mg ofloxacin and control group (receiving placebo. The effect of prophylactic antibiotics on the incidence of bacteriuria after ESWL and the impact of variables such as gender, age, urolithiasis size and location and underlying diseases in the incidence of UTI after ESWL were evaluated.Results:Totally, 67 of the population had positive urine cultures. Twenty-nine (10.13%) of them were in the treatment group (n=286) and 38 (13.01%) of them were in the control group (n=292). All 67 patients had asymptomatic bacteriuria. Escherichia coli and proteus were the grown microorganisms in most samples. The mean age of sample population was 44.8±23, and 67.16% of patients with positive urine culture were older than 45 years.Conclusions:The results indicated that prophylactic antibiotics prior to ESWL in patients with urinary calculi and negative urine culture had no significant decrease in urinary tract infection after lithotripsy. It is better that the use of prophylactic antibiotics is limited to patients with risk factors.

EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY;

Background: Urolithiasis is a common ailment that costs billions of Dollars everyyear. Recurrent urinary tract obstruction or urolithiasis may stimulate the fibrogenic flow, whichis responsible for the definite functional loss of renal parenchyma. In the few past years, themanagement of urinary calculi undertook a remarkable modification. Open surgery for stonesis nearly replaced by minimal or non-invasive operative procedures like ureterorenoscopy,percutaneous nephrolitholapaxy and extracorporeal shock wave lithotripsy (ESWL). StudyDesign: Randomized Controlled Trial. Setting: Department of Urology Services HospitalLahore. Duration of Study: 1st January -30th December 2016. Material and methods: Thecomparative study of 60 cases through Non probability convenient sampling was conducted toevaluate the outcome of ESWL in patients with single lithiasis of lower pole calyx with differentinfundibulopelvic angles as measured on pre-treatment IVU. Results: The mean age of all thepatients was 33.70±10.72 years. Out of 60 Patients 32(53.3%) were males while 28(46.7%)were females with 1.14 male to female ratio. In group A, the mean LIPA was 78.83±4.71o andin group B, was 100.53±5.73o. The overall mean LIPA of the patients was 89.68±12.11o.Stoneclearance was noted in 39 (65%) patients. 15 patients (38.46%) and 24 patients (61.53%) ingroup A and B respectively. p-value=0.015. After ESWL stone clearance was more in patientshaving IPA ≥ 90°as compared to IPA 70-90o. Conclusion: Stone clearance is significantlyhigher with IPA&gt;90o as compared to IPA70-90o.In future now we are able to implement the useof IPA&gt;90o instead of using &lt;90o that is more successful in achieving stone clearance.

Predictive Variables of Success in Extracorporeal Shock Wave Lithotripsy

Introduction: Kidney stone is a prevalent disease, especially in desert and arid areas like Rafsanjan in Iran. Extracorporeal Shock Wave Lithotripsy (ESWL) is a non-invasive treatment of kidney stones that success rate of which depends on various factors. This study aimed at investigating predictive variables of success in ESWL in patients referred to the ESWL Unit of Moradi hospital (Rafsanjan, Kerman, Iran) in 2016.Methods: All patients referred to the ESWL unit in the hospital during a 6-month period in 2016 were included in this study. Demographic information, size, location, and orientation of stones were collected from interviews and sonography observations. Finally, the obtained data was investigated with the statistical Chi-square and logistic regression tests.Results: The male to female ratio in patients with kidney stones was almost 2:1, and the overall estimated rate of lithotripsy was 71.7%. There was no difference between the male and female patients in the success of lithotripsy and, in addition, stone location did not affect the rate of success. The only successful predictor of ESWL was stone size. The larger stones were more successful broken than smaller.Conclusions: Stone size plays an important role in the selection of treatment method. Breaking of larger stones is more successful in ESWL due to the greater absorption of ultrasonic energy emitted by the machine and because of the more accurate determination of their location.

PD30-04 PERIOPERATIVE MANAGEMENT OF LOW-DOSE ASPIRIN IN SURGICAL KIDNEY STONE MANAGEMENT: A SURVEY OF CURRENT ENDOUROLOGIC PRACTICE PATTERNS.

You have accessJournal of UrologyStone Disease: Surgical Therapy III1 Apr 2017PD30-04 PERIOPERATIVE MANAGEMENT OF LOW-DOSE ASPIRIN IN SURGICAL KIDNEY STONE MANAGEMENT: A SURVEY OF CURRENT ENDOUROLOGIC PRACTICE PATTERNS. Joshua Ebel, Brian Eisner, Michael Lipkin, Ben Chew, and Bodo Knudsen Joshua EbelJoshua Ebel More articles by this author , Brian EisnerBrian Eisner More articles by this author , Michael LipkinMichael Lipkin More articles by this author , Ben ChewBen Chew More articles by this author , and Bodo KnudsenBodo Knudsen More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1369AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The recently published American Urological Association guidelines on the surgical management of kidney stones state that ureteroscopy (URS) is the preferred treatment for patients on continuous antiplatelet regimens, however multiple recent case series questioned whether continuing low-dose aspirin at the time of percutaneous nephrolithotomy (PCNL) or extracorporeal shockwave lithotripsy (ESWL) could be safe in certain settings. We conducted a survey study to further define current practice trends and guide future research into the topic. METHODS An electronic survey was sent to approximately 2000 members of the Endourology Society in September of 2016. 184 substantive responses (9.2%) were received from members in six continents. The resulting data was analyzed and associations were measured by Pearson's chi-squared test. RESULTS 63% of respondents were fellowship trained, 67% practiced in academic centers, and 70% practiced in North America or Europe. 79% of respondents stated that they routinely performed URS on patients taking 81 mg of Aspirin (ASA) daily as opposed to only 29% when asked the same question with regard to PCNL (Odds Ratio (OR): 17.4, p < 0.001) and 18% with regard to ESWL (OR: 9.2, p < 0.001). Those in academic practice were more likely to perform PCNL (OR: 2.4, p = 0.02) but not ESWL (p = 0.51) on patients while taking ASA. Respondents from outside North America or Europe rarely reported performing PCNL or ESWL on patients taking ASA (40% vs. 5%, p <0.001 and 22% vs 7%, p = 0.01). Neither fellowship training nor high case volumes were associated with an increased likelihood of performing PCNL or ESWL in patients taking ASA; however if a surgeon performed fellowship training in North America or Europe, they were significantly more likely to routinely perform PCNL on patients taking ASA (p <.0001). Those who performed PCNL or ESWL on ASA were significantly less likely to consult cardiology regarding cessation of ASA pre-operatively (p <.001). There was a trend toward younger physicians performing PCNL and ESWL on ASA (p = 0.06, 0.05, respectively). CONCLUSIONS Urologists commonly perform URS in patients taking aspirin, but only a minority perform ESWL and PCNL in patients on ASA. There was a wide regional variation in aspirin usage in ESWL. Surgeons in academic centers and with fellowship training from North America or Europe were more likely to perform PCNL on ASA. The next step is to evaluate the safety and outcomes of remaining on ASA for surgery. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e579 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Joshua Ebel More articles by this author Brian Eisner More articles by this author Michael Lipkin More articles by this author Ben Chew More articles by this author Bodo Knudsen More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Assessment of plasma homocysteine as a marker of acute renal injury in patients undergoing extracorporeal shock wave lithotripsy for renal stone disease - 1-year cross-sectional study

Context: Extracorporeal shock wave lithotripsy (ESWL) commonly used procedure for treating upper urinary tract stones may result in acute kidney injury (AKI) with release of biomarkers. Association of plasma total homocysteine (tHCy), serum high-sensitivity C-reactive protein (hs-CRP), and serum creatinine with renal dysfunction and their role as acute renal injury markers is to be assessed. Aim: The study aims to assess plasma tHCy as a marker of AKI in patients undergoing ESWL for renal stone disease and compare the same with other markers, i.e., serum creatinine and serum hs-CRP. Setting and Design: One-year cross-sectional study at a tertiary care teaching hospital. Subjects and Methods: Sixty-four patients undergoing ESWL for renal stone disease were investigated for plasma tHCy, serum creatinine, and serum hs-CRP 24 h before and after ESWL procedure. Patients were divided into AKI and non-AKI group. Statistical Analysis: SPSS statistical software, rates, ratios, percentages, and mean ± standard deviation. A P ͳ 0.05 at 95% confidence interval was considered as statistically significant. Results: Following ESWL, AKI developed in 56.25% of the patients. Post-ESWL mean plasma tHCy levels were significantly high in patients with AKI (21.01 ± 7.67 vs. 16.93 ± 7.44 μmol/L; P = 0.036) compared to those who did not develop AKI. The post-ESWL mean serum creatinine levels and mean change were significantly high in patients with AKI. The post-ESWL mean serum hs-CRP levels were comparable in patients with AKI and those who did not develop AKI. However, 72.22% of the patients with AKI had significant rise of serum hs-CRP (≥2-fold of baseline) level following ESWL which was the only insult on kidney in 24 h. Conclusion: Plasma tHcy, Serum hs-CRP, and Serum creatinine can be used as acute renal injury markers following ESWL in patients with renal stone disease.

Comparison of ultrasonography and Intravenous urography in predicting the outcome of Extracorporeal Shockwave lithotripsy in nephrolithiasis

Introduction: ultrasound has a well established role in evaluating the kidney. Calculus is readily picked up on ultrasound. Normal sonographic features with doppler detection of ureteric jets indicate presence of normal renal function. Using these advantages we undertook this present study to determine whether ultrasound (USG) can replace intravenous urography (IVU) in the pre-operative evaluation of extracorporeal shockwave lithotripsy (ESWL) patients. Methods and Material: This study was a prospective observational study conducted in the Department of Radiodiagnosis, Regional Institute of Medical Sciences (RIMS), Imphal, during a period of 2 years. 50 patients with confirmed renal stones referred for ESWL treatment in the Department of Urology, RIMS, Hospital, Imphal were included. USG and IVU were independently interpreted. Cases were grouped as excellent, good, borderline or poor cases. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of USG and IVU are compared. Results: The sensitivity and specificity of ultrasound in predicting the outcome after ESWL for solitary renal calculus is 95.8% and 50% respectively with a PPV and NPV of 97.8% and 33.33% respectively and the sensitivity and specificity of IVU in predicting the outcome after ESWL are 97.9% and 50% respectively with a PPV and NPV of 97.8% and 50% respectively. Conclusions: USG can be the alternative radiological examination in the pre-operative evaluation of ESWL patients as the USG and IVU have comparable predictive values.

C160: Evaluation of efficacy of the extracorporeal shockwave lithotripsy in patients with and without stent in the ureter

C160: Evaluation of efficacy of the extracorporeal shockwave lithotripsy in patients with and without stent in the ureter

Immediate and long-term high levels of plasma homocysteine after extracorporeal shock wave lithotripsy in patients with renal stone disease.

Plasma homocysteine levels increase in patients with chronic renal failure. Numerous studies have demonstrated that kidney function is one of the most important determinants of plasma total homocysteine (tHcy) concentration. In this study we aimed to evaluate the relationship between tHcy levels and extracorporeal shock wave lithotripsy (ESWL) for patients with renal stones and to see if the change in homocysteine levels continued if renal dysfunction improved. The study consisted of 20 patients who underwent first-time ESWL for renal stones. Every patient gave 3 blood samples at 24 h before surgery and at 2 days and at 3 months after ESWL for measurement of plasma levels of tHcy, creatinine, vitamin B6, and vitamin B12. The 20 patients (12 male, 8 female) had a mean age of 42.8 ± 11.7 years. tHcy levels showed a statistically significant increase from 9.4 ± 1.4 to 18 ± 4.8 and 11.2 ± 2.1 at 2 days and at 3 months, respectively. Serum creatinine also showed a statistically significant increase compared to baseline at 2 days and at 3 months after ESWL. After first-time ESWL, the increase in serum levels of creatinine and tHcy due to renal injury, such as ischemia/reperfusion injury, may be severe and continue for a long period, such as 3 months. According to baseline levels, the increase in homocysteine levels as an indicator of oxidant stress was more severe than the creatinine levels after ESWL for renal stones. Our patients were first-time ESWL patients; however, in patients who undergo EWSL more than once long-term high tHcy levels should also be considered as renal.

817 Urgent extracorporeal shockwave lithotripsy in patients with obstruction solitary or both kidneys

817 Urgent extracorporeal shockwave lithotripsy in patients with obstruction solitary or both kidneys

Previous Open Renal Surgery Increased Vascular Complications in Percutaneous Nephrolithotomy (PCNL) Compared with Primary and Secondary PCNL and Extracorporeal Shock Wave Lithotripsy Patients: A Retrospective Study

Objective: To evaluate the vascular complications of percutaneous nephrolithotomy (PCNL) patients who have undergone previous open surgery, PCNL and extracorporeal shock wave lithotripsy (ESWL). Patients and Methods: 360 patients who underwent a PCNL procedure were included into the study. The patients were divided into 4 groups: group 1: primary PCNL (n = 232); group 2: previous open nephrolithotomy (n = 42); group 3: previous PCNL (n = 33); group 4: previous ESWL (n = 63). The periods of operation and fluoroscopy use of the groups were compared in terms of residual stones, with haematuria, pre-operation and post-operation first-day haemoglobin values. Patients with persistent haematuria were assessed through ultrasonography (US), Doppler US, computed tomography and angiography. Results: Upon comparison of the patients' pre- and post-operative haemoglobin changes, haemoglobin was statistically higher in the previous open operation group than the others (p = 0.02). Permanent and intermittent haematuria were detected in 12 (3%) and 7 patients (1%), respectively. Angiography was done in 7 (1.94%) patients. This rate was 9.5% for group 2 and 3% for group 3. These rates were found to be statistically higher than compared to the other groups. Arteriovenous fistula (AVF) was detected in 4 of these patients and pseudoaneurysm in 1. While 1 of the patients with AVF improved spontaneously, embolisation was applied to 4 patients. Four of the patients had had a previous open operation, while 1 had had a PCNL treatment. Conclusions: Vascular complication is a rare complication of PCNL that can be successfully managed with angioembolisation. Our results indicate that previous open surgery significantly predicted the occurrence of these lesions.

Morbidity and Efficacy of Ureteroscopic Stone Treatment in Patients with Neurogenic Bladder

There is a lack of information on the safety and efficacy of ureteroscopy in the neurogenic bladder population. We hypothesized that ureteroscopy in patients with neurogenic bladder would be associated with an increased risk of complications and a lower stone clearance rate than in patients without neurological impairment. We reviewed a local registry of patients with ICD-9 codes for urolithiasis between 2004 and 2012. The study cohort was assembled from all eligible patients with neurogenic bladder and a randomly selected control group that had undergone ureteroscopy. Statistical analysis of demographic variables and surgical outcomes was performed. Complications were classified according to the Clavien system. Clearance was defined by computerized tomography, renal/bladder ultrasound or direct ureterorenoscopy. Ureteroscopy was performed a total of 173 times in 127 controls and a total of 45 times in 20 patients with neurogenic bladder. There was no difference between presenting episodes by gender (p = 1.0), race (p = 0.654) or body mass index (p = 0.519). Bacteriuria was associated with the stone episode in 16.4% of controls and 67% of neurogenic bladder cases (p <0.001). Median operative time was significantly longer in those with neurogenic bladder (80.5 minutes, IQR 50-110.5 vs 52, IQR 33-78, p = 0.0003). The proportion of complications was significantly different (p = 0.013). Stones cleared in 86.6% of controls compared to 63% of neurogenic bladder cases (p = 0.004). Patients with neurogenic bladder have increased morbidity after ureteroscopy for upper tract calculi compared to neurologically unaffected controls. Infection has a role in this morbidity. The clearance rate is lower but the stone burden is more significant in those with neurogenic bladder.

Stone clearance after extracorporeal shockwave lithotripsy in patients with solitary pure calcium oxalate stones smaller than 1.0 cm in the proximal ureter, with special reference to monohydrate and dihydrate content

Objective. The aim of this study was to assess stone-free rates following extracorporeal shockwave lithotripsy (ESWL) of pure calcium oxalate (CaOx) stones in the proximal ureter. Material and methods. The investigators retrospectively examined 53 patients with 5–10 mm pure CaOx stones in the proximal ureter from the medical archives of 593 consecutive patients treated with ESWL. The compositions of calcium oxalate monohydrate (COM) and dihydrate (COD) in a given stone were determined by infrared spectrometry. Stone size, attenuation number and stone-to-skin distance (SSD) were measured using plain radiography and computed tomography (CT). ESWL success was evaluated by stone-free status after the first single session. Results. On average, calculi were 8.0 × 5.3 mm in size, with an SSD of 11.0 cm. The mean CT attenuation value was 740.1 HU. Attenuation numbers correlated significantly with stone diameter (r = 0.49), but had no correlation with the stone content of COM or COD. A negative correlation was observed between COM and COD content (r = –0.925). With regard to patients' physical characteristics and COM and COD content, no differences were found between study subgroups with stone-free and residual status (n = 38 and 15, respectively). There were also no differences in clinical features between patient subgroups with COM- or COD-predominant stones (n = 22 and 31, respectively). Conclusion. The findings indicated that the differences in COM and COD content of CaOx stones had no impact on stone clearance after ESWL and that a favorable stone-free rate of the stones treated with ESWL may be achieved independently of CaOx hydration.