Extracorporeal Shock Wave Lithotripsy Monotherapy Research Articles

Effects of stone density on alteration in renal resistive index after extracorporeal shock wave lithotripsy for non-obstructed kidney stones

Aim: The doppler-based renal resistive index is a recently proposed technique for measuring changes in renal perfusion and predicting acute kidney damage. The purpose of this study was to look at the influence of stone density on the renal resistive index (RI) after extracorporeal shock wave lithotripsy (ESWL) in patients with non-obstructed kidney stones.Material and Method: Between May 2020 and July 2021, 48 consecutive patients with unilateral renal calculi of ≤ 20 mm were treated with ESWL monotherapy. The patients' non-contrast computed tomography (NCCT) images were processed and grouped into two groups using Hounsfield units (HU) (Group 1, n=27, ≤ 1000 HU; Group 2, n=21, > 1000 HU). The same radiologist performed Doppler ultrasonography on all cases before, one hour, and one week following ESWL. Measurement of the RI taken in the remote region (at least 20 mm from the stones). Patient age, gender, BMI, stone laterality, stone size, and stone position were investigated as potential predictors.Results: The average stone size for Group 1 was 11.7±3.3 mm and 12.1±2.8 mm for Group 2. The mean RI values before ESWL for Group 1 and Group 2 were 0.54 and 0.53, respectively. On comparing the pre-treatment data with the 1 hour after ESWL, a statistically significant increase was recorded in the RI value for both groups. However, there was no significant difference in RI values between groups 1 and 2 1 hour and 1 week following lithotripsy therapy. After one week, the mean RI returned to pretreatment levels, according to a follow-up doppler investigation. There was no association between stone density and RI (p > 0.05). Conclusion: High stone densities detected with NCCT were not associated with a significant change in RI. Post-ESWL therapy alterations are present and reversible one week after the treatment.

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

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

Evaluation of Factors Influencing Outcome of Extracorporeal Shock Wave Lithotripsy (Eswl) for Renal Stone in Adult

Background: Renal stone disease is a common disorder with a prevalence ranging from 4-15% in different parts of the world. Modalities of kidney stone management includes drug therapy, extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), Retrograde intrarenal surgery ureteroscopy (RIRS) and open surgery. ESWL is an acceptable technique and widely used because it is a non-invasive treatment and does not require anesthesia and usually done on an outpatient basis. Generally, ESWL is the treatment of choice for kidney stones &lt;1 cm. However, not all ESWL treatments are successful. The success rate has been reported to be between 50%-87%, depending on various factors. This study was conducted in order to evaluate thefactors affecting renal stones treatment by extracorporeal shock wave lithotripsy (ESWL).On the basis of different variables andfactors affecting the renal stones treatment by ESWL was evaluated. Objectives: To evaluate the factors affecting the outcome of Extracorporeal Shock Wave Lithotripsy (ESWL) in the treatment of renal stone in adults.To assess the success and failure rate by using ESWL for treatment of renal stone, to determine the effects of stone related factors to correlate the success rate with characteristics of the patients condition of the urinary tract and stone features; to observe the patient groups most likely to benefit from or fail an initial intervention with ESWL and to evaluate the post ESWL complications. Materials and methods: This is a prospective observational and analytical, hospital based study. Total 500 patients with single or multiple radio-opaque renal stones were treated with ESWL monotherapy using Siemens MODULARIS Variostarlithotriptor. This study was carried out inthe Department of Urology, Combined Military Hospital, Dhaka for a period of two years between 01 July 2015 to 31 July 2017. The results of treatment were evaluated after 3 months of follow-up. Treatment success was defined as complete clearance of the stones or presence of clinically insignificant residual fragments (&lt;3mm). The results of treatment were correlated with the patient characteristics (age, sex, body mass index) and stone features (size, site, number &amp; radio density). Results: At 3-months follow-up, the overall success rate is 87.6%. Among them, repeated ESWL sessions were required in 266 patients (53.2%). Post-ESWL complications were recorded in 62 patients (12.4%). Using the chi-square test, only four factors have a significant impact on the success rate, namely stone site, size (the largest diameter of the stone), stone number, BMI (body mass index) of the patient. The success rate is highest for stones located in the upper calyx (136/136; 100%) and lowest for those located in lower calyx 104/78; 75%) (p=0.001). Stone with a largest diameter of &lt;10mm are associated with a success rate of 93.6% (307/328), compared to 76.2% (131/172) for those with a diameter of &gt;10mm (p=0.001). The success rate was also higher for single stone (396/437; 90.6%) than multiple stones (42/63; 66.7%) (p=.001). Patients with lower BMI (&lt;24) have a better success than higher BMI (&gt;25) (p=.001). Other factors including age, sex and stone radio density compared to ipsilateral 12th rib have no significant impact on the success rate. Conclusion: The success rate of ESWL for the treatment of renal stones can be predicted by stone size, location, number, and patients BMI. Bangladesh Journal of Urology, Vol. 22, No. 2, July 2019 p.141-150

Prognostic Factors of Success of Extracorporeal Shock Wave Lithotripsy 46 (ESWL) in The Treatment of Renal Stones.

Background: Renal calculi are common approximately 50% of patient between the ages of 30and 50 years. The development of endourological and extracorporeal lithotripsy techniques ledto an increasing number of options for the management of renal calculi.&#x0D; Objective: To define factors those have a significant impact on the success rate after extracorporealshock wave lithotripsy (ESWL) for treatment of renal stones.&#x0D; Materials and Methods: Between April 2008 &amp; December 2008, 64 patients with single ormultiple radiopaque renal stones (::s;30mm) were treated with ESWL monotherapy using StortzModulith SLX-F2 lithotriptor.The results of treatment were evaluated after 3 months of followupTreatment success was defined as complete clearance of the stones or presence ofclinically insignificant residual fragments (::s;4mm).The results of treatment were correlated withthe patient characteristics (age, sex, body mass index) and stone features (size, site, nature &amp;radio density).&#x0D; Results: At 3-months follow-up, the overall success rate is 76%. Among them, repeated ESWLsessions are required in 19 patients (53.9%). Post-ESWL complications are recorded in 8patients (12.5%). Using the x2 test, only three factors have a significant impact on the successrate, namely: stone site, size (the largest diameter of the stone), stone number &amp; BMI (BodyMass Index). The success rate is highest for stones located in the upper calyx (15/15; 100%)and lowest for those located in the lower calyx (10/16; 62.5%) (p=.005). Stones with a largestdiameter ot s 15mm are associated with a success rate of 90.2% (37 /41), compared to 52.2%(12/23) for those with a diameter of &gt;15mm (p=.001). The success rate is also higher forsingle stone (46/56; 82%) than multiple stones (3/8; 37.5%) (p=0.005).Patients with lowerBMI (&lt;24) have a better success than higher BMI (&gt;25) (p=0.01)&#x0D; Conclusion: The success rate of ESWL for the treatment of renal stones can be predicted bystone size, location, number and patient BMI.&#x0D; Journal of Surgical Sciences (2016) Vol. 20 (2) :46-50

Management of ‘forgotten’ encrusted JJ stents using extracorporeal shockwave lithotripsy: A single-centre experience

ABSTRACTObjective: To evaluate the role of extracorporeal shockwave lithotripsy (ESWL) for the management of ‘forgotten’ encrusted stents.Patients and Method: This is a retrospective study of 133 patients with forgotten JJ stents, treated between January 2015 and January 2018. Encrustation was mainly found in the renal coil of the stent with distal concomitant encrustation in the vesical and/or ureteric segment. After laboratory and radiological assessment, treatment started with ESWL for the renal encrustation before successful extraction. Auxiliary endourological procedures were used for the encrusted vesical or ureteric segments. Failed cases underwent open surgery.Results: The mean (SD; range) JJ stent indwelling time was 25.84 (10; 14–70) months. In all, 96 (72.2%) patients were seen after treatment for stone disease. In total, 94 patients (70.7%) were managed by ESWL monotherapy, whilst in 36 (27%) additional endourological procedures were required before successful extraction including: cystolithotripsy 19 patients (52.8%), ureteroscopic lithotripsy eight (22.2%), and percutaneous nephrolithotomy nine (25%). Open surgery was required in only three patients (2.3%). A mean of 0.28 procedures per patient was required before smooth stent extraction. The encrusted stents were removed after the first, second, third, and fourth ESWL sessions in 44 patients (33.1%), 43 (32.3%), 26 (19.5%), and 17 (12.8%), respectively. Patients with forgotten indwelling JJ stents for >2 years had significantly larger and harder encrustation at both JJ coils.Conclusion: ESWL proved a feasible first-line treatment for forgotten encrusted JJ stents. The indwelling time of forgotten stents in the urinary tract is associated with greater encrustation burden, density and multiple sites of encrustation.Abbreviations: CLT: cystolithotripsy; ESWL: extracorporeal shockwave lithotripsy; HU: Hounsfield unit; KUB: plain abdominal radiograph of the kidneys, ureters and bladder; PCNL: percutaneous nephrolithotomy; URL: ureteroscopic lithotripsy

Factors Affecting the Success Rate of Renal Stone Treatment by Extracorporeal Shock Wave Lithotripsy

ESWL is one of the treatment modalities for kidney stones smaller than 2 cm. However, not all ESWL treatments are successful. The success rate has been reported to be between 50% to 87%, depending on various factors. This study was conducted to evaluate factors affecting the success rate of renal stone treatment by extracorporeal shock wave lithotripsy (ESWL). The study was carried out for a period of one year where total 96 patients with single or multiple radio-opaque renal stones treated with ESWL monotherapy using Stortz Modulith SLX-F2 lithotriptor were included. The results of treatment were evaluated after 3 months of follow-up. Treatment success was defined as complete clearance of the stones or presence of clinically insignificant residual fragments (&lt;4mm). The results of treatment were correlated with the patient characteristics (age, sex, body mass index) and stone features (size, site, number and radio density). At 3-months follow-up, the overall success rate was 76%. Among them, repeated ESWL sessions were required in 19 patients (53.9%). Post-ESWL complications were recorded in 8 patients (12.5%). Four factors had statistically significant impact on the success rate, namely stone site, size (the largest diameter of the stone), stone number, BMI (body mass index) of the patient. The success rate is highest for stones located in the upper calyx (26/26; 100%) and lowest for those located in lower calyx (15/20; 75%) (p=0.019). Stone with a largest diameter of &lt;15mm are associated with a success rate of 93.6% (59/63), compared to 75.82% (25/33) for those with a diameter of &gt;15mm (p=0.01). The success rate is also higher for single stone (76/84; 90.5%) than multiple stones (8/12; 66.7%) (p=0.02). Patients with lower BMI (&lt;24) have a better success than higher BMI (&gt;25) (p=0.001).Other factor including age, sex and stone radio density compared to ipsilateral 12th rib have no significant impact on the success rate. The success rate for ESWL for the treatment of renal stones can be predicted by stone size, location, number, and patient BMI.&#x0D; Bangladesh Med J. 2017 May; 46 (2): 1-6

Factors Affecting the Success Rate of Renal Stone Treatment by Extracorporeal Shock Wave Lithotripsy

ESWL is one of the treatment modalities for kidney stones smaller than 2 cm. However, not all ESWL treatments are successful. The success rate has been reported to be between 50% to 87%, depending on various factors.&#x0D; Aim: This study was conducted to evaluate Factors affecting the success rate of renal stone treatment by extracorporeal shock wave lithotripsy (ESWL).&#x0D; Materials and methods: The study was carried out for a period of one year where total 96 patients with single or multiple radio-opaque renal stones treated with ESWL monotherapy using Stortz Modulith SLX-F2 lithotriptor were included. The results of treatment were evaluated after 3 months of follow-up. Treatment success was defined as complete clearance of the stones or presence of clinically insignificant residual fragments (&lt;4mm). The results of treatment were correlated with the patient characteristics (age, sex, body mass index) and stone features (size, site, number &amp; radio density).&#x0D; Results: At 3-months follow-up, the overall success rate was 76%. Among them, repeated ESWL sessions were required in 19 patients (53.9%). Post-ESWL complications were recorded in 8 patients (12.5%). Four factors had statistically significant impact on the success rate, namely stone site, size (the largest diameter of the stone), stone number, BMI (body mass index) of the patient. The success rate is highest for stones located in the upper calyx (26/26; 100%) and lowest for those located in lower calyx (15/20; 75%) (p=0.019). Stone with a largest diameter of &lt;15mm are associated with a success rate of 93.6% (59/63), compared to 75.82% (25/33) for those with a diameter of &gt;15mm (p=0.01). The success rate is also higher for single stone (76/ 84; 90.5%) than multiple stones (8/12; 66.7%) (p=0.02). Patients with lower BMI (&lt;24) have a better success than higher BMI (&gt;25) (p=0.001).Other factor including age, sex and stone radio density compared to ipsilateral 12th rib have no significant impact on the success rate.&#x0D; Conclusion: The success rate for ESWL for the treatment of renal stones can be predicted by stone size, location, number, and patient BMI.&#x0D; J Dhaka Medical College, Vol. 27, No.1, April, 2018, Page 72-78

Extracorporeal shock wave lithotripsy (ESWL) versus flexible ureteroscopy (F-URS) for management of renal stone burden less than 2 cm in children: A randomized comparative study

ObjectiveTo compare the outcome of flexible ureteroscopy (F-URS) versus extracorporeal shock wave lithotripsy (ESWL) for the management of renal stone burden less than 2 cm in children. Patients and methodsA randomized comparative study was conducted at our hospital between December 2013 and May 2015. Seventy two children with renal stone burden less than 2 cm were assessed for eligibility. Our primary outcome is to assess the stone free rate after the first session. The secondary goal is to assess the operative outcome and the associated postoperative complications. ResultsFinally, 57 children were completed the treatment and follow up; 27 patients in F-URS group and 30 patients in ESWL group. Patient's demographics and stone characteristics were comparable between both groups. F-URS group was associated with significantly longer operative time and hospital stay versus ESWL group. Overall complications occurred in 29.6% and 33.3% in F-URS groups and ESWL group, respectively (p value = 0.1) and most of them were of minor degree. F-URS was associated with significantly higher stone free rate after the first session which reached 81.4% versus 53.3% for ESWL group (p value = 0.00). The overall success was 92.5% and 90% in F-URS and ESWL group, respectively (p value = 0.5). ConclusionStone free rate after one session of F-URS is higher than ESWL with comparable rates of complications. F-URS could be offered to children who are less likely to respond completely after ESWL monotherapy.

The effiectiveness of extracorporeal shock wave lithotripsy in treating proxima ureteral stones

To conduct a comprehensive assessment of the effectiveness of ESWL in treating proximal ureteral stones and determine the appropriateness of using -blockers to stimulate residual stone clearance. ESWL was performed in 40 patients with X-ray positive proximal ureteral stones. Before ESWL and at 3 months after the treatment all patients underwent multispiral computed tomography. ESWL was considered successful if there was a complete clearance of the stones with no residual fragments on the control MSCT. If a residual ureteral stone was found at 3 months after ESWL, a 2-week course of silodosin was administered. Complete stone clearance was achieved in 37.5% of patients. Silodosin therapy for residual stones resulted in stone clearance in 68.4% of cases. Taken together, ESWL monotherapy and additional 3 months of lithokinetic therapy resulted in stone clearance in 70.0% of patients. The remaining patients underwent contact ureteral lithotripsy. Spontaneous stone passage after ESWL for proximal ureteral stones occurs not in all patients. Most commonly it occurred during the first three weeks after ESWL, and thereafter stone passage was not observed. In half of the patients with residual stones they were asymptomatic. The effectiveness of ESWL as a monotherapy for ureteral stones greater than 15 mm is incomplete. Adding silodosin during the long-term post ESWL period improves the passage of asymptomatic residual stones in 2/3 of patients, which makes its use promising.

Extracorporeal shock wave lithotripsy (ESWL) monotherapy in children: Predictors of successful outcome

Although extracorporeal shock wave lithotripsy (ESWL) is the first choice for pediatric renal calculi <2cm, the success rate after the first session is low. This is in contrast to other minimally invasive procedures like percutanous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS), which have higher rates of success. Therefore, the present study sought to identify predictors of success after one session of ESWL. A prospective study including 100 children with renal stone burden <2cm who underwent ESWL at the present institution. The success rate after the first session was analyzed, and the predictors of success were investigated. The success of ESWL monotherapy was defined by absence of any residual fragments after 3 months, on non-contrast spiral computerized tomography (NCCT) scan, without need of any additional intervention. Between January 2013 and October 2015, 100 children were treated with a Dornier Gemini lithotripter at the present institution. The mean patients age and stone size were 6 years (range: 1.8-14) and 13.1mm (range: 6-20), respectively. After one session, 47% of patients showed complete clearance 3 months postoperative, those patients versus those who required an additional session or auxiliary procedures were younger in age, with smaller stone size and lower density. On multivariate analysis, only patient age was an independent predictor of success (odds ratio (OR) 0.9; P < 0.001). Patient's age was an important predictor for response after ESWL monotherapy: not only did children respond better than adults, but age was also an independent predictor within the pediatric group.

46 - Extracorporeal shock wave lithotripsy (ESWL) monotherapy in children; predictors of successful outcome

46 - Extracorporeal shock wave lithotripsy (ESWL) monotherapy in children; predictors of successful outcome

Extracorporeal shockwave lithotripsy monotherapy for treating patients with bladder stones

ObjectivesTo describe our experience with extracorporeal shockwave lithotripsy (ESWL) for the treatment of bladder stones of <20mm. Patients and methodsThis study was prospectively performed in two hospitals (Althawrah Modern General Hospital, and Ibn Sina Specialized Hospital) between November 2012 and November 2015. In all, 44 patients presented with urethral or bladder stones. The location and size of the stones was assessed by abdominal ultrasonography and plain abdominal radiography of the kidneys, ureters and bladder. All patients with radiopaque stones of <20mm underwent ESWL monotherapy after fixation of a Foley catheter in a supine position under intravenous analgesia. ResultsThe mean size of the stones was 15.8mm and spontaneous evacuation occurred after removal of the Foley catheter without the need for adjuvant procedures in 40 patients (90.9%). Four patients (9%) developed acute urinary retention due to urethral impaction of large stone fragments. In two of them, the urethral catheter was successfully re-inserted pushing the fragments back to the bladder and a complementary session of ESWL resulted in more fragmentation of the stones, with spontaneous passage after catheter removal. In the other two patients (4.5%), the catheter could not be re-inserted and urgent endoscopic intervention was required. ConclusionsESWL monotherapy is safe and effective method for treatment of bladder stones with no other causes of infra-vesical obstruction. Several indications can be met including patients with high anaesthetic risk, patients fearing anaesthesia or endoscopic procedures, and patients who have difficulty in positioning.

Treatment of Renal Stones ≥20 mm with Extracorporeal Shock Wave Lithotripsy

Aims: To identify subgroups of patients with renal stones ≥20 mm that are more suitable for extracorporeal shock wave lithotripsy (ESWL) monotherapy. Methods: A total of 376 patients with renal stones ≥20 mm underwent monotherapy with ESWL. The treatment outcome was evaluated after 3 months of follow-up. A stone-free status or fragmentation of stones to 4 mm or smaller was considered efficacious. Results: At 3 months after treatment, the overall stone-free rate was 64.4%, and the efficacy rate was 70.7%. The efficacy rate was 89.4% for patients with a residual stone surface area ≤50% of baseline after the first ESWL, while the efficacy rate was 32.4% for other patients. The efficacy was 92.2% for stones ≤400 mm² and those with lower radiodensity, as determined by a plain (KUB) film. Conclusions: For renal stones with a surface area ≤400 mm² and a radiodensity equal to or less than that of the 12th rib as determined by a KUB film, ESWL may be considered the first line of treatment, even for stones with a diameter ≥20 mm. For large stones requiring repeat treatments, the surface area of the residual stones after the first ESWL is a predictor of the final treatment result.

Mid ureteric stone clearance by Extracorporeal Shock Wave Lithotripsy (ESWL): a clinical study

Background: In the last 20 years, the management of ureteric stones has changed dramatically from an open operative procedure to endoscopic,minimally invasive and non invasive methods. Urinary stone disease is a major problem due to its high prevalence and incidence and recurrence. The present study aimed to determine the outcome of in situ Extracorporeal Shock-Wave Lithotripsy (ESWL) in mid-ureteric stone in terms of stone clearance, per operative and post operative complications. Methods: This prospective study was conducted in the Department of Urology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, between September 2011 and August 2012. Total 30 patients with mid ureteric stone sized less than 10 mm were selected purposively. They were evaluated preoperatively by history, physical examination and relevant investigations. ESWL monotherapy with Siemens Lithoscope (3rd generation) lithotripter was used to treat mid ureteric stone. Statistical analysis was done by using SPSS version 13,0. Results: Mean age of the patients was 36.73±8.03 years with a range of 20–51 years. Among the patients 18 (60.0%) were male and 12 (40.0%) were female. Seventeen (56.7%) patients had stone in the right ureter and 13(43.3%) had stone in the left ureter. Mean stone size was 8.07±1.32 mm with a range of 6.00–10.00 mm. Most of the patients (96.7%) had post procedure pain, 15 (50.0%) had haematuria and 9 (30.0%) had fever. Final outcome of treatment showed that complete stone clearance was 83.3% after one month. Conclusion: Mid ureteric stone clearance with ESWL is more than eighty percent in with a very low rate of complications. So ESWL may be recommended as safe and first line therapy for mid ureteric stones. DOI: http://dx.doi.org/10.3329/jdmc.v22i2.21523 J Dhaka Medical College, Vol. 22, No.2, October, 2013, Page 136-143

Efficacy of Extracorporeal Shock Wave Lithotripsy in Pediatric and Adolescent Urolithiasis

PurposeTo retrospectively evaluate the efficacy of extracorporeal shock wave lithotripsy (ESWL) by age and current condition as a first-line treatment for pediatric and adolescent urolithiasis.Materials and MethodsThe computerized records of 55 children were retrospectively reviewed from March 1991 to July 2007. The children were below 18 years of age and had undergone ESWL monotherapy for urolithiasis. There were 36 boys (65.5%) and 19 girls (34.5%), with a mean age of 8.5 years (range, 0.5-18 years). There were 24 patients aged 7 years or less and 31 patients aged more than 7 years.ResultsThe mean size of the stones was 9.48 mm (range, 4-22 mm). The overall success rate of ESWL was 90.9% (50 children). The mean number of ESWL sessions was 2.02 (range, 1-10). The mean number of ESWL sessions for the patient group aged 7 years or less was 1.16 (range, 1-2) and that for the patient group aged more than 7 years was 2.97 (range, 1-10; p=0.037). There was also a statistically significant difference in the mean number of ESWL sessions between the younger and older patients who needed general anesthesia (1.16 vs. 2.2 sessions, respectively; 0.042).ConclusionsIn the patient group aged 7 years or less, the number of ESWL sessions and the complication rate were comparable with those for endoscopic management. Thus, ESWL is an effective first-line treatment modality for patients aged less than 7 years.

Editorial Comment

The stone incidence in children has increased during the past 30 years. 1 VanDervoort K. Wiesen J. Frank R. et al. Urolithiasis in pediatric patients: a single center study of incidence, clinical presentation and outcome. J Urol. 2007; 177: 2300-2305 Abstract Full Text Full Text PDF PubMed Scopus (252) Google Scholar Many believe this is secondary to the increasing obesity in the pediatric population. 2 Srivastava T. Alon U.S. Urolithiasis in adolescent children. Adolesc Med Clin. 2005; 16: 87-109 Crossref PubMed Scopus (36) Google Scholar This parallels observations in adults, with obesity again blamed for the increased stone risk. 3 Straub M. Hautmann R.E. Developments in stone prevention. Curr Opin Urol. 2005; 15: 119-126 Crossref PubMed Scopus (46) Google Scholar As with adults, the major treatment options for pediatric stones include extracorporeal shock wave lithotripsy (ESWL), ureteroscopy with laser and/or basket, percutaneous nephrolithotomy, or open surgery, with open surgery used for combined stone removal and repair of anomalies. A shift has occurred toward less-invasive stone treatment for children in the past 25 years, such having been facilitated by the development of small ureteroscopes and nephroscopes. ESWL is potentially the least invasive modality and is usually performed fairly quickly. This article is a nice report of 24 pediatric cases of nephrolithiasis, each with a relatively large stone burden (average stone size 31 mm for all patients, maximal dimension) successfully treated with ESWL. The clearance rate was high, with 83% of patients ultimately becoming stone free and most requiring >1 ESWL session, with 1 patient requiring 4 sessions. Renal function did not change after ESWL, and there did not seem to be any other short-term sequelae. The complication rate was 25% (colic in 2 and steinstrasse in 4), but only 1 of the 6 patients with complications required hospitalization. No stents were used. This is in contrast to the frequent use of stents after ureteroscopy at other institutions. 4 Tan A.H. Al-Omar M. Denstedt J.D. et al. Ureteroscopy for pediatric urolithiasis: an evolving first-line therapy. Urology. 2005; 65: 153-156 Abstract Full Text Full Text PDF PubMed Scopus (103) Google Scholar Extracorporeal Shock Wave Lithotripsy Monotherapy for Renal Stones >25 mm in ChildrenUrologyVol. 74Issue 1PreviewTo determine the safety and efficacy of extracorporeal shock wave lithotripsy (ESWL) as monotherapy for renal stones >25 mm in children. Full-Text PDF

Clinical Trials of the Surgical Management of Urolithiasis: Current Status and Future Needs

We reviewed the literature on the surgical treatment of urolithiasis. All prospective, randomized trials on the surgical treatment of stone disease were reviewed. Percutaneous nephrolithotomy (PNL) is superior to shockwave lithotripsy (SWL) or open surgery in the treatment of staghorn calculi. For ureteral stones, ureteroscopy appears to result in a higher stone-free rate and lower need for retreatment compared with SWL but has a higher complication rate and increased hospital stay. For lower pole renal calculi, PNL results in a higher stone-free rate and lower need for retreatment compared with SWL but has a higher complication rate and increased hospital stay. Most areas of surgical stone treatment have been addressed by a randomized controlled trial; however, most trials were of poor quality. Trials tend to focus only on radiologic outcomes. No study to date has been able to show a measurable quality of life benefit to patients, possibly because no condition-specific quality of life instruments have been developed. In addition, economic impact, both direct and indirect, has been rarely characterized. The surgical treatment of kidney stones is poorly researched. Future trials should be performed with adequate funding and patient-focused outcomes.

Prospective Study of the Long-Term Effects of Shock Wave Lithotripsy on Renal Function and Blood Pressure

We clarified the long-term effects of extracorporeal shock wave lithotripsy on renal function and blood pressure, and its relation to body mass index and type of lithotriptor. A total of 100 patients with a single radiopaque renal stone 2 cm or less in length were followed for 18 to 57 months (mean 43.6 +/- 13.8) after being stone-free by extracorporeal shock wave lithotripsy monotherapy using 2 lithotriptors. Mean patient age was 47.9 +/- 9.1 years (range 23 to 66). Nuclear scintigraphy using (99m)technetium-mercaptoacetyltriglycine was done for all patients before extracorporeal shock wave lithotripsy, as well as at the last followup visit to estimate glomerular filtration rate, clearance and split renal function. Blood pressure measurements were recorded at admission and at each followup visit. Before extracorporeal shock wave lithotripsy treated side mean (99m)technetium-mercaptoacetyltriglycine clearance, glomerular filtration rate and split function were 146.22 +/- 59.48, 52.66 +/- 13.69 and 49.7 +/- 7.31, respectively. At the last followup visit they were 145.1 +/- 58.82 (p = 0.842), 54.85 +/- 15.75 (p = 0.114) and 49.96 +/- 8.68 (p = 0.577), respectively. Of 100 patients 18 were hypertensive before extracorporeal shock wave lithotripsy and 21 were hypertensive at the last followup visit. Mean diastolic blood pressure before extracorporeal shock wave lithotripsy was 80.2 +/- 6.2 vs 80.6 +/- 7.8 mm Hg (p = 0.674) at the end of followup. Mean systolic blood pressure before extracorporeal shock wave lithotripsy was 121.2 +/- 9 vs 121.55 +/- 10.2 mm Hg by the end of the study (p = 0.748). There were no statistically significant differences among body mass index groups or lithotriptor groups. Extracorporeal shock wave lithotripsy is a safe procedure and has no significant long-term effects on renal function or blood pressure regardless of the type of machine used or body mass index.

Comparative study of extracorporeal shock wave lithotripsy outcomes for proximal and distal ureteric stones

To assess the efficacy of extracorporeal shock wave lithotripsy (ESWL) monotherapy for isolated proximal ureteral calculi and compare it to that for isolated distal calculi. We treated 68 patients with isolated ureteral stones using MPL 9000. Stones were located in the proximal and distal ureters in 44 and 24 patients, respectively. Patients were stratified according to stone burden and degree of obstruction. Data of all patients were prospectively collected for stone burden, stone localization, number of sessions, number of shock waves, stone-free rates (SFRs), complications, re-treatment rates and auxiliary procedures. Outcomes regarding ureteral localization were compared. The overall SFR was 85.3% with a 41.2% re-treatment and 17.6% auxiliary procedure rate. The mean number of shock waves applied for each stone was not different among the two ureteral locations. The SFRs were 86.3% and 79.1% for proximal and distal ureteral stones, respectively (P=0.17). For the group with stones <100 mm(2), the SFR was 85.4% and 89.5% for the proximal and distal ureter, respectively. Although the degree of obstruction did not affect SFR of the entire group (P=0.12) and the proximal ureter group (P=0.96), it adversely affected SFR in the distal ureter (P=0.017). ESWL outcomes for the ureteral calculi support the use of lithotripsy particularly for stones <100 mm(2). Treatment efficacy was not significantly different among stones localized in proximal and distal ureters. Degree of obstruction did not affect the ESWL outcomes in the proximal ureter, but it adversely affected SFR in the distal ureter.

Prognostic Factors of Success of Extracorporeal Shock Wave Lithotripsy (ESWL) in the Treatment of Renal Stones

To evaluate the factors that affect the success rate of extracorporeal shock wave lithotripsy (ESWL) for treatment of renal stones. Between January 2000 and December 2003, 427 patients with single or multiple renal stones (< 30 mm, largest diameter) underwent ESWL monotherapy using Storz SL 20 lithotriptor. The results of treatment were evaluated after 3 months of follow-up. Treatment success was defined as complete clearance of the stones or presence of clinically insignificant residual fragments < 4 mm. The success rate was correlated with the characteristics of the patients, conditions of the urinary tract and stone features. At 3-month follow-up, the overall success rate was 333/427 (78%). Repeat treatment was needed in 226 patients (53.1%). Post-ESWL auxiliary procedures were required in 36 patients (8.4%). Post-ESWL complications were recorded in 16 patients (3.7%). Of the 10 prognostic factors studied, 5 had a significant impact on the success rate, namely: renal morphology, congenital anomalies, stone size, stone site and number of treated stones. Other factors including age, sex, nationality, stone nature (de novo or recurrent) and ureteric stenting had no significant impact on the success rate. The success rate of ESWL for the treatment of renal stones could be predicted by stone size, location and number, radiological renal features and congenital renal anomalies.