Extracorporeal Shock Wave Lithotripsy Research Articles

COVID-19 outbreak impact on urolithiasis treatments: A multicenter retrospective study across 9 urological centers

Abstract Background The coronavirus disease (COVID-19) pandemic has posed challenges to the global health care community, affecting the management of upper urinary tract stones. Materials and methods This retrospective study involved 9 Italian centers. We compared the 12-month period prior to COVID-19 (March 1, 2019, to February 28, 2020; Period A) with the COVID-19 period (March 1, 2020, to February 28, 2021, Period B). This study aimed to compare outcomes during Periods A and B, specifically focusing on the overall number of treatments, rate of urgent/elective cases, and operational complexity. Results A total of 4018 procedures were collected, comprising 2176 procedures during Period A and 1842 during Period B, indicating a loss of 15.35% (p < 0.001). In the elective cases, 1622 procedures were conducted in Period A, compared with 1280 in Period B, representing a 21.09% reduction in cases (p = 0.001). All types of stone treatments were affected: extracorporeal shock wave lithotripsy (−29.37%, p = 0.001), percutaneous nephrolithotomy (−26.47%, p = 0.008), retrograde surgeries for renal stones (−10.63%, p = 0.008), and semirigid ureterolithotripsy (−24.86%, p = 0.008). Waiting lists experienced significant delays during Period B. The waiting time for elective procedures increased during Period B (p < 0.001). For ureteral stones, the mean waiting time in Period A was 61.44 days compared with 86.56 days in Period B (p = 0.008). The waiting time for renal stones increased from 64.96 days in Period A to 85.66 days in Period B for retrograde intrarenal surgery (p = 0.008) and from 96.9 days to 1103.9 days (p = 0.035) for percutaneous nephrolithotomy procedures. Conclusions Our study demonstrates that COVID-19 significantly disrupted endourological services across the country. Our data underline how patients received treatment over a prolonged period, potentially increasing the risk of stone-related complications and patient discomfort.

Extracorporeal Shockwave for Intermittent Claudication and Quality of Life

Intermittent lower limb claudication limits function and quality of life. Supervised exercise programs are not readily available, and a noninvasive alternative is needed. To assess extracorporeal corporeal shockwave therapy in improving quality of life in patients with claudication. In this double-blind, placebo-controlled randomized clinical trial, patients in the outpatient setting at a single tertiary center for vascular surgery were randomized in a 1:1 ratio to extracorporeal shockwave therapy or placebo therapy with no shockwaves delivered. Recruitment was between June 2015 and January 2020, with 12-week follow-up ending in March 2020. A convenience sample of patients with claudication and conservative treatment requirements who refused or were unable to participate in supervised exercise were eligible. Patients receiving anticoagulation therapy or with an active cancer were excluded. Of 522 patients screened, 389 were eligible, 138 were enrolled, and 110 completed follow-up and were included in the primary analysis. Statistical analysis was completed by May 2021. In the intervention group, patients received 100 impulses of 0.1mJ/mm/cm2 in an area of the gastrocnemius muscle 3 times weekly for 3 weeks. The steps for treatment were replicated for the control group without delivering the treatment. The primary outcome was the Physical Functioning domain of the 36-item Short-Form Quality of Life Questionnaire at 12-week follow-up. Secondary outcomes included walking distances, ankle brachial pressure index, and other quality-of-life measures. Of 138 patients recruited and randomized, 92 (67%) were male, and the mean (SD) age of the study population was 67 (9.6) years. The intervention group had a significantly higher physical function score at 12 weeks (estimated median difference 3.8; 95% CI, 0.0-7.7; P = .03). However, this significance did not remain when adjusting for covariates. At 12 weeks, the intervention group had significantly longer pain-free and maximum walking distances (pain-free estimated median difference, 34.1, 95% CI, 11.4-56.8; P = .004; maximum estimated median difference, 51.4; 95% CI, 10.7-86.5; P = .01). To our knowledge, this is the first double-blind, placebo-controlled, randomized clinical trial to consider extracorporeal shockwave therapy for the management of intermittent claudication. It demonstrated efficacy for walking distances, may have a positive effect on quality of life, and may provide a safe, noninvasive alternative therapy for patients with intermittent claudication. ClinicalTrials.gov Identifier: NCT02652078.

The effect of combination treatment with low-intensity shockwave therapy and daily tadalafil on severe erectile dysfunction: a double-blind, randomized, sham-controlled clinical trial.

Patients with severe erectile dysfunction (ED) remain the most challenging group in terms of available noninvasive treatment modalities. The study sought to assess the role of combination therapy with low-intensity shockwave therapy (LiST) and daily tadalafil 5mg in a highly select group of patients with severe vasculogenic ED through a double-blind, randomized trial. Forty-eight sexually active men were randomly assigned to 12 sessions of LiST 3 times weekly and tadalafil 5mg once daily (n = 34) or sham therapy and tadalafil (n = 17) for 4 weeks. Patients were assessed at 1 and 3 months after completion of treatment. Improvement of erectile function was evaluated through the International Index of Erectile Function-Erectile Function domain (IIEF-EF) or 6-item IIEF and the Sexual Encounter Profile (SEP) diary. The primary outcome was the difference between the groups in the IIEF-EF at 3 months after completion of treatment. Secondary outcomes comprised (1) the difference between the groups in the IIEF-EF at 1 month after completion of treatment, (2) the difference between the groups in the "yes" responses to question 3 of the SEP diary at 1 and 3 months, and (3) the treatment-related adverse events. The number of patients attaining a minimal clinically important difference in the IIEF-EF (improvement of at least 7 points) was also assessed. After treatment, the absolute scores in the IIEF-EF were higher in patients receiving LiST and tadalafil vs sham therapy and tadalafil both at the 1-month (12.1 ± 2.4 vs 10.2 ± 1.7; P = .002) and at the 3-month (12.9 ± 2.1 vs 10.8 ± 1.8; P < .001) evaluation. Between the 2 groups, the proportion of "yes" responses to question 3 of the SEP diary was not statistically significant, whereas the number of patients attaining a minimal clinically important difference in the IIEF-EF was statistically significant only at the 3-month evaluation. No adverse events occurred. Application of LiST in patients with severe vasculogenic ED receiving daily dose tadalafil may further improve erectile function compared with tadalafil as a stand-alone treatment on the short term. Although we provided the first study in the field, severe vasculogenic ED was defined based on medical history and clinical examination and not based on penile ultrasound measures. The combination of 12 sessions LiST 3 times weekly and daily tadalafil for 4 weeks led to a 2-point difference in the IIEF-EF compared with sham therapy and daily tadalafil among patients with severe vasculogenic ED after 1 and 3 months from completion of treatment.

Does Radial Extracorporeal Shockwave Therapy Applied to the Achilles Tendon Influence Ankle Functionality?

This study aimed to determine the effectiveness of radial extracorporeal shockwave therapy (rESWT) in enhancing ankle function in patients with Achilles tendon injuries. The choice of rESWT was based on previous success in the treatment of musculoskeletal conditions. The study involved an intervention group that received rESWT, and a control group that received sham therapy. The results revealed that rESWT led to significant improvements in single-leg vertical jump (d = 0.55, p &lt; 0.05), indicating enhanced power generation and ankle functionality that were not observed in the control group. Additionally, the therapy resulted in increased ankle mobility, as observed by improvements in plantar flexion and heel-rise tests. Interestingly, these functional gains were not accompanied by changes in the Achilles tendon stiffness, suggesting that the benefits of rESWT may be more functional than structural. This study highlights rESWT as a promising tool for rehabilitation, particularly following Achilles tendon injuries. The study concluded that, although rESWT appears to improve certain aspects of ankle function, further studies with a larger and more diverse population over a longer period are necessary to confirm these findings and establish comprehensive treatment protocols.

The Efficacy of Extracorporeal Shockwave Therapy Compared with Compression Therapy in Healing Venous Leg Ulcers.

Background: Innovative methods of physical therapy delivered via modern medical devices have significantly extended the possibility of applying conservative treatments in healing venous leg ulcers. The primary objective of this study was to compare the therapeutic efficacy of selected mechanical physical therapies (intermittent pneumatic compression vs. radial extracorporeal shockwave vs. focal extracorporeal shockwave) vs. standard care in the treatment of venous leg ulcers over a 4-week period. Materials: This study included 69 patients, comprising 45 females (65%) and 24 males (35%), with a mean age of 67.1 ± 8.6 years (range: from 52.0 to 80.0 years). Methods: The patients were allocated into four groups: the IPC group was treated with intermittent pneumatic compression therapy, the R-ESWT group was treated with radial extracorporeal shockwave therapy, the F-ESWT group was treated with focal extracorporeal shockwave therapy, and the SC group was treated with standard care. Results: After one month of therapy, the median percentage decrease in wound total surface area after treatment was as follows: in the IPC group, there was a 52.9% decrease (range: 3.3-100%); in the R-ESWT group, there was a 31.6% decrease (range: 2.4-95.8%); in the F-ESWT group, there was an 18.0% decrease (range: 1.9-76.1%); and in the SC group, there was a 16.0% decrease (range: 1.5-45.8%). Conclusions: All the studied therapies caused a statistically significant reduction in the surface area of venous leg ulcers. The best results were observed with the intermittent pneumatic compression, while the radial and focal extracorporeal shockwave therapies appeared less effective. The standard care alone turned out to be the least effective. Our results did not show statistically significant changes in the values of RBC deformability at the investigated shear rates.

Radiometry in a comprehensive assessment of the effectiveness of extracorporeal shock wave therapy of calcifying tendinobursopathy of the shoulder

Introduction. Uncomfortable working conditions and excessive professional loads on the shoulder joints cause a high prevalence of degenerative-dystrophic changes in the periarticular tissues. Calcifying tendinitis and bursitis occupy a special place, characterized by multifocal accumulation of calcium phosphate crystals in tendons, mucous bags and muscles. The study is devoted to solving the problem of optimizing the X-ray diagnostics of the evolution of calcifying tendinobursopathy of the shoulder (CTS) in the dynamic assessment of the effectiveness of extracorporeal shock wave therapy.&#x0D; The aims of the study to optimize the X–ray diagnosis of calcifying tendinobursopathy of the shoulder in people working under the influence of adverse production factors.&#x0D; Materials and methods. The authors conducted a comparative retrospective analysis of the results of a comprehensive dynamic clinical and X-ray examination of 155 able-bodied men aged 35-57 years with an average work experience of 14.5±2.7 years (miners, loaders, bricklayers) examined for pain syndrome and dysfunction in the shoulder joint. The main group (65 people) are patients with CTS clinic, the presence of calcifications in the periaricular tissues of the rotator cuff and in the biceps muscle of the shoulder, evaluated in dynamics after shock wave therapy (SWT) of the shoulder in the phases of rest, resorption and recovery. The comparison group (90 people) consisted of patients with the absence of instrumentally detectable signs of multifocal accumulation of calcium phosphate crystals in the periarticular tissues of the shoulder. The study included patients whose routine conservative treatment proved ineffective. The following criteria for the effectiveness of therapy were identified: pain at rest, measured using a visual analog scale (VAS); dimensions (calcification area (in mm2)); optical density and calcification density gradient. Specialists evaluated the data at the initial stage of the study before the use of therapy, immediately after treatment and 12 months after the final SWT session.&#x0D; Results. In patients of the main group with the presence of CTS, the main manifestations of shoulder-scapular periarthritis (SSP) both in the main group and in the comparison group were moderately pronounced, however, the frequency of detection of the main SSP syndromes, primarily rotator cuff lesion, as well as background pathology (arthrosis of the shoulder joint) and acromioclavicular joint) were significantly higher in the main group. The effectiveness of SWT was demonstrated by regression of pain syndrome and positive dynamics of density characteristics of periarticular tissues of shoulder joints in areas of interest (in anatomotopographic projections of localization of tendons, mucous bags and muscles). In all patients of the main group, the decalcification process was characterized by both a visually perceptible pattern of disintegration and a decrease in its area, and a decrease in optical density immediately after the end of treatment. In 36.9% of patients, 12 months after the start of SWT, the X-ray and X-ray densitometric picture confirmed the prolongation of the decalcification process up to complete lysis of foci and calcification sites.&#x0D; Conclusions. In a comprehensive assessment of the effectiveness of CTS therapy, along with traditional X-ray diagnostics, special methodological techniques of radiometry (X-ray diffraction and X-ray densitometry in areas of interest) can be used, allowing for more accurate and more objective reflection of the direction of the dynamics of changes.&#x0D; The use of X-ray calcifications in the arsenal of methodological techniques, such as area, optical density and optical density gradient, can significantly improve the quality of diagnosis and avoid the use of computed tomography and an increase in radiation exposure to the patient.&#x0D; High-energy extracorporeal shockwave therapy is largely able to solve the problem of treating resistant forms of calcifying tendinobursopathy of the shoulder.

Aesthetic Rehabilitation Medicine: Enhancing Wellbeing beyond Functional Recovery

Although rehabilitation medicine emphasizes a holistic health approach, there is still a large gap of knowledge about potential interventions aimed at improving overall wellbeing through cosmetic interventions. Therefore, this narrative review investigates the role of different rehabilitative techniques in enhancing aesthetics, quality of life, and psychosocial wellbeing for patients with disabilities. The study follows the SANRA framework quality criteria for a narrative review. Literature searches across PubMed/Medline, Web of Science, and Scopus identified articles focusing on rehabilitation strategies within the aesthetic rehabilitation domain. The review identified evidence supporting injection procedures, such as Botulinum Toxin, Platelet-Rich Plasma, Hyaluronic Acid, Ozone, and Carboxytherapy, and assessing their applications in several disabling disorders. Additionally, physical therapies like Extracorporeal Shock Wave Therapy, Laser Therapy, Microcurrent Therapy, Tecar Therapy, and physical exercises were explored for their impact on cutaneous microcirculation, cellulite treatment, wound healing, and scar appearance improvement. Lastly, the manuscript underlines the role of manual therapy techniques in addressing both physical discomfort and aesthetic concerns, discussing their effectiveness in adipose tissue therapy, scar tissue mobilization, and regional fat thickness reduction. Taken together, this review emphasizes the role of a multidisciplinary approach, aiming to provide valuable insights into potential benefits for both functional and aesthetic outcomes.

Effect of Focal Zone Size on Treatment Outcomes and Renal Injury Following Extracorporeal Shockwave Lithotripsy of Renal Calculi: A Prospective Randomized Study.

Background: The narrower focal zone (FZ) size of modern lithotripter was considered as one of the factors that resulted in suboptimal treatment result of extracorporeal shockwave lithotripsy (SWL). Therefore, we investigate the efficacy and safety of standard narrow or extended (FZ) sizes in SWL for patients with renal stones. Materials and Methods: In this prospective study conducted between April 2018 and October 2022, patients with renal stones were randomized to receive SWL with either standard or extended FZ. Treatment was delivered using a Modulith SLX-F2 lithotripter with a maximum of 3000 shocks at 1.5 Hz. The primary outcome was treatment success 12 weeks after a single SWL session, defined as the absence of a stone or stone fragment <4 mm on computed tomography. Secondary outcomes included the incidence of perinephric hematoma, stone-free rate (SFR), and changes in the urinary levels of acute renal injury markers. Results: A total of 320 patients were recruited, and 276 patients were randomized into the two groups. The two groups had similar baseline parameters. The treatment success rate was significantly better for standard FZ (74.3%) than the extended FZ group (59.3%) (p = 0.009). Standard FZ also had a significantly better SFR (Grade-A, 36.8% vs 23.0%, p = 0.013) and less pain after treatment. Both groups had similar perinephric hematoma formation rates, unplanned hospital admission rates, and changes in urinary acute renal injury markers. Conclusions: The standard narrow FZ has better treatment efficacy and similar safety compared with the extended FZ during SWL for renal stones. This clinical trial has been registered in the public domain (CCRBCTR) under trial number CUHK_CCRB00510.

Variation coefficient of stone density and renal cortical thickness: the parameters evaluating non-contrast computed tomography imaging for predict extracorporeal shock wave lithotripsy success.

The stone density (SD) is not the same in all parts of the stone due to the heterogeneous nature of the stone and the shock wave (SW) passes through tissues of many different densities until it reaches the stone. These factors affect the success of Extracorporeal Shock Wave Lithotripsy (ESWL). We aimed to evaluate the effect of the Variation Coefficient of Stone Density (VCSD) and Renal Cortical Tickness (RCT) on the success of ESWL. Between 2020 and 2023, 510 patients who underwent ESWL were divided into 2 groups treatment success (n:304) and treatment failure (n:206). Non-Contrast Computed Tomography (NCCT) imaging values of hydronephrosis degree of the kidney, stone location, stone volume (SV), stone-skin distance (SSD), SD, Standard deviation of Stone Density (SDSD), VCSD, RCT, Soft-Tissue Thickness (STT), Muscle Thickness (MT) were analyzed. VCSD value was obtained by dividing SDSD by SD. Along the SW, tissues were divided into three components: kidney (renal cortex), muscle and other soft tissues. RCT, MT and SSD were measured at three different angles (0°, 45°, and 90°) and these 3 lengths were averaged. In univariate analysis, Body Mass Index (BMI), SV, SD, VCSD, SSD, RCT and STT were demonstrated to affect ESWL success. In multivariate analysis, low BMI, SV, SD, RCT and large VCSD were significant independent predictors of ESWL success. Among these parameters, VCSD had the highest prediction accuracy, followed by SD, SV, RCT and BMI, respectively. This study demonstrated that VCSD value and RCT are predictive parameters in determining the treatment of patients with urinary calculi and selecting suitable ESWL candidates.

Advancements in De Quervain Tenosynovitis Management: A Comprehensive Network Meta-Analysis

This study presents a network meta-analysis aimed at evaluating nonsurgical treatment modalities for De Quervain tenosynovitis. The primary objective was to assess the comparative effectiveness of nonsurgical treatment options. The systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Searches were performed in multiple databases, and studies meeting predefined criteria were included. Data extraction, risk of bias assessment, and statistical analysis were carried out to compare treatment modalities. The analysis was categorized into short-term (within six weeks), medium-term (six weeks up to six months), and long-term (one year) follow-up. The analysis included 14 randomized controlled trials encompassing various treatment modalities for De Quervain tenosynovitis. In the short-term, extracorporeal shockwave therapy demonstrated statistically significant improvement in visual analog scale pain scores compared with placebo. Extracorporeal shockwave therapy also ranked highest in the treatment options based on its treatment effects. Corticosteroid injections (CSIs) combined with casting and laser therapy with orthosis showed favorable outcomes. Corticosteroid injection alone, platelet-rich plasma injections alone, acupuncture, and orthosis alone did not significantly differ from placebo in visual analog scale pain score. In the medium-term, extracorporeal shockwave therapy remained the top-ranking option for visual analog scale pain score, followed by CSI with casting. In the long-term (one year), CSI alone and platelet-rich plasma injections demonstrated sustained pain relief. Combining CSI with orthosis also appeared promising when compared with CSI alone. Corticosteroid injection with a short duration of immobilization remains the primary and effective treatment for De Quervain tenosynovitis. Extracorporeal shockwave therapy can be considered a secondary option. Alternative treatment modalities, such as isolated therapeutic injection, should be approached with caution because they did not show substantial benefits over placebo. Therapeutic I.

Efficacy and safety of extracorporeal shock wave therapy combined with sodium hyaluronate in treatment of knee osteoarthritis: a systematic review and Meta-analysis.

To assess the efficacy and safety of extracorporeal shockwave therapy (ESWT) combined with sodium hyaluronate (HA) for the treatment of knee osteoarthritis (KOA). PubMed, Embase, the Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang database, China Science and Technology Journal Database, and SinoMed were searched from inception to July 2020. The quality of the randomized controlled trials was evaluated independently by two reviewers according to the criteria in the Cochrane Collaboration for Systematic Reviews. The identified articles were then screened individually using EndnoteX9 for eligibility in this Meta-analysis. The heterogeneity among the articles was evaluated using I2. A total of 17 studies, comprising 2000 individuals, were included in this Meta-analysis. The results showed that a significant improvement was observed in knee pain and function based on the clinical efficacy of ESWT combined with HA. Statistical analysis of clinical efficacy showed that [relative risk (RR) = 1.21, 95% confidence interval (CI) (1.12, 1.30), P < 0.01]. Statistical analysis of visual analog scale showed that [standardized mean difference (SMD) = －2.84, 95%CI (－4.01, －1.66), P < 0.01]. Western Ontario and McMaster University osteoarthritis index statistical analysis showed that [SMD = －1.57, 95% CI (－2.52, －0.61), P < 0.01]. Lysholm score statistical analysis showed that [SMD = 1.71, 95% CI (0.98, 2.44), P < 0.01]. In addition, only minor side effects, such as redness and swelling of the skin, were observed. Medium to low quality evidence showed that ESWT combined with HA offers an inexpensive, well-tolerated, safe, and effective method to improve pain and functionality in patients with KOA. However, tightly controlled, randomized, large multicenter trials are warranted to validate the current findings.

449 The Efficiency of Non-surgical Therapies for the Treatment of Mortons Neuroma: A Systematic Review

INTRODUCTION: Morton’s neuroma or Intermetatarsal neuroma is a benign inflammation of the peripheral nerves in the feet causing sharp, burning metatarsalgia and significant morbidity while walking, running, etc. It occurs more in females because tight shoe styles put pressure on the nerve. METHODS: Keyword search of “Morton’s Neuroma”, “treatment”, “conservative” and “non-surgical” was conducted across MEDLINE, EMBASE, and Cochrane databases. Two cohort studies and seven Randomised Controlled Trials were included for review following PRISMA guidelines. These studies were reviewed for pain relief, functionality, and limitations of each procedure. RESULTS: Methylprednisolone injections were proved to reduce the Visual Analog Scale score with &gt;50% cases showing no difficulty in functional daily activity at 9 months post-procedure. Short-term relief was achieved by alcohol and capsaicin injections independently. Modifications in the shoe insole indicated better functionality and analgesia compared to a flat insole but combined with steroids it showed better outcomes. Extracorporeal shockwave therapy provided relief for up to 3 months compared to radiofrequency ablation which provided relief for a longer period. CONCLUSIONS: Although these procedures show statistically significant changes, they are not without limitations. Well-designed randomized controlled trials looking into the avenues for radiofrequency ablation and shockwave therapies as opposed to surgical excision of neuromas are vital.

Extracorporeal Shockwave Treatment as Additional Therapy in Patients with Post-Stroke Spasticity of Upper Limb-A Narrative Review.

Stroke is a severe injury of the central nervous system (CNS) and one of the leading causes of long-term disability and mortality. One of the main symptoms of neurological diseases is spasticity. This is defined as a motor condition characterized by a velocity-dependent increase in tonic stretch reflexes with exaggerated tendon jerks and resulting in the hyperexcitability of the stretch reflex. Rehabilitation after a stroke is focused on relearning lost skills and regaining independence. Many new methods in neurorehabilitation have been introduced. This review concentrates on the current evidence for extracorporeal shockwave therapy (ESWT) as a noninvasive alternative to treat spasticity. We present the effect of EWST and radial EWST interventions to post-stroke patients with spasticity in the upper limb. Our collected data suggest that different parameters of shockwaves can be used to achieve functional improvementsin the upper limb after a stroke. Our accumulated data imply that ESWT is safe and can be used for pain relief, reduced muscle tension, and an increased range of motion. According to many studies, complications after shockwave treatment are infrequent. Transient complications after shockwave therapy (ESWT) include redness, tingling, pain, and bruising. We reviewed clinical trials that present the possible benefits in upper-limb function after shockwave therapy for post-stroke patients. In this article, we used many database search engines, including PEDro. In the stroke rehabilitation literature, a key methodological problem is the design of double-blind studies, which very often are not feasible.

Efficacy and safety of extracorporeal shock wave lithotripsy (ESWL) in pielic stones and infected hydronephrosis after double-J stent insertion

Efficacy and safety of extracorporeal shock wave lithotripsy (ESWL) in pielic stones and infected hydronephrosis after double-J stent insertion

A randomized controlled trial evaluating low-intensity shockwave therapy for treatment of persistent storage symptoms following transurethral surgery for benign prostatic obstruction.

Low-intensity shockwave therapy (Li-SWT) can improve bladder function through enhancement of angiogenesis and nerve regeneration and suppression of inflammation and overactivity. In this trial, we aimed to evaluate the efficacy of Li-SWT on persistent storage symptoms after transurethral surgery (TUS) for benign prostatic obstruction (BPO). Between July 2020 and July 2022, 137 patients with persistent storage symptoms; urgency episodes/24 h ≥ 1 and daytime frequency ≥8, for at least three months after TUS for BPO were randomly allocated to Li-SWT versus sham versus solifenacin 10 mg/day in 3:1:1 ratio. The primary end point was the percent reduction from baseline in overactive bladder symptom score (OABSS) at 3-month follow-up. The changes in 3-day voiding diary parameters, quality of life (QoL) score, peak flow rate and residual urine at 3 and 6-month follow-up were compared. Treatment-related adverse effects were also evaluated. Baseline data were comparable between groups. The percent reduction from baseline in OABSS at 3-month follow-up was significantly higher in Li-SWT compared to sham (-55% versus -11%), and it was comparable between Li-SWT and solifenacin-10 (-55% versus -60%). Li-SWT achieved significant improvement like solifenacin-10 in 3-day voiding diary parameters and QoL score at 3-month follow-up. This improvement remained comparable between Li-SWT and solifenacin-10 at 6-month follow-up. No adverse effects related to Li-SWT were noted apart from tolerable pain during the procedure. Solifenacin-10 was associated with bothersome adverse effects in 73% of the patients with 11.5% discontinuation rate. Li-SWT ameliorates persistent storage symptoms and promotes QoL after TUS for BPO, with comparable efficacy and better tolerance compared to solifenacin.

The role of manual correction methods and extracorporeal shock wave therapy in the prevention of chronic tension headaches

Introduction. Tension-type headache is an urgent problem in the modern medicine due to a significant decrease in the efficiency and quality of patient′s life, despite the benign nature of the disease.The aim of the study is to develop and scientifically substantiate the comprehensive application of extracorporeal shock wave therapy and manual methods of preventive treatment of the chronic tension-type headache.Materials and methods. The prospective randomized study included 90 patients with tension-type headache (chronic), G44.2, and 20 healthy patients in the age from 24 to 50 years. Participants were divided into 3 equal groups with 30 participants in each one. In the I group the pharmacotherapy with amitriptyline was performed, in the II group — manual treatment, and in the III group — complex rehabilitation with manual methods of treatment and extracorporeal shockwave therapy. Additionally, 20 healthy patients were included in the study (group IV). To assess the treatment effectiveness the following methods were used: a headache diary, manual examination, NRS scale, HADS scale.Results. The data obtained demonstrated that the combined use of manual treatment and extracorporeal shock wave therapy, as well as single-impact manual treatment methods, contributes to clinical improvement to a greater extent than pharmacotherapy. A comparative analysis of the study groups in the long-term follow-up period (after 3 months) showed more significant results in the group with comprehensive rehabilitation, which is clearly reflected in the form of a significant decrease in pain intensity and overall pain score. The methods used significantly improved the psycho-emotional status of patients, however, pharmacotherapy with amitriptyline was accompanied by side effects.Conclusion. The comprehensive application of extracorporeal shock wave therapy and manual methods of treatment leads to a significant improvement in both clinical and psycho-emotional states of patients with tension-type headache.

Community-Acquired Infection among the Hospitalized Renal Stone Patients

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

(O-23) EFFECTIVENESS OF COMPREHENSIVE TREATMENT FOR ERECTILE DYSFUNCTION WITH MEDICATION AND SHOCKWAVE THERAPY: A REAL-LIFE STUDY

Abstract Objective To evaluate the effectiveness of adding shockwave therapy to pharmacological treatment in a cohort of men with erectile dysfunction in Colombia and Peru. Methods Observational cohort study. Patient records from those treated for erectile dysfunction in 2022 were reviewed. Patients over 18 years old, without other sexual dysfunctions were included. Changes in the IIEF-EF questionnaire score and the proportion of patients achieving penetration capability (EHS &amp;gt;2) after treatment were assessed. Results 317 patients met the criteria and were included in the analysis. 150 received medication only (group 1) and 167 received shockwave therapy + medication (group 2). The median duration of treatment was 4.8 months for group 1 and 5.6 months for group 2. The initial IIEF-EF score for group 1 was 15.8 (+/-5.4) and the average increase at the end of treatment was 7.35 (+/-5.4) points. In group 2, the initial IIEF-EF was 14.7 (+/-4.9) and the average increase was 7.47 (+/-5.8). At the end of treatment, 39.3% of patients in group 1 and 42.5% in group 2 reported no ED according to the IIEF-EF score. The proportion of patients who could not achieve penetration (EHS &amp;lt;=2) before treatment and achieved sufficient rigidity for penetration (EHS &amp;gt;2) after treatment was 85% in group 1 and 94% in group 2. Conclusions The additional use of shockwave therapy improves the outcomes of pharmacological treatment in patients with ED. Financing Boston Medical Group.

A Review of Common Interventions and Preventive Options Used in the Treatment of Plantar Fasciitis

Plantar fasciitis is a frequent, chronic ailment that significantly affects day-to-day functioning. This review takes a deep look at the different therapies and preventions used in the treatment of this condition to improve foot function, reduce pain, and improve patient outcomes. The efficacy of common treatment options such as physical therapy, medication, stretching, night splints, therapeutic ultrasound, and extracorporeal shock wave therapy has been mentioned again in this study. Moreover, the importance of injection treatment and surgery also play a significant role in the management of plantar fasciitis. In addition to conventional treatment, the health care professional also needs to pay attention to the prevention of this overuse foot injury. The available approaches involve stretching the particular posterior muscles of the low limbs. Eventually, the impact of interdisciplinary considerations, including physiological factors and strength training methods, on plantar fasciitis was explored in order to provide a certain theoretical basis for clinical practice.

PERIOPERATIVE ANTIBIOTIC PROPHYLAXIS IN UROLOGICAL SURGERY: AN UPDATE SYSTEMATIC REVIEW

Background: Perioperative antibiotic prophylaxis (PAP) is provided to avoid local or systemic infections, such as surgical site infections (SSI), urinary tract infections (UTI), or sepsis. However, PAP may not be effective in reducing symptomatic UTI in some procedures, such as extracorporeal shock wave lithotripsy and cystoscopy. The aim: This study aims to determine the effectiveness of perioperative antibiotic prophylaxis in urological surgery. Methods: By comparing itself to the standards set by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, this study was able to show that it met all of the requirements. So, the experts were able to make sure that the study was as up-to-date as it was possible to be. For this search approach, publications that came out between 2014 and 2024 were taken into account. Several different online reference sources, like Pubmed, SAGEPUB, and ScienceDirect, were used to do this. It was decided not to take into account review pieces, works that had already been published, or works that were only half done. Results: In the PubMed database, the results of our search brought up 105 articles, whereas the results of our search on SAGEPUB brought up 6 articles, our search on ScienceDirect brought up 129 articles. In the end, we compiled 9 papers, 7 of which came from PubMed, and 2 of which came from ScienceDirect. We included nine research that met the criteria. Conclusion: Perioperative antibiotic prophylaxis (PAP) can lower SSI, UTI, and sepsis incidences in urological surgery. In addition, PAP showed a lower positive blood culture. To minimize side effects and lower the risk of drug-resistant organisms, the use of reasonable PAP is advised.