Lithotripsy Therapy Research Articles

Does Previous Open Nephrolithotomy or Failed Extracorporeal Shock Wave Lithotripsy Therapy Affect Percutaneous Nephrolithotomy Performance and Outcome?

Does Previous Open Nephrolithotomy or Failed Extracorporeal Shock Wave Lithotripsy Therapy Affect Percutaneous Nephrolithotomy Performance and Outcome?

Shockwave Therapy: Still Little Known Issues

Background: In the last few years the development of Extracorporeal shock wave therapy (ESWT) was very fast. Shock waves can help reduce inflammation in muscoloskeletal areas of the body. At the first time medical ESWT was used in urologic discipline for lithotripsy therapy later the opportunity of transmit mechanical energy by shock waves led to different technical and medical applications. Aim: to evaluate the different indications for ESWT in more or less frequent orthopedic pathologies. Material and Method: We enrolled 423 patients: 174 males and 249 females. All people presented orthopedic disease with specific therapeutic indication to ESWT in skeletal segments. Conclusion: The therapeutic efficacy of ESWT is still unclear for less frequent orthopedic pathologies. Further studies needed to improve the quality of the health care preventing chronic painful disease.

A randomized, double-blind, placebo-controlled clinical trial of the use of hydroxycitric acid adjuvant to shock wave lithotripsy therapy in patients with calcium stones. Stone fragmentation results

A randomized, double-blind, placebo-controlled clinical trial of the use of hydroxycitric acid adjuvant to shock wave lithotripsy therapy in patients with calcium stones. Stone fragmentation results

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.

1145 BAIL-OUT INTRAVASCULAR CORONARY LITHOTRIPSY FOR THE TREATMENT OF STENT IN-STENT UNDER EXPANSION

Abstract Background in-stent restenosis remains a significant clinical problem for which optimal treatment is under debate. Intravascular lithotripsy (IVL) is mostly used for safe and effective treatment of de novo coronary calcifications, while the use of this technology to support bailout procedures, including stent under-expansion, is still off-label. One of the advantages of lithotripsy is the possible use after stent deployment. Case presentation a 66-year-old male patient was admitted to our Institution due to a medically refractory angina and a coronary computed tomography (CCT) detecting three vessel disease with multiple critical stenosis. The patient had multiple comorbidities including history of hypertension, dyslipidemia, type 2 diabetes and multiple myocardial rivascularization. In 2003 he underwent coronary artery by-pass (CABG) with left internal mammal artery (LIMA) to left anterior descending (LAD) artery and free saphenous vein graft (VG) to the ramus intermedius (RI). In 2009 the patient underwent percutaneous coronary intervention (PCI) of the right coronary artery (RCA) with the implantation of a stent at the central segment, and a second stent at the crux cordis. For recurrent in-stent restenosis of the stent previously implanted at the central segment the patient was treated in 2013 with percutaneous balloon angioplasty (POBA) and in 2017 with the implantation of another drug eluting stent (Resolute Onyx, Medtronic, Santa Rosa, California) overlapping the proximal part of the scaffold. Coronary angiography revealed, a severe coronary artery disease with 80% stenosis of distal left main. The LAD was occluded at the middle segment and the ramus presented 99% stenosis at the proximal segment. The RCA had a diffuse severe in-stent restenosis involving the Resolute Onyx stent. Therefore, the operator decided to treat the restenosis with a direct stenting (Xience, Abbott Vascular Santa Clara, USA), but he was unaware of the fact that there was already an Onyx stent that was barely visible. After implantation, an inadequate expansion of the stents was observed (Figura 1A-B), which persisted despite post-dilation with non-compliant balloon (NCB) at high-pressure (Figure 1C). Given the persistence of stents under-expansion, it was decided to perform bail-out intravascular lithotripsy (IVL) therapy with a Shockwave balloon catheter (Figure 2A). The stent was then post-dilated with a NCB (Figure 2B). The final angiographic image and intravascular ultrasound (IVUS) showed an optimal stent expansion (Figure 3). Conclusion intravascular lithotripsy could be used to treat undilatable stent-in-stent restenosis. Of interest, the case presented demonstrated, for the first time, the possible use of IVL in 2-stent layers, with an optima final stent expansion.

Abstract 14140: Efficacy of Coronary Intravascular Lithotripsy Therapy on Severely Calcified Coronary Stenoses

Introduction: Intravascular lithotripsy (IVL) is rapidly proving its effectiveness in modifying calcific coronaries. IVL causes cracks in calcium with acoustic waves Fig1 (A-D). Hypothesis: IVL is effective in calcific coronary artery modification. Methods: Study aims to assess the effectiveness in calcific coronary artery modification. This study is a prospective, single arm single center study designed to assess the effectiveness of the IVL. The primary endpoint is to determine the extent of procedural success. The calcium modification is assessed by optical coherence tomography (OCT). Based on OCT imaging the percentage of stent expansion after IVL was categorized into ‘Optimal’ and ‘Suboptimal’ and ‘Subpar’ outcomes. Results: Patients (n:26; M:17; F:9) were enrolled in last 6 months. IVL was used in 22 LAD (84.6%) and 4 RCA (15.4%). Mean calcified segment length was 33.8 mm, mean angle of calcium arc was 202.3 degrees and superficial calcific lesions were 5 out of 26 (19.2%). OCT demonstrated multiplane and longitudinal calcium fractures after IVL in all (100%) lesions. There were no subpar outcomes among our cohort. 19 patients (73%) had optimal outcomes and 7 (27%) had suboptimal but acceptable outcomes. Final in-stent gain in diameter at maximum stenotic area was 1.83±0.67mm. Out of 7 patients with sub-optimal (80-95%) stent expansion, 5 patients were found to have superficial calcific lesion. Similarly, out of 20 deep calcific lesions only 2 patients had sub-optimal stent expansion. Conclusions: IVL typically causes circumferential calcium fractures in several planes like circumferential, transmural planes, and thus seldom results in uniplanar "troughs" arising with atherectomy technologies due to guidewire bias. Procedural success achieved in 100% in our cohort. Superficial calcific lesions had strong association with sub-optimal stent expansion outcome (p: 0.000383). IVL is proving to be a valuable tool in dealing with coronary calcification.

Clinical Characteristics of Patients With Chronic Pancreatitis With or Without Prior Acute Pancreatitis Are Different

The aim of the study is to clarify the clinical characteristics of patients with chronic pancreatitis (CP) who had no prior acute pancreatitis (AP) attack. We retrospectively analyzed patients with CP who were admitted to our center between January 2012 and January 2020. A total of 274 patients were divided into the following 3 groups: group A: CP without prior AP (n = 103 [37.6%]), group B: CP preceded by a single episode of AP (n = 39 [14.23%]), and group C: CP preceded by recurrent AP (n = 132 [48.18%]). At the diagnosis, patients in group A had a higher incidence of pancreatic duct stones (41.7% vs 25.8%, P = 0.012), higher proportion of idiopathic CP (68.9% vs 48.5%, P = 0.001), and higher mean pancreatic volume change rate (37.61% vs 10.48%, P = 0.007) compared with Group C. Patients in group A underwent the most episodes of extracorporeal shockwave lithotripsy therapy among the 3 groups (P < 0.001). Approximately 37.6% of patients had no prior AP attack before CP diagnosis. Patients with CP without prior AP had higher incidence of pancreatic duct stones and pancreas volume shrank faster.

Risk Factors for Intra-operative Bleeding in Percutaneous Nephrolithotomy in an Academic Center: A Retrospective Study.

Percutaneous nephrolithotomy (PNL) is the treatment of choice for renal stones as a safe, effective, and minimally invasive method. However, bleeding remains a major concern in the procedure. This study aimed to investigate the risk factors of bleeding in PNL. This retrospective descriptive cross-sectional study was conducted in the Urology department of Razi hospital. The data of patients with urinary calculi staghorn type who underwent PNL in a prone position under general anesthesia were recorded. A checklist including patients' demographics, surgical characteristics, and outcomes was filled out for each patient. The data from 151 complete files were gathered. The mean age of the cases was 47.89 ± 12.41 years. The mean hemoglobin (Hb) drop was 1.92 ± 1.56 mg/dL. At least 1 mg/dL Hb drop was observed in all cases. The highest Hb drop was 3 mg/dL.). There was no significant relationship between stone bulk, age, BMI, GFR, surgery duration, and the number of tracts, and Hb drop during PNL (P > 0.05). But there was a positive correlation between Urinary Tract Infection (UTI) history (P = 0.01) and transfusion (P = 0.0001) and Hb drop during PNL. Also, the history of open kidney surgery (P = 0.031), nephrostomy insertion (P = 0.003), and extracorporeal shock wave lithotripsy therapy (ESWL) (P = 0.041) were correlated with the increased risk of Hb drop. Urinary tract infection, history of open surgery, nephrostomy implantation, and ESWL were significantly associated with more bleeding in PNL.

Could "Retrograde Intrarenal Surgery" be Used as an Efficient Technique in the Treatment of Calyceal Diverticula Stones.

To evaluate the efficacy of retrograde intrarenal surgery (RIRS) and holmium laser lithotripsy in the treatment of symptomatic renal calyceal diverticular (CD) stones. A case series. Department of Urology, Hisar Intercontinental Hospital, from 2008 and 2019. Patients who underwent holmium laser lithotripsy with RIRS to manage symptomatic CD stones were evaluated retrospectively. Demographics, stone size, operation and hospital stay duration, the success of treatment and complications were noted. Among the 30 treated patients, 13 patients were female and 17 were male. The mean age was 45.4 ± 11.9 (26-64), the stone diameter was 14.4 ± 4.1 mm, operation time was 70.47±35.7 (35-155) minutes, and mean length of hospital stay was 1.27±0.5 (1-3) days. In those patients who underwent RIRS, 26 (86.7%) were successfully treated while in 4 of 30 patients (13.3%) the procedure was not successful. Complications were observed in 10 (33.3%) patients. Clavien-I complications were demonstrated in 6 patients, Clavien III complications were demonstrated in 3 patients. One patient had urosepsis, 2 patients had ureteral laceration, and one patient with Clavien IV complication had perirenal hematoma. Laser lithotripsy therapy with RIRS is a safe and effective treatment for symptomatic calyceal diverticular stones and can be offered as the first-line treatment for calyceal diverticular stones. Calyceal diverticula, Stone disease, Flexible ureterorenoscopy, Holmium laser, RIRS.

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

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

Use of the Shock Wave Therapy in Basic Research and Clinical Applications-From Bench to Bedsite.

Shock Waves (SW) are acoustic disturbances that propagate through a medium carrying the energy. These specific sonic pulses are composed of two phases—high positive pressure, a rise time < 10 ns, and a tensile wave. Originally Shock Waves were introduced to clinical practice as a part of the lithotripsy therapy focused on disrupting calcific deposits in the body. Since that time, shock wave therapy (SWT) has gone far beyond the original application related to the destruction of kidney stones. In this narrative Review, we present basic clinical applications of the SWT along with the potential therapeutic application in clinical practice.

Furosemide improves the stone clearance rate of extracorporeal shockwave lithotripsy for kidney stones but not ureteral stones: a systematic review and meta-analysis.

Introduction:We conducted a meta-analysis (MA) to investigate the effects of furosemide on the prognosis of extracorporeal shockwave lithotripsy (SWL) therapy to remove renal (RS) and ureteric stones (US).Methods:We screened scientific databases including PubMed, Clinicalkey, Google Scholar, Medline, Embase, and Cochrane, from the date of establishment until March 2022, to search for randomized controlled trials evaluating SWL, in combination with furosemide (experimental group) or with SWL alone (control group), in treating RS or US. Our search terms included furosemide, extracorporeal SWL, and urolithiasis. For this MA, we employed the Cochrane Collaboration’s RevMan version 5.3.0.Results:Six trials, involving 1344 participants, with RS (n = 1097) and/or US (n = 247), met our predefined criteria. This included 137 proximal ureteral stones (PUSs), 35 mid-ureteral stones (MUS), and 75 distal ureteral stones (DUS). In case of RS, the experimental group exhibited significantly enhanced clearance, relative to controls (risk ratio [RR] = 1.16, 95% confidence interval [CI] = 1.07–1.25, p = 0.0002), yet there was no obvious difference in the PUS, MUS, and DUS (RR = 1.14, 95% CI = 0.97–1.33, p = 0.10; odds ratio [OR] = 1.26, 95% CI = 1.40–3.95, p = 0.69; RR = 1.21, 95% CI = 0.99–1.49, p = 0.06). There was also no marked difference between fragmentations in either group. Only reports of SWL treatment of RS provided adequate data on shocks, sessions, and complications for our analysis. Unfortunately, there was no significant alteration between the two groups.Conclusion:According to our analysis, furosemide strongly accelerates the clearance rate of SWL-treated RS. However, it does not enhance the fragmentation rate. Given this evidence, we propose that furosemide does not significantly improve the efficacy of SWL therapy in removing US.Registration:Our work is registered with PROSPERO (CRD42020204780).

Primary Angioplasty of Calcified Coronary Lesions Using Coronary Lithotripsy in Acute ST-Segment Elevation Myocardial Infarction.

This study reports procedural and short-term clinical outcomes from a real-world series with the use of coronary lithotripsy in the context of primary angioplasty in ST-segment elevation myocardial infarction (STEMI). This was a prospective registry conducted at 2 hospitals, which included 10 patients who presented a culprit calcified lesion within acute STEMI and underwent coronary lithotripsy during primary angioplasty, between July 2019 and July 2020. Mean age was 69.2 ± 11.8 years, and there was a high proportion of hypertension (70%) and dyslipidemia (60%). All lesions (type B/C) were predilated with a semicompliant balloon. Coronary lithotripsy was performed in all cases once macroscopic thrombus was successfully retrieved by thrombus aspiration catheter. Before lithotripsy, rotational atherectomy was used in 1 case and cutting balloon was used in 2 cases. On average, coronary lithotripsy required the use of 1 lithotripsy balloon (range, 1-2) delivering a mean of 70 pulses. Two lithotripsy balloons were ruptured during lithotripsy therapy without any adverse event. Successful coronary lithotripsy was achieved in 90%. There were no periprocedural cardiac complications. Coronary lithotripsy seems to be a safe and effective technique in patients with STEMI and a culprit calcified lesion undergoing primary angioplasty for calcium modification in the absence of angiographic thrombus, and a suitable option to achieve adequate stent expansion and apposition.

Association between renal urolithiasis after extracorporeal shock wave lithotripsy therapy and new-onset hypertension: an updated meta-analysis.

ObjectiveThe long-term effect of extracorporeal shock wave lithotripsy (SWL) is still controversial. A previous meta-analysis showed no association between new-onset hypertension and entire upper urinary urolithiasis after SWL. Recently, there have been some reports on this topic. Therefore, we aimed to examine the association between new-onset hypertension and nephrolithiasis after SWL therapy.MethodsEmbase, the Cochrane Central Search Library, and PubMed were used to search for reports on new-onset hypertension and patients with nephrolithiasis after SWL. A meta-analysis of the association between new-onset hypertension and nephrolithiasis after SWL was carried out. The data of relevant research were synthesized and the relative risk was computed.ResultsSeven eligible studies were included in our meta-analysis. There was a significant association between nephrolithiasis after SWL and new-onset hypertension. The overall relative risk with a 95% confidence interval was 1.21 (1.11–1.31) in a fixed-effects model.ConclusionOur meta-analysis suggests an association between new-onset hypertension and patients with nephrolithiasis after SWL, which is in contrast with the finding of a previous meta-analysis.

Factors affecting the success of pediatric extracorporeal shock wave lithotripsy therapy: 26-year experience at a single institution.

Despite its widespread use, few studies have evaluated the success of extracorporeal shock wave lithotripsy (ESWL) in pediatric patients with several parameters and a large group of patients. In the present study, we aimed to analyze the factors that affect the outcomes of pediatric ESWL treatment, which we have practiced for 26 years. This study included 1012 pediatric patients who underwent ESWL between March 1991 and November 2017. Pre-procedure radiological evaluations were performed using kidney-ureter-bladder and/ or urinary system ultrasonography. Demographic data, stone characteristics, and ESWL treatment data and complications were recorded and univariate and multivariate analyses were performed for the stone-free rate (SFR). Receiver operating characteristic (ROC) analysis was performed to determine the cut-off values for stone size to predict ESWL success for both kidney and ureteral stones. Age, body mass index (BMI), congenital renal anomaly, stone location, stone size, number of stones, and stone composition significantly affected the SFRs in univariate analysis; however, only age, BMI, stone location, and stone size were significant in the multivariate analysis. If no residual fragments were detected after three sessions of ESWL application, the procedure was considered successful. The cut-off stone size values for the kidney and ureter that predicted treatment success were 96.28 mm2 and 44.16 mm < sup > 2 < /sup > , respectively. ESWL is an effective and safe treatment in the pediatric age group that provides high SFRs. Age, BMI, and stone location, size, and composition are particularly critical factors that can predict the success of ESWL.

Impact of previous SWL on ureterorenoscopy outcomes and optimal timing for ureterorenoscopy after SWL failure in proximal ureteral stones.

We aimed to evaluate the impact of previous unsuccessful shock wave lithotripsy (SWL) therapy on ureterorenoscopy (URS) outcomes in proximal ureteral stones and to define whether there is any optimal timing for safe URS after SWL. The patients who underwent URS for proximal ureteral stones between the years 2015 and 2018 in eight centers were included. Patients were divided into two groups according to previous SWL history; group 1 consisted of patients without SWL before URS for the stone [SWL (-)] and group 2 consisted of patients with a previous SWL for the stone [SWL (+)]. Demographics, operation outcomes and stone characteristics were compared between these two groups. Regarding the complication and success rates, optimal timing for URS after SWL for the stone was calculated with receiver operator characteristics curve analysis. Totally 638 patients were included (group 1: 466 patients and group 2: 172 patients). The operation and hospitalization times, rate of ureteral stenting and complications were significantly higher in group 2. Stone free status was similar between the groups. Optimal timing for URS after SWL was calculated as 16.5days (AUC = 0.657, p = 0.012) with a sensitivity of 68% and specificity of 72%, regarding the complication rates. Complication rates were significantly higher in patients who were operated before 16.5days (27.7% vs 6.5%, p < 0.001). The optimal timing; 2-3weeks delay of the URS procedure after unsuccessful SWL may decrease complication rates according to our results.

Hiroaki Shimokawa.

Hiroaki Shimokawa.

Laser Lithotripsy vs. Conventional Therapy for Complex Bile Duct Stones

Approximately 90% of common bile duct stones can be removed by conventional biliary sphincterotomy and balloon extraction during endoscopic retrograde

Tu1407 Randomized Trial of Cholangioscopy-Guided Laser Lithotripsy vs. Conventional Endoscopic Therapy for Large Bile Duct Stones

Tu1407 Randomized Trial of Cholangioscopy-Guided Laser Lithotripsy vs. Conventional Endoscopic Therapy for Large Bile Duct Stones

Extracorporeal shockwave lithotripsy under sedoanalgesia for treatment of kidney stones in infants: a single-center experience with 102 cases.

We present the efficacy of shockwave lithotripsy (SWL) therapy administered with sedoanalgesia in infants with kidney stones. We enrolled 102 patients aged 5-24 months who had kidney stones and received SWL therapy under sedoanalgesia using a Siemens Lithostar Modularis device. Patient and stone characteristics, therapy parameters, pain score, complications, discharge time, and follow-ups were registered and evaluated. Pain score was assessed using a Neonatal Infant Pain Score (NIPS). Postanesthetic discharge scoring system (PADSS) was used for the assessments of postprocedural discharge procedure. Mean age of the patients was 17.2 ± 6.3 months (5-24 months). Mean stone size was 7.9 ± 3.3 mm (5-23 mm). The most common concomitant metabolic disorders were hypercalciuria and hypocitraturia. The stone-free rates of the infants were 70.6, 87.3, and 99.1 % after the first, second, and third sessions of SWL therapy, respectively. The mean NIPS scores procedure during, and at 1 h after SWL procedure were determined as 0.24 ± 0.45 and 0.34 ± 0.47, respectively. There was no statistically significant difference between two pain score values (P = 0.114). The mean discharge time of patients after the SWL procedure were 108.6 ± 27.9 min. Forty-two patients (41.1 %) were followed up. The follow-up period varied between 8 and 48 months (mean 19.5 months); none of those patients showed evidence of diabetes mellitus, hypertension, or renal function impairment. SWL therapy under sedoanalgesia is a safe and efficient treatment modality that can be administered with low complication rates and high stone-free rates in the treatment of renal stones in infants.