Safety Of Extracorporeal Shock Wave Lithotripsy Research Articles

The modern view on the surgical treatment of nephrolithiasis

The choice of surgical treatment for nephrolithiasis remains a matter of debate. The article is a literature review dedicated to a comparative analysis of the efficacy and safety of extracorporeal shock-wave lithotripsy (ESWL) and endoscopic methods for the treatment of nephrolithiasis. The literature review was based on the analysis of articles published in the PubMed / MEDLINE, and eLibrary databases. Sixty publications on the topic of the review were analysed. As a result of data analysis, endoscopic therapies have a significant advantage over ESWL with comparable safety. The development and dissemination of less invasive techniques such as mini-percutaneous nephrolithotripsy and ultra-mini-percutaneous nephrolithotripsy in the future may change the approach to the surgical treatment of any form of nephrolithiasis.

What Is the Ideal Treatment for 20-30 mm Kidney Stones? Comparative Outcomes of 1197 Patients.

Background: The purpose of this study is to compare the efficacy and safety of extracorporeal shockwave lithotripsy (SWL), retrograde intrarenal surgery (RIRS), mini-percutaneous nephrolithotomy (mPNL), and standard-percutaneous nephrolithotomy (stPNL) for the treatment of 20-30 mm kidney stones. Methods: The records of 1197 patients (SWL = 149, RIRS = 205, mPNL = 525, and stPNL = 318) from 8 centers were reviewed retrospectively. Four procedures were compared for stone-free rates (SFRs), auxiliary treatment, and associated complications. Results: Initial SFRs were 43.6%, 54.6%, 86.7%, and 87.7% in SWL, RIRS, mPNL, and stPNL, respectively (P < .001), whereas the final SFRs were 71.8%, 80%, 90.5%, and 89.6% (P < .001). The rate of auxiliary treatment in the groups was 38.3%, 26.8%, 5%, and 4.4%, respectively (P < .001). The initial and final SFRs in the mPNL and stPNL groups were higher than those in SWL and RIRS groups (P < .001). The rate for auxiliary treatment was lower in the mPNL and stPNL groups (P < .001). The operation time was longer in the RIRS group (P = .005). According to the Clavien-Dindo classification, the complication rate in the SWL group was lower than that in the surgical approaches (P < .001); however, no statistical difference was detected between RIRS, mPNL, and stPNL groups. mPNL and stPNL had a higher success rate than RIRS or SWL for treating 20-30 mm kidney stones. Conclusion: In the treatment of 2-3 cm renal stones, RIRS and PNL were more effective than SWL to obtain a better SFR and less auxiliary treatment rate. Compared with RIRS, mPNL and stPNL provided a higher SFR with similar complication rates.

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.

Results of using of terpens-based medication renotinex in patients with urolithiasis after extracorporeal shockwave lithotripsy

In spite of high efficacy and safety of extracorporeal shockwave lithotripsy (ESWL), the question of reduction of this procedure complications risk continues to be relevant. In this study results of Renotinex prescription for patients with urolithiasis after ESWL are presented. Renotinex is a terpens-based drug and it has anti-inflammatory and lithokinetic properties. Inclusion of this medication in complex therapy leads to reduction of terms of stone fragments excretion, pain sensation reduction, bacteriuria frequency decrease.

Which is the best treatment of pediatric upper urinary tract stones among extracorporeal shockwave lithotripsy, percutaneous nephrolithotomy and retrograde intrarenal surgery: a systematic review

BackgroundAlthough the indications of minimally invasive treatments for pediatric urolithiasis are similar to those in adults, it is still crucial to make the right treatment decision due to the special considerations of children. This review aims to evaluate the efficacy and safety of extracorporeal shockwave lithotripsy (SWL), percutaneous nephrolithotomy (PCNL), and retrograde intrarenal surgery (RIRS) in the management of pediatric upper urinary tract stones.MethodsEMBASE, PubMed, and the Cochrane Library were searched from their first available date to March 2018. The studies that meet the inclusive criteria were included. The efficacy and safety of the treatments were assessed by means of meta-analysis of the stone free rate (SFR), complication rate, effectiveness quotient (EQ) and secondary outcome indicators.ResultsA total of 13 comparative studies were identified for data analysis. PCNL presented a significantly higher SFR compared with SWL. Similarly, the single-session SFR of RIRS was significantly higher than SWL. However, no significant difference was found between RIRS and SWL in the overall SFR. There was no significant difference between PCNL and RIRS in the SFR. Furthermore, no significant differences in complication rates were found among the three therapies. Compared with the other two treatments, PCNL had a longer operative time, fluoroscopy time and hospital stay. SWL had a shorter hospital stay, higher retreatment rate and auxiliary rate in comparison with the other two treatments. The present data also showed that PCNL presented a higher EQ than the other two treatments, and RIRS had a lower efficiency than SWL and PCNL. In the subgroup analysis of pediatric patients with stone ≤20 mm, the comparative results were similar to those described above, except for the higher complication rate of PCNL than SWL.ConclusionsAlthough SWL as an outpatient procedure provides shorter hospital stay and reduces operative time, it has a lower SFR and higher retreatment rate than the other two treatments. PCNL exhibits a higher SFR and EQ than SWL; nevertheless, it has a longer operative time and fluoroscopy time than the other two procedures. RIRS offers a similar SFR as PCNL but a lower efficiency than PCNL.

Extracorporeal shockwave lithotripsy in children: results of treatment in cases of large renal stones

Background. The incidence of kidney stone disease (KSD) in children varies from 1% to 5%. Pediatric surgery of KSD employs methods similar to surgical technologies used for adults: extracorporeal shockwave lithotripsy (ESWL), ureterolithotripsy (ULT), retrograde intrarenal surgery (RIRS), percutaneous nephrolithotomy (PCNL), open and laparoscopic lithotomy. ESWL remains the method of choice for urolithiasis management in children; however, the number of publications describing application of minimally invasive procedures (PCNL, RIRS) for large stones in children is increasing. The said existing tendency determines the need for a comparative study in order to reveal the efficiency and safety of ESWL and PCNL/RIRS as treatment methods for large stones in children. Objectives. The study results of the ESWL use in the treatment of children with stones greater than 2 cm. Materials and methods. During the period from 2013 through 2018, ESWL was performed for 146 patients (70 (47.9%) boys and 76 (52.5%) girls) to treat 170 stones. Age of the patients: 6 months to 17 years (mean age: 73 months). Stones were found on the left side in 96 (61.1%) patients, on the right side — in 58 (38.8%) cases, bilaterally — in 16 (9.41%) children. Large stones exceeding 2 cm were diagnosed in 16 patients (8 (50%) boys and 8 (50%) girls). Urolithiasis was revealed on the right side in 3 (18.7%) patients, on the left side — in 11 (68.7%) cases, bilaterally — in 2 (12.5%) children. All patients were subdivided into 2 subgroups: Subgroup I — 6 (37.5%, 7 kidneys) patients with staghorn urolithiasis, Subgroup II — 10 (62.5%, 11 kidneys) patients with non-staghorn stones. Postoperative complications were evaluated in accordance with the Clavien-Dindo classification. Results. In Subgroup I, complete elimination of C-1 stones in one patient took two ESWL sessions (16.67%). Three (50%) children needed 3 ESWL sessions. One (16.67%) child underwent 4 fragmentations. One (16.67%) patient with bilateral C-2 stones had 2 ESWL on the right side, 2 ESWL of the left-side calculus, and 1 ESWL session of stone fragments in distal ureter with prior insertion of ureteral catheter. In Subgroup II, a single ESWL session was sufficient to eliminate a calculus completely in 3 cases (30%). 2 patients (20%) had to undergo two ESWL sessions. 3 patients (30%) needed three ESWL sessions. Four ESWL sessions were carried out for one child (10%). One patient with bilateral stones underwent 2 sessions on the left side, 3 sessions on the right side, the child also had an ESWL to correct the steinstrasse condition in the lower third segment of the left ureter. Grade IIIb postoperative complications according to the Clavien-Dindo classification were observed in 1 (14.9%) patient of Subgroup I and in one (9.09%) patient of Subgroup II. No lithogenesis recurrences were registered. Conclusions. In cases of children suffering from concrements larger than 2 centimetres, ESWL is a safe and efficient procedure even without prior urine derivation resulting in lower incidence of complications compared with other minimally invasive KSD treatment technologies.

Extra corporeal shock wave lithotripsy in renal and ureteric stones: an institutional experience

Introduction:Urolithiasis is one of the most common clinical conditions in the history of medicine. Treatment methods include conservative, surgical treatment and extracorporeal shock wave lithotripsy (ESWL). Several stone characteristics are known to affect outcome of ESWL such as fragility, Hounsfield unit, size, site, composition etc. No study has been done till now regarding the efficacy and safety of ESWL in eastern Indian patients. Objectives: To assess the efficacy and safety of ESWL in the management of patients with renal and ureteral stones. Methods: 112 outpatients were treated with ESWL. Stone size, location, total number of shockwaves, stone-free rate, complications and adjunctive interventions were investigated. Chi-Square and Logistic Regression analyses were used, with p<0.05 set as the level of significance. Result & Conclusion: The authors found significant association between the size and number of stones with fragmentation status. The authors found that stones of more than 11mm size are more resistant to ESWL. Authors found statistically significant association between the number of ESWL sessions with fragmentation status. However, more than 3 sessions also did not help much. It was also found that complications were more in partially fragmented group and more adjunctive procedures were required in partially fragmented group. The authors also noticed that the stented or non stented status and total number of shocks were not significantly associated with the fragmentation status of stones.

Extracorporeal Shock Wave Lithotripsy for Large Common Bile Duct and Pancreatic Duct Stones: Efficacy, Safety and Analysis of Factors That Favor Stone Fragmentation

Abstract Background: Extracorporeal shockwave lithotripsy (ESWL) with subsequent endoscopic extraction of residual fragments is an established treatment option in technically challenging situations for extraction of pancreatic and common bile duct calculi. Common bile duct (CBD) stone fragmentation rates of 71 to 95% have been reported with ESWL, leading to final duct clearance rates of 70 to 90%. While complete clearance of 76% and partial clearance of 17% of pancreatic duct calculi have been documented with ESWL, our study was undertaken to investigate the efficacy and safety of ESWL in clearance of difficult bile duct and large pancreatic duct calculi. Methods: The study population consisted of 61 patients who had either large or difficult bile duct calculi or large pancreatic duct calculi documented on ultrasonography abdomen or magnetic resonance cholangiopancreatography (MRCP). All patients were subjected to ESWL sessions with endoscopic nasobiliary drainage (ENBD) placement till stones got fragmented. Results: A total of 1,284 patients underwent ERCP for either choledocholithiasis or pancreatic duct calculi during the study period (June 2015 to December 2016). Out of them 61 patients had either large or difficult CBD calculi or large pancreatic duct calculi. Forty (65.57%) had choledocholithiasis (Group-A) and 21 (34.42%) had chronic calcific pancreatitis (Group-B). CBD was cleared in 37 patients (92.5%) and 3 patients (7.5%) underwent surgical intervention. Main pancreatic duct (MPD) was cleared in all patients with clearance rate of 100%. Conclusions: ESWL is an effective and safe method for clearance of difficult CBD and pancreatic duct calculi. Combined efficacy of duct clearance is &gt;90%. Complications are minimal and managed conservatively.

Comparison of efficacy and safety of ESWL in paediatric and adolescent versus adult urolithiasis: A single center 5-year experience from a tertiary care hospital

ObjectiveTo retrospectively compare the efficacy and safety of extra-corporeal shock wave lithotripsy (ESWL) for renal/upper ureteric calculi in pediatric/adolescents (group 1) vs adults(group 2). Subjects and methodsMedical records of 948 patients who underwent ESWL for renal/upper ureteric calculi at a tertiary care center in North India from January 2012 to December 2017 (five years). The Dornier compact alpha-K1025163 (Dornier Med Tech) equipment was used for ESWL. We evaluated the stonefree rates, the number of ESWL sessions, use of ancillary procedures and complications between the two groups. ResultsA total of 110 patients were in group 1 and 838 patients were in group 2. The mean stone size in group 1 patients was 1.20±1.18cm2 while in group 2 it was 1.49±0.37cm2. The stone clearance rate was 85/110 (77%) for the group 1 and 545/838(65%) for group 2 patients. In group 1, a second session was required in 28/110 (25.4%) patients and the third session was required in 5/110 (4.5%) patients while in the adult group two sessions were required in 175 (20.8%) and three sessions were required in 24 (19.2%) patients. The overall complication rate in group 1 was 15/110 (13.63%) and in the group, II was 105/838 (12.5%). No statistical difference was found between post-ESWL complications and use of ancillary procedures (DJ stenting/PCNL) (p=0.067). ConclusionIn renal/upper ureteric calculi ESWL has got better efficacy, comparable safety and requires equivalent ancillary procedures in children and adolescents compared to adults.

Extracorporeal Shock Wave Lithotripsy in the Treatment of Single Ureteric Stone. Initial Data from Iraq

Background: Extracorporeal shock wave lithotripsy (ESWL) became the first line in the treatment of ureteric stone after failure of conservative treatment because of its safety, simplicity and effectiveness. It is not invasive procedure and can be done on outpatient basis without anesthesia and with few complications which is most probably temporary and treatable. The objective of this study is to evaluate the efficiency and safety of ESWL in treatment of ureteric stone in Iraq. Materials and Methods: A total of 112 Iraqi patients with ureteric stones were participated in this prospective observational study in which patients scheduled for ESWL treatment for a period of 6 months. Patients were divided into 2 groups: 1) Group 1: 52 patients with proximal ureteric stone; 2) Group 2: including 60 patients with distal ureteric stone. Preoperatively all patient underwent bowel preparation and were asked to fast for 8 hours before the procedure. Results: The age ranged between 22 and 55 with mean of 42 (SD = 5) years. Around 46% had proximal ureteric stone and the rest were in distal ureter. Around 44% needed one session and 40% needed two sessions to be stone-free respectively. In regards to associated symptoms, 74% had ureteric colic, 3% haematuria, 43% microhematuria and 12% UTI. Mild hydronephrosis was found in 90% of the cases and 30 reported had previous intervention. Success rate was 90%. Conclusions: ESWL is safe and effective in treatment of ureteric stone with few complications and must be regarded first choice after conservative treatment in a patient with uncomplicated ureteric stone.

Do the applied shock wave numbers and the application side affect pancreatic exocrine functions in patients who have undergone extracorporeal shock wave lithotripsy for upper urinary tract calculi?

Aim: To investigate the effect of extracorporeal shock wave lithotripsy (ESWL) on the pancreatic exocrine functions related to the number of high-energy shock waves and the ESWL-applied kidney side for upper urinary tract stones. Materials and methods: Included in the study were 76 patients undergoing ESWL for proximal ureteral or kidney stones. The right kidney group (RKG) consisted of 40 patients who underwent ESWL for right kidney stones and the left kidney group (LKG) consisted of 36 patients who underwent ESWL for left kidney stones. Results: The observed changes in plasma amylase and lipase levels were not statistically significant compared with the pre-ESWL values in both groups. The relationship between the number of applied shock waves (SWs) and the serum amylase and lipase after ESWL showed a statistically significant positive correlation in the RKG but not in the LKG. Conclusion: There were no statistically significant differences between the pre- and post-ESWL serum amylase and lipase levels. However, a statistically significant positive correlation was found between the number of SWs applied and the post-ESWL amylase and lipase levels in the RKG. Although clinical and experimental studies have shown the safety of ESWL, avoiding excess sessions and an unnecessarily high number of SWs may be helpful in the prevention of the potential risks of ESWL.

Safety of ESWL in elderly: Evaluation of independent predictors and comorbidity on stone‐free rate and complications

Urinary stone disease affects people of all ages. With its satisfactory efficacy ranges in all age groups and lack of side-effects, extracorporeal shock wave lithotripsy (ESWL) has become the preferred treatment modality for uncomplicated renal and proximal calculi ≤ 20 mm. In the present study, we aimed to assess the safety and efficacy of the ESWL treatment in elderly patients. A retrospective study was carried out on patients aged over 65 years who underwent shock wave lithotripsy at our Department from 2009 to 2011, with a Siemens Lithostar electromagnetic shockwave lithotripter. A total of 231 patients (157 males, 74 females) out of 1694 (13.6%) were studied. The patients were divided into two groups (group 1 = 65-70; group 2 >70). The effect of age and other possible predicting factors (sex, stone localization and stone size) were investigated. Concomitant diseases and related complications were also evaluated. An overall stone-free rate (SFR) of 82.2% was found. The influence of sex on SFR was non-significant. There was no significant difference when comparing SFR between the age groups. When patients were divided into those with renal and ureteral stones, the SFR were 94.4% and 67.6% (P < 0.01), respectively. The SFR of the stone size groups, ≤ 10 mm and > 10 mm were 80% and 84.4%, respectively. Comorbidity was present in 148 patients. Complications were noted in 56 of 231 patients. Of 56 patients, 43 had minor complications and 13 major complications. ESWL seems to be an effective first-line treatment choice for urinary stones in elderly patients with careful patient selection and personalized preparation.

Extracorporeal shock wave lithotripsy for clearance of bile duct stones resistant to endoscopic extraction

Background: Endoscopic extraction of bile duct stones after sphincterotomy has a success rate of up to 95%. Failures occur in patients with extremely large stones, intrahepatic stones, and bile duct strictures. This study examined the efficacy and the safety of extracorporeal shock-wave lithotripsy in a large cohort of patients in whom routine endoscopic measures including mechanical lithotripsy had failed to extract bile duct stones. Methods: Out of 1587 consecutive patients, endoscopic stone extraction including mechanical lithotripsy was unsuccessful in 313 (20%). These 313 patients (64% women, median age, 73 years) underwent high-energy extracorporeal shock-wave lithotripsy. Stone targeting was performed fluoroscopically (99%) or by ultrasonography (1%). Results: Complete clearance of bile duct calculi was achieved in 281 (90%) patients. In 80% of the patients, the fragments were extracted endoscopically after shock-wave therapy; spontaneous passage was observed in 10%. For patients with complete clearance compared with those without there were no differences with regard to size or number of the stones, intrahepatic or extrahepatic stone location, presence or absence of bile duct strictures, or type of lithotripter. Cholangitis (n = 4) and acute cholecystitis (n = 1) were the rare adverse effects. Conclusions: In patients with bile duct calculi that are difficult to extract endoscopically, high-energy extracorporeal shock-wave lithotripsy is a safe and effective therapy regardless of stone size, stone location, or the presence of bile duct stricture. (Gastrointest Endosc 2001;53:27-32.)

Washington University experience with extracorporeal shock-wave lithotripsy of pancreatic duct calculi

To ascertain the effectiveness and safety of extracorporeal shock-wave lithotripsy (ESWL) for pancreatic calculi. Fourteen ESWL treatments were performed in 12 patients with chronic pancreatitis. Fragmentation was perceptible after 13 of 14 treatments. Subsequent endoscopic manipulation resulted in complete extraction, partial extraction, and failed extraction of the fragments after 7, 4, and 2 of the ESWL treatments, respectively. No complications occurred and no patient had pancreatitis following ESWL. At a median follow-up of 19 to 22 months, 4 patients have had complete relief of symptoms, 4 have had a decrease in both severity and frequency of pain, and 4 have had no improvement. ESWL is a safe and useful noninvasive adjunct in the treatment of patients with pancreatic duct calculi.

The Effect of Ursodiol on the Efficacy and Safety of Extracorporeal Shock-Wave Lithotripsy of Gallstones

In the treatment of gallstones with extracorporeal shock-wave lithotripsy, the bile acid ursodiol is administered to dissolve the gallstone fragments. We designed our study to determine the value of administering this agent. At 10 centers, 600 symptomatic patients with three or fewer radiolucent gallstones 5 to 30 mm in diameter, as visualized by oral cholecystography, were randomly assigned to receive ursodiol or placebo for six months, starting one week before lithotripsy. The stones were fragmented in 97 percent of all patients, and the fragments were less than or equal to 5 mm in diameter in 46.8 percent. On the basis of an intention-to-treat analysis of all 600 patients, 21 percent receiving ursodiol and 9 percent receiving placebo (P less than 0.0001) had gallbladders that were free of stones after six months. Among those with completely radiolucent solitary stones less than 20 mm in diameter, 35 percent of the patients receiving ursodiol and 18 percent of those receiving placebo (P less than 0.001) were free of stones after six months. Biliary pain, usually mild, occurred in 73 percent of all patients but in only 13 percent of those who were free of stones after three and six months (P less than 0.01). There were few adverse events. Only diarrhea occurred with a significantly different frequency in the two groups: 32.6 percent were affected in the ursodiol group, as compared with 24.7 percent in the placebo group (P less than 0.04). Severe biliary pain occurred in 1.5 percent of all patients, acute cholecystitis in 1.0 percent, and acute pancreatitis in 1.5 percent; endoscopic sphincterotomy was performed in 0.5 percent, and cholecystectomy in 2.5 percent. Extracorporeal shock-wave lithotripsy with ursodiol was more effective than lithotripsy alone for the treatment of symptomatic gallstones, and equally safe. Treatment was more effective for solitary than multiple stones, radiolucent than slightly calcified stones, and smaller than larger stones.