Shock Wave Lithotripsy Sessions Research Articles

The efficacy of early extracorporeal shockwave lithotripsy for the treatment of 5 to 10 mm upper ureteral stones: An observational study.

This study aimed to determine the effectiveness of extracorporeal shockwave lithotripsy (SWL) performed in the early period (within the first 24 hours). Data of patients who underwent SWL with a diagnosis of unilateral radiopaque 5 to 10 mm upper ureteral stones were retrospectively examined. Patients were divided into 2 groups. Group 1 (early SWL) consisted of patients with SWL performed within 24 hours after the onset of colic pain (<24 hours), while group 2 (deferred SWL) comprised patients with SWL performed 24 hours or more from the onset of pain (≥24 hours). The primary endpoint of the study was planned to determine 1-month SFR in both groups. The secondary endpoint was determined to be the factor affecting SWL success. The mean age of 216 patients (130 men, 86 women) included in this study was 46.5 ± 12.1 years. SFR within 1 month was detected in 175 patients (81%). In the early SWL group, the average number of SWL sessions was fewer (1.26 vs 1.83 P = .026) and the time to the stone-free state was shorter (11 vs 15.4 days P = .044). SFR within 1 month was higher in the early SWL group (85.5% vs 71.8% P = .036). In multivariate analysis, stone size, Hounsfield Units, and early SWL were predictive factors for SWL success. Performing SWL within the first 24 hours is highly effective in patients with symptomatic 5 to 10 mm upper ureteral stones.

CT-Based AI model for predicting therapeutic outcomes in ureteral stones after single extracorporeal shock wave lithotripsy through a cohort study.

Exploring the efficacy of an artificial intelligence (AI) model derived from the analysis of CT images to precisely forecast the therapeutic outcomes of singular-session extracorporeal shock wave lithotripsy (ESWL) in the management of ureteral stones. A total of 317 patients diagnosed clinically with ureteral stones were included in this investigation. Unenhanced CT was administered to the participants within the initial fortnight preceding the inaugural ESWL. The internal cohort consisted of 250 individuals from a local healthcare facility, whereas the external cohort comprised 67 participants from another local medical institution. The proposed framework comprises three main components: an automated semantic segmentation model developed using 3D U-Net, a feature extractor that integrates radiomics and autoencoder techniques, and an ESWL efficacy prediction model trained with various machine learning algorithms. All participants underwent thorough postoperative follow-up examinations four weeks hence. The efficacy of ESWL was defined by the absence of stones or residual fragments measuring ≤2mm in KUB X-ray assessments. Model stability and generalizability were judiciously validated through a fivefold cross-validation approach and a multi-center external test strategy. Moreover, Shapley Additive Explanations (SHAP) values for individual features were computed to elucidate the nuanced contributions of each feature to the model's decision-making process. The semantic segmentation model we constructed exhibited an average Dice coefficient of 0.88 ± 0.08 on the external testing set. ESWL classifiers built using Support Vector Machine (SVM), Random Forest (RF), XGBoost (XB), and CatBoost (CB) achieved AUROC values of 0.78, 0.84, 0.85, and 0.90, respectively, on the internal validation set. For the external testing set, SVM, RF, XB, and CB predicted ESWL with AUROC values of 0.68, 0.79, 0.80, and 0.83, respectively, with the last one being the optimal algorithm. The radiomics features and auto-encoder features made significant contributions to the decision-making process of the classification model. This investigation unmistakably underscores the remarkable predictive prowess exhibited by a scrupulously crafted AI model using CT images to precisely anticipate the therapeutic results of a singular session of extracorporeal shock wave lithotripsy for ureteral stones.

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.

Comparison of ureteral stone measurements for predicting the efficacy of a single session of extracorporeal shockwave lithotripsy: one-, two-, and three-dimensional computed tomography measurements.

The objective of this study was to compare the value of one-, two- and three-dimensional computed tomography (CT) measurements for predicting the efficacy of a single session of extracorporeal shock wave lithotripsy (ESWL) in patients with a single ureteral stone. A total of 165 patients were included based on the inclusion and exclusion criteria. Different models were constructed using a combination of patients' clinical data and measurements obtained by manual sketching and automated extraction software. Multivariate logistic regression was used to develop the models. Receiver operating characteristic curves were used to assess the performance of the models. There was good interobserver agreement for all measurements in different dimensions (P < 0.001). We also found that hydronephrosis, the largest diameter, the largest area, volume, and mean CT value were significantly greater in the failure group than in the success group (P < 0.01). Furthermore, all sizes and CT measurement values were found to be independent predictors for predicting efficacy after one session of ESWL (P < 0.05). In addition, the multivariate logistic analysis showed that the area under the curve (AUC) for two-dimensional and three-dimensional measurements was superior to that of one-dimensional measurement (P < 0.01). However, when size alone was included as a measurable predictor, there was no significant difference in the AUC among the one-, two-, and three-dimensional measurements (P > 0.05). In summary, after adjusting for clinical data, two- and three-dimensional measurements combining ureteral stone size and CT values were found to be the best predictors of ESWL efficacy, and software-based three-dimensional measurements should be considered to avoid interobserver variability in clinical practice.

A Predictive Strategy for Nonsurgical Management of Pancreatic Stones.

We set out to predict whether nonsurgical treatment is likely to succeed in removing pancreatic stones in a given patient and also to determine an optimal maximal number of extracorporeal shock wave lithotripsy (ESWL) sessions for treatment of pancreatolithiasis in that patient. We ascertained the number of ESWL sessions for each of 164 patients undergoing that treatment for pancreatolithiasis between 1992 and 2020. Median follow-up duration was 31 months (range, 0-239), median age was 58 years (22-83), and the male to female ratio was 5.1:1.0. Patients were divided into 2 groups based upon an optimal maximal number of ESWL sessions determined by receiver operating characteristic analysis. Total stone clearance was achieved in 130 of 164 patients (79%). The median number of ESWL sessions was 3 (1-61). Receiver operating characteristic analysis determined 7 to be the optimal maximal number of sessions. Complete clearance was more frequent (87%) among the 131 patients requiring 7 or fewer ESWL sessions than among the 33 undergoing more (48%, P < 0.001). Seventeen patients (52%) undergoing 8 or more sessions still had residual stones. If any pancreatic stones persist after 7 ESWL sessions, we recommend transition to medical or surgical treatments.

A New Nomogram to Predict the Success of Shock Wave Lithotripsy in Ureteral Stones

Purpose. To design a new nomogram predicting the probability of stone‐free status of shock wave lithotripsy (SWL) in patients with ureteral stones. Materials and Methods. We retrospectively enrolled 2,144 patients with ureteral stones who underwent SWL between January 1993 and April 2020. The demographic and clinical parameters were assessed. The predictors of stone‐free status following SWL were identified. A logistic regression‐based nomogram was created by including the significant predictors in the multivariate analysis. Results. The mean age was 42.93 ± 13.85 in the stone‐free group (Group 1) and 46.51 ± 13.66 in the treatment‐failure group (Group 2) (p = 0.001). The cutoff value of the age was 45.5 years. The mean stone load was 0.71 ± 0.36 cm2 in Group 1 and 0.96 ± 0.51 cm2 in Group 2 (p = 0.001). Of the 2,144 patients, 1,708 (79.6%) were stone‐free within the first three SWL sessions. According to the multiple logistic regression analysis, older age, a stone load larger than 1 cm2, the presence of multiple stones, third‐generation lithotripter use, and pre‐SWL catheterization were statistically associated with low stone‐free rates. The C‐index was determined to be 0.75 in the bootstrapping method. Conclusion. A stone load larger than 1 cm2, age older than 45.5 years, the presence of multiple stones, new‐ (third‐) generation lithotripter use, and pre‐SWL catheterization had statistically significant effects on lower stone‐free rates in patients who underwent SWL due to ureteral stones. A nomogram was developed to predict the success of SWL. As a result of the internal validation of the nomogram, it was concluded to be suitable for clinical use.

Assessment of the dynamics of concentration of biomarkers of acute kidney injury in remote shock wave lithotripsy in children

BACKGROUND: For several decades, remote shock wave lithotripsy has been considered a universally recognized gold standard for the treatment of upper urinary tract concrements. Despite its noninvasiveness, each lithotripsy session causes acute kidney injury which cannot be reliably assessed with traditional indicators used in nephrourology. Currently, new modern indicators found in the urine and serum are thought to be more informative biomarkers. In this paper, we investigated the effectiveness of some of them for possible potentials in the diagnostics of acute kidney injury in remote lithotripsy.&#x0D; AIM: To evaluate changes in acute kidney injury biomarkers during remote shock wave lithotripsy in children.&#x0D; MATERIALS AND METHODS: 54 children with urolithiasis, who had a session of remote shock wave lithotripsy, were enrolled in the study. In all patients, samples of urine and blood serum were taken three times for assessing biomarkers concentration: before lithotripsy session, after 45 min and after 24 h.&#x0D; RESULTS: Statistically significant changes in the concentration of all urine biomarkers (NGAL, L-FABP, TIMP-2, calbindin-D, KIM-1) were registered at the basal level and 45 min after the procedure. A number of markers studied by us in the blood serum showed more significant changes 24 h after the procedure (IL-18, TNF-α). Although IGFBP-1 concentration increased slightly after 45 min, this change was not statistically significant (p 0.781). The level of cystatin C did not increase after lithotripsy.&#x0D; CONCLUSION: The performed analysis of changes in biomarkers concentration has revealed a sufficiently high informative value of biomarkers in assessing the degree of acute kidney injury during remote lithotripsy in children. It also allows to suggest that the studied biomarkers may be promising indicators characterizing such an injury.

The effect of piezo-lithotripsy with 2-and 8-mm focus sizes on stone disintegration and renal injury.

To compare the efficacy and safety of shock-wave lithotripsy (SWL) using a narrow-focus and wide-focus for renal stones. A double-blind randomized trial included adult patients with solitary radio-opaque renal pelvic stone 1-2 cm. Patients were randomized into two groups; narrow-focus (2 mm) SWL and wide-focus (8mm) SWL. The stone-free rate (SFR) and presence of complications such as hematuria, fever, pain, and peri-renal hematoma were evaluated. Preoperative and postoperative urinary markers (NGAL and KIM-1) levels were compared to assess the renal injury. A total of 135 patients were recruited for this study. The SFR after the first SWL session was 79.2% and 69.1% in narrow- and wide-focus groups, respectively. There was a comparable rise in the median (IQR) 2-hour NGAL level in both groups (p= 0.62). However, the rise in the median (IQR) 2-hour KIM-1 level was significantly higher in the narrow-focus 4.9 (4.6, 5.8) ng/mL compared with the wide-focus group 4.4 (3.2, 5.7) ng/mL; (p=0.02). Nevertheless, 3-day urinary markers were significantly improved in NGAL and in KIM-1 (p= 0.263 and 0.963), respectively. The overall SFR after three sessions was 86.6% and 86.8% in narrow- and wide-focus groups, respectively (p=0.77). Both groups were comparable in complications, apart from the median (IQR) pain score and the percentage of high-grade hematuria which were significantly higher in the narrow-focus group (p<0.001and p=0.03), respectively. Narrow-focus and wide-focus SWL were associated with comparable outcomes and re-treatment rates. However, narrow-focus lithotripsy was associated with significantly higher morbidity in terms of pain and hematuria.

The effect of bioelectric impedance analysis on the success of extracorporeal shock wave lithotripsy.

Bioelectric impedance analysis (BIA) is a non-invasive method that can show the distribution of fatty and lean mass of the body. In this study, we aimed to determine the effect of BIA on extracorporeal shock wave lithotripsy (SWL) success. Our secondary aim was to determine the factors predicting transition from a single SWL session to multiple sessions. Patients who underwent SWL due to kidney stones were prospectively included. Demographics, pre-procedural BIA parameters (fat percentage, obesity degree, muscle mass, total water and metabolic rate), stone parameters, and number of SWL sessions were recorded. Univariate and multivariate regression analyzes were made to determine independent risk factors for success. Then, the successful group was divided into two subgroups according to their SWL session number as one session or multiple sessions and multivariate regression analysis was made to determine independent risk factors. Stone-free status was achieved in 114 (61.2%) of 186 patients. Stone Hounsfield Unit (HU) (OR: 0.998, p = 0.004), stone volume (OR: 0.999, p = 0.023) and fat percentage (OR: 0.933, p = 0.001) were independent risk factors for stone-free status in multivariate analysis. HU value of the stone (OR: 1.003, p = 0.005) and age (OR: 1.032, p = 0.031) were determined as independent risk factors for transition to multiple sessions in the subgroup analysis of the successful group. Fat percentage, stone volume, and stone density were determined as factors affecting success in SWL. Routine use of BIA may be considered to predict success before SWL. The probability of SWL success in a single session decreases as the age and stone's HU value increase.

Prospective comparison of extracorporeal shock wave lithotripsy and ureteroscopy in distal ureteral stones.

The optimal treatment modality of distal ureteral stones is controversial. Therefore, we conducted a prospective study to evaluate the efficacy, safety, and cost of early second shock wave lithotripsy (SWL) sessions versus ureterorenoscopy (URS) in patients with distal ureteral stones.This prospective study was conducted in a tertiary hospital from June 2020 to April 2022. Patients who underwent SWL or URS for distal ureteral stones were enrolled in this study. The stone-free rate (SFR), secondary treatment rate, complications, and costs were recorded. Propensity-score matching (PSM) analysis was also performed. A total of 1023 patients were included, of whom 68.4% (700) were treated with SWL and 31.6% (323) with URS. Based on PSM, SWL had an equivalent SFR (87.4% vs. 84.9%,P = 0.325) at one month after SWL and secondary treatment rate (10.7% vs.10.8%,P = 0.958) when compared with URS. Complications were rare and comparable between the SWL and URS groups (6.0% vs. 5.9%,P > 0.05), while the incidence of ureteral injuries (i.e., perforations) was higher in the URS group compared with the SWL group (1.3% vs. 0%,P = 0.019). The hospital stay was significantly shorter (1day vs. 2days,P < 0.001) and the costs considerably less (2000 RMB vs. 25,030 RMB;P < 0.001) in the SWL group compared with the URS group. This prospective study demonstrated that early second SWL sessions had equivalent efficacy in addition to reduced complication rates and costs compared with URS in patients with distal ureteral stones. Our findings may help guide clinical decision making.

MP05-13 COMPARISON OF EFFICACY AND SAFETY OF NARROW FOCUS VERSUS WIDE FOCUS SHOCK WAVE LITHOTRIPSY IN MANAGEMENT OF 1-2CM RENAL CALCULI USING TRI-FOCAL LITHOTRIPSY MACHINE: FIRST DOUBLE-BLIND RANDOMIZED STUDY

You have accessJournal of UrologyCME1 Apr 2023MP05-13 COMPARISON OF EFFICACY AND SAFETY OF NARROW FOCUS VERSUS WIDE FOCUS SHOCK WAVE LITHOTRIPSY IN MANAGEMENT OF 1-2CM RENAL CALCULI USING TRI-FOCAL LITHOTRIPSY MACHINE: FIRST DOUBLE-BLIND RANDOMIZED STUDY Yasser Noureldin, Walid Abdel Halim, Ezzat Elnahif, Ahmed Abdelbaky, and Salah El Hamshary Yasser NoureldinYasser Noureldin More articles by this author , Walid Abdel HalimWalid Abdel Halim More articles by this author , Ezzat ElnahifEzzat Elnahif More articles by this author , Ahmed AbdelbakyAhmed Abdelbaky More articles by this author , and Salah El HamsharySalah El Hamshary More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003216.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The objectives of this study were to compare efficacy and safety of shock wave lithotripsy (SWL) using a narrow focus of 2 mm (F1) versus a wide focus of 8 mm (F3) for renal stones 1-2 cm using a new tri-focal SWL machine. METHODS: This double-blind randomized study recruited adult patients presented with solitary radio-opaque renal pelvic stone 1-2 cm. Patients were electronically randomized into two groups; F1-group received narrow focus (2 mm) SWL while F3-group received wide focus (8 mm) SWL using Piezo Lith3000 plus (Richard Wolf, Germany). Ramping protocol was employed under simple analgesia, with maximum shocks of 3000 and maximum sessions of 3, two weeks apart. Baseline patient’s and stone characteristics were collected. The SFS (%) and complications were identified. Primary outcome was overall SFS (%) calculated one month following the 3rd session. Secondary outcomes were presence of complications in terms of pain and hematuria. Two urinary renal injury markers [neutrophil gelatinase-associated lipocalin (NGAL) and Kidney Injury Molecule-1 (KIM-1)] were measured with ELISA before, 2 hours after and 72 hours after the 1st SWL session. RESULTS: A total of 135 patients were recruited; 67 in F1 group and 68 in F3 group. Preoperative parameters were comparable in terms of age (p=0.16), female gender (p=0.52), BMI (p=0.71), stone size (1.2±0.3 vs. 1.1±0.3 mm; p=0.18), and HU (858±2 vs. 844±2; 0.70), NGAL (101.7±32.5 vs. 104.1±38.33 ng/dL; p=0.71), KIM-1 (4.3±0.9 vs. 4.5±1.1 ng/dL; p=0.17). The overall SFS and auxiliary interventions were comparable (92.5% vs. 91.2%; p=0.77) and (23.4% vs. 23.2%; p=0.23), respectively. In terms of complications, patients in F1 group had significantly higher experience of hematuria (Clavien 1) (95.5% vs. 83.8%; p=0.02), and pain (Clavien 1) (65.7% vs. 19.1%; p<0.001). Following the first SWL session, the rise in 2-h NGAL was comparable (109.6±32.7 vs. 112.7±40.6; p= 0.62). However, the rise in the 2-hr KIM-1 was significantly higher in F1 (4.9±1.1 vs. 4.4±1.4; p=0.022). Nevertheless, both markers were significantly improved to almost half of the baseline after 3 days (56.7±14 vs. 59.7±16.2; p=0.26) and (2.1±0.55 vs. 2.1± 0.5; p=0.96), respectively. CONCLUSIONS: Narrow and wide focus were associated with comparable lithotripsy outcomes and re-treatment rates. However, narrow focus was associated with significantly higher pain and hematuria. Both F1 and F3 SWL of Piezo Lith3000 plus were potentially safe in terms of the renal injury. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e48 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yasser Noureldin More articles by this author Walid Abdel Halim More articles by this author Ezzat Elnahif More articles by this author Ahmed Abdelbaky More articles by this author Salah El Hamshary More articles by this author Expand All Advertisement PDF downloadLoading ...

Could twinkling artifact be a parameter in predicting the success of shock wave lithotripsy? A prospective study.

It is important to predict success before the treatment of urolithiasis. We aimed to predict the success of shock wave lithotripsy (SWL) by comparing twinkling artifact (TA) revealed through colour Doppler ultrasonography (CDUS) with stone density in non-contrast computed tomography (NCCT). Eighty patients who underwent SWL between January 2021 and January 2022 were included in the study. Patients with stones of 5-20 mm in the renal pelvis and proximal ureter at NCCT were included. Patients' demographics, Hounsfield units (HU) in NCCT, and TA grades in CDUS were recorded. The stone-free rate after SWL, additional treatments, overall success rates, and the association between TA and success rates were evaluated. The mean age was 47.41 ±15.08 years. The mean BMI was 24.49 ±3.67 kg/m2. Twenty-three (28.8%) patients were TA grade 0, 33 (41.2%) patients were grade 1, and 24 (30%) were grade 2. The mean HU of TA grades 0, 1, and 2 of stones were 628 ±107, 864 ±123, and 1166 ±292, respectively. The HU increased along with the increase in the TA grade of the stone (p <0.01). The mean number of SWL sessions was 2.26 ±0.75 in patients with TA grade 0, and 2.92 ±0.40 in patients with TA grade 2. The mean number of SWL sessions increased along with the increase in TA grade (p <0.01). The stone-free rate decreased as the TA grade increased. Stone diameter and TA were the only predictors of SWL success. We think that TA may be useful in predicting SWL success.

Remote shock wave lithotripsy in the treatment of urolithiasis in children: types and possibilities

Introduction. Recently, the prevalence of urolithiasis in pediatric population has been steadily increasing, but up to now there is no any universal technique for treating urolithiasis in children. Among many options for surgical treatment of upper urinary tract urolithiasis, remote lithotripsy occupies one of the leading positions.Purpose. To highlight principles and mechanisms of remote lithotripsy, its indications and contraindications using a systemic review of modern literature for the period of 2001–2021.Material and methods. A systematic review of foreign and domestic literature for the period of 2001–2021 was made. Key words for the search were : urinary stone disease, urolithiasis, remote (shock wave) nephrolithotripsy, fragmentation of stones. 64 full-text articles out of 1339 literature sources are included in the review.Results. On analyzing the obtained results, it has been found out that one session of remote shock wave lithotripsy is effective in more than 90% of cases, if calculus dimensions are less than 20 mm and its density is less than 1200–1500 Hounsfield units. Location of the calculus also plays a role.Conclusion. Remote shock wave lithotripsy is a reasonable option due to a number of facts, the main of which are non-invasive approach and a large percentage of favorable outcomes associated with cleaning the upper urinary tract from stones.

Shock Wave Lithotripsy Outcomes for Upper and Lower Ureteral Stones in Non-obese and Non-Pre-stented Adults: Is One Session Sufficient?

PurposeThis study aims to evaluate differences in shock wave lithotripsy (SWL) outcomes between upper and lower ureteral stones and identify patients who are likely to have a stone-free status after one session of SWL.Materials and methodsAfter approval from the institutional review board and from a prospectively maintained database of 628 patients, 182 were retrospectively identified, who have had SWL for a single lower or upper ureteral stone and met the inclusion criteria. Age, body mass index (BMI), and stone size were similar among the groups. This study included non-pre-stented patients with solitary lower or upper ureteral radiopaque stones identified on non-contrast-enhanced computed tomography (NCCT), did not have acute obstruction, and had either normal body mass index (BMI) or overweight status. Patients were treated with Sonolith i-sys electroconductive lithotripter (focal length: 21 cm) (EDAP TMS, Vaulx‐en‐Velin, France). Success was defined as the absence of residual of any size or a residual of ≤2 mm on NCCT after one month, whereas failure was having fragments >2 mm or requiring surgical intervention. Post-SWL assessments were completed one week after every session with an X-ray of the kidney-ureter-bladder (KUB-XR) and NCCT after one month.ResultsThe upper and lower ureteral stone-free rates (SFRs) were 95% and 64.7%, respectively. Of them, 65% and 45%, respectively, were stone-free after one session. The cohort having a stone-free status after one SWL session was similar in age, sex, BMI, and stone density. The upper ureteral stone arm has a significant chance for one SFR session with a larger stone size, shocks per session, and maximum power delivered. In the receiver operating characteristic (ROC) curves, the optimal cut point number of sessions of 1.5, mean stone density (MSD) of 895, and stone size of 10.5 mm are the most likely to have successful SWL in the ureter.ConclusionFor patients having ureteral stones with favorable factors, SWL modality is effective and safe. Moreover, SWL can be done for one or two sessions only with the presence of favorable factors.

Modified shockwave propulsion lithotripsy improves the lower pole renal stone clearance.

The shockwave lithotripsy is an established modality for the treatment of urinary stone disease. The aim of the study was to present our modified shockwave lithotripsy (SWL) technique, a shockwave propulsion lithotripsy (SWPL) technique, for the treatment of lower pole renal stones and compare its clinical outcomes with the standard SWL technique. An evaluation of a prospectively collected database including 168 patients divided into two groups and treated with ultrasound-guided SWL (n = 80) and SWPL (n = 88) were included in our study. The data were collected between January 2016 and December 2021. Patients older than 18years old with single lower pole stones sized up to 2cm were included in the study. SWPL was associated with significant higher SFR compared to standard SWL (85.2 vs. 62.5%, p = 0.001) and required less applied shockwaves (2151 vs. 2502, p = 0.001). Most of the patients in both groups underwent only one SWL session. Overall, a 7.1% complication rate (12 out of 168 patients) was reported, with no difference between groups. In conclusion, our proposed SWPL technique was aimed to overcome difficulties associated with the gravity and anatomic specificities of the lower pole, increased SFR and decreased the need for additional treatment.

The Outcome of Shock Wave Lithotripsy (SWL) in the Treatment of Urinary Stone Disease: 115 Cases in SOMCH

Purpose: Urinary stone disease is a systemic metabolic and recurrent disease. It is the third most common disease of the urinary tract. Urolithiasis affects 4%-15% of the world population and this is increasing. Treatment of urinary stone disease moved dramatically from open operative procedures to endoscopic, minimally invasive, and noninvasive methods. The introduction of shock wave lithotripsy (SWL) has revolutionized the treatment of urinary stones with the concept of disintegration of stones. The present study aims to evaluate the outcome of SWL in the treatment of urinary stone disease. Methods and Materials: This retrospective observational study was conducted in the department of urology, SOMCH from June 2019- to March 2021. Renal stone &lt;2.0 cm &amp; upper Ureteric stone &lt;1.5 cm were included and radiolucent stones, patients having ureteral obstruction with grossly impaired renal function, UTI, uncontrolled bleeding disorder, pregnancy &amp; BMI &gt;30kg/m2 were excluded. A total of 115 patients was enrolled. SWL with Siemens Lithoskope (3rd generation) lithotripter was used with a standard number of shock waves 2500-3500 per session &amp; an energy setting of 3.0-3.5 KV. NSAID was given in suppository form and intravenous pethidine just before starting shock for analgesia and all were under antibiotic prophylaxis. Patients were discharged the day after the SWL procedure with the advice of follow-up every 2 weeks for 3 months. All patients were followed up with history, urine R/M/E &amp; C/S to detect UTI, plain X-ray KUB region to see stone clearance or any other complications. Results: Total 179 sessions of SWL procedure done for 115 patients (1.55/ patient) with the urinary stone of both gender between 19 to 70 years. Of them, 82(71.3%) were male and 33(28.7%) female and 94(81.5%) were in the 20-60 years age group. Renal stones 78(67.9%), upper ureteric stones 37(32.1%), and 70(60.8%) were on the left side. Preprocedure stenting was done in 35(30.4%) patients due to obstruction &amp; residual stones. 70(60.9%) have achieved stone clearance after the first session of SWL. After a maximum of 3 sessions of SWL and 3 months follow up found that 99(86%) patients were stone-free. Only 16(14%) found treatment failure and needed auxiliary procedures like URS, RIRS, etc because of hard stone, steinstrasse, and patients’ non-compliance due to pain &amp; fearlessness. 13(11.3%) patients complain of moderate pain after SWL and needed a maximum of 2 days of hospitalization with an injectable pain killer. UTI was found in 9(7.8%) patients, of the 7(6.1%) were pre-stenting. Gross hematuria was found in 2(1.7%) patients due to HDN &amp; UTI. Conclusion: As the stone clearance rate is high with fewer complications however multiple sessions are required, SWL, a noninvasive procedure, is a good option for the treatment of urinary stone disease. Bangladesh J. Urol. 2021; 24(2): 166-169

Efficacy of electromagnetic extracorporeal shockwave lithotripsy on high-density ureteral stones.

Our aim was to evaluate electromagnetic extracorporeal shockwave lithotripsy (SWL) in treating high-density radiopaque ureteral stones on non-contrast computed tomography (NCCT). Adult patients with radiopaque stones in the ureter who underwent SWL in a high volume center between 2016 and 2017 were retrospectively included. NCCT characteristics such as mean stone density (MSD), stone size, skin to stone distance (SSD) were recorded before treatment. Treatment success was defined as complete stone clearance (SF). 108 patients were included. Global stones MSD was 1119 HU. 55% and 62% of patients were SF respectively after 1 and 2 sessions of SWL. There was no difference of success rates between the treatment of low MSD (<1000HU, n=33) and high MSD (≥1000HU, n=75) (P=0.57, OR=0.79, 95% CI [0.35-1.80]). The SF rate dropped to 31.6% for 19 patients with ureteral stenting before treatment (P=0.02, OR=3.34, 95% CI [1.16-9.62]). Mean stone size was 7.2mm, SF rate for stones over 7mm were statistically lower (P=0.04, OR=2.18, 95% CI [1.00-4.73]). 4 patients needed ureteral stenting in emergency after SWL (3.7%). Electromagnetic SWL is a safe and effective way to treat ureteral stones. A high-density stone on NCCT may not be detrimental. Many parameters should be involved in the treatment decision such as stone size and ureteral stenting. 4.

Assessment of the Ideal Time Interval between Repeated Shock Wave Lithotripsy Sessions for Renal Stones

Assessment of the Ideal Time Interval between Repeated Shock Wave Lithotripsy Sessions for Renal Stones

Predictors of successful emergency shock wave lithotripsy for acute renal colic

The role of emergency shockwave lithotripsy (SWL) in persistent pain control in patients with ureteral stones is not well established. The aim of this study is to evaluate efficacy as well as the predicting variables for successful early SWL patients with symptomatic ureteral stones. Eighty-six patients with a persistent renal colic secondary to single ureteral stone (6–12 mm) were prospectively enrolled in this study. SWL was performed within 24 h of the onset of flank pain. Pain control and stone-free rate after emergency SWL session were 58.1% and 44.2%, respectively. Seven patients required post-SWL ureteroscopy and ureteral stent placement for uncontrolled pain. The overall 3-month stone-free rate after SWL monotherapy was 83.7%. On multivariate analysis, predictors for pain relief after emergency SWL were lower Hounsfield (HU) stone density, mild hydronephrosis (HN) at presentation and presentation during the first colic episode. Lower HU stone density was the single predictor of successful stone clearance after single emergency SWL session on multivariate analysis. In conclusion, early SWL is feasible and effective in management of ureteral stones presented by renal colic with low HU.

A randomized trial of adjuvant tamsulosin as a medical expulsive therapy for renal stones after shock wave lithotripsy.

Adjuvant medical expulsive therapy (MET) for shock wave lithotripsy (SWL) is controversial. With limited use of the computed tomography (CT), the stone free rate (SFR) become overestimated. Herein we evaluate tamsulosin post-SWL for renal stone using the CT to assess SFR. A randomized controlled trial (NCT05032287) was carried out for renal stone patients amenable for SWL. Patients were allocated after 1st session of SWL to receive tamsulosin 0.4 mg or placebo once daily from the 1st day of SWL and for 3-months or becoming stone free. The primary outcome was SFR, defined by presence of residual fragments (RF) ≤ 3 mm (3C-SFR). The 3C-SFR were 73.8% and 59.6% in tamsulosin and placebo groups, respectively (p=0.03). The median (IQR) pain scores were 3 (3, 5) and 5 (3, 6) in tamsulosin and placebo groups, respectively (p=0.04), However, the post-SWL complication and add-on analgesia needed showed no significance differences between groups. The median time for stone free were 30 days (95% CI: 27.29-32.71) in tamsulosin arm, and 36 days (95% CI: 31.01-40.99) in placebo arm, HR= 1.42 (95% CI: 1.02-1.98). Tamsulosin has more reversible adverse effect, compared to placebo (p=0.03). In our study, the use of tamsulosin as MET following SWL facilitates expulsion of retained residual fragments. Tamsulosin shortens time to reach stone free, decreases pain scores. However, tamsulosin does not affect the add-on IV analgesics and have more reversible adverse effect, compared to placebo.