Shock Wave Lithotripsy Sessions Research Articles

Prospective randomized trial comparing shock wave lithotripsy and flexible ureterorenoscopy for lower pole stones smaller than 1 cm

In this study, we aimed to compare the success and complications of flexible ureterorenoscopy (F-URS) with its advanced technology and the accomplished method of shock wave lithotripsy (SWL) in the treatment of lower pole stones smaller than 1 cm. One hundred and forty patients were randomized as 70 undergoing SWL (Group 1) and 70 undergoing F-URS (Group 2). Patients were evaluated by plain X-ray and urinary ultrasound 1 week and after 3 months following SWL. The same procedure was done for F-URS patients 1 week after surgery and after 3 months. Success rates were established the day following the procedure and after 3 months. Fragmentation less than 3 mm was considered success. Mean operative time was 44 ± 7.4 min for Group 2 and mean fluoroscopy duration was 51 ± 12 s. In F-URS group, all the patients were stone free after 3 months (100 %). Group 1 had 2.7 ± 0.4 sessions of SWL. Sixty-four patients were stone free in that group after 3 months (91.5 %). The procedure yielded significant success in FURS group, even though patients underwent SWL for 2.7 ± 0.4 sessions and F-URS for 1 session (p < 0.05). With higher success and similar complication rates, fewer sessions per treatment, and advances in technology and experience, we believe F-URS has a potential to be the first treatment option over SWL in the future.

Concomitant Treatment of Ureteropelvic Junction Obstruction and Renal Calculi With Robotic Laparoscopic Surgery and Rigid Nephroscopy

The treatment of ureteropelvic junction obstruction (UPJO) and concomitant calculus poses a technically challenging situation. We present our experience with using rigid nephroscopy for renal calculi removal during robot-assisted pyeloplasy (RAP) for UPJO. From December 2010 to November 2012, 25 patients with UPJO had RAP at our institution; 9 of those had concurrent renal calculi, which were simultaneously treated with rigid nephroscopy. For stone extraction, a rigid ureteroscope was passed through an assistant trocar under laparoscopic vision directly into a previously created pyelotomy. The stones were extracted using a rigid grasper or stone basket through the rigid ureteroscope. For the removal of the stones within the upper and lower calyces, the rigid ureteroscope was introduced into the incised renal pelvis through robotic trocars if the "assistant trocar" route failed. Complete stone clearance was achieved in 8 of 9 patients. Residual calculi in 1 patient were removed with a single session of extracorporeal shock wave lithotripsy. At the mean follow-up of 10.2 months, no patients had obstruction or recurrent stones. The mean operative time was 187.1 minutes, which was 40.9 minutes longer than the mean operative time in patients without renal calculi. There was no significant difference in blood loss, hospital stay, complications, and success rates between patients with and without renal calculi. Our data suggest that the use of a concomitant rigid nephroscope and RAP is a safe and feasible option for the treatment of UPJO complicated with renal calculi.

ERCP in the management of pancreatic diseases in children

ERCP experience in pancreatic disorders in children is limited. This study evaluated the utility and efficacy of ERCP in children with pancreatic diseases at a tertiary care referral center. Consecutive patients 18 years of age and younger who underwent ERCP for pancreatic diseases from January 2010 to June 2011 were identified. Indications, findings, interventions, adverse events, and outcomes were recorded. A total of 221 ERCPs were performed in 172 children (102 boys, mean ± standard deviation age 13.8 ± 3.2 years, 157 therapeutic). A total of 143 children (83.1%) had chronic pancreatitis (CP), 19 (11%) had recurrent acute pancreatitis (RAP), and 10 (5.8%) had acute pancreatitis (AP). Indications included pain (153, 89.4%), pancreatic fistula (11, 6.3%), symptomatic pseudocyst (4, 2.3%), and jaundice (3, 1.7%). In chronic pancreatitis patients, findings included a dilated and irregular main pancreatic duct (92, 64.3%), pancreatic duct (PD) calculi (76, 53%), dominant PD stricture (23, 16%), PD leak (7, 4.9%), pancreas divisum (35, 24.5%), and common bile duct (CBD) stricture (3, 2%). Therapeutic procedures included major papilla sphincterotomy (93, 65%), minor papilla sphincterotomy (32, 22.3%), PD stenting (77, 53.8%), and CBD stenting (3, 2.2%). PD stones larger than 5 mm were retrieved endoscopically after 57 extracorporeal shock wave lithotripsy sessions in 50 patients (34.9%). In patients with RAP, 6 (31.5%) had complete and 1 partial pancreas divisum. All underwent minor papillotomy. In patients with AP, 4 (40%) had stenting for PD leak, 2 (20%) underwent CBD clearance for biliary pancreatitis, and 4 (40%) had transpapillary pseudocyst drainage. During 13 ± 4.7 months (range 6-22 months) of follow-up, improvement of symptoms was seen in 143 of 172 (83%) patients. Procedure-related adverse events were seen in 8 (4.7%) patients. Retrospective study. ERCP is a safe therapeutic option for pancreatic disorders in children.

Comparison of Shockwave Lithotripsy and Microperc for Treatment of Kidney Stones in Children

We aimed to compare the outcomes of microperc and shockwave lithotripsy (SWL) for treatment of kidney stones in children. The medical records of 145 patients under the age of 15 years with opaque and single kidney stones treated with either SWL or microperc were retrospectively reviewed. Both groups were compared in terms of fluoroscopy and operative time, re-treatment, complications, success rate, and secondary and total number of procedures. Microperc and SWL were performed on 37 and 108 pediatric patients, respectively. The mean age of the patients was 5.91±4.03 years (1-15) and 8.43±4.84 (1-15) years in the SWL and microperc groups, respectively (P=0.004). The mean stone size was 11.32±2.84 (5-20) mm in the SWL group and 14.78±5.39 (6-32) mm in the microperc group (P<0.001). In the SWL group, 31 (28.7%) patients underwent a second SWL session and 6 (5%) had a third session. Finally, 95 (88%) patients were stone free at the end of the SWL sessions. In the microperc group, the stone-free rate was 89.2% in a single session (P=0.645). The mean duration of hospitalization was 49.2±12.3 (16-64) hours in the microperc group and 8.4±2.3 (6-10) hours per one session in the SWL group (P<0.001). The fluoroscopy time was significantly longer in the microperc group compared with the SWL group (147.3±95.3 seconds vs 59.6±25.9 seconds, P<0.001). The rate of requirement for an auxiliary procedure was higher in the SWL group than in the microperc group. The overall complication rates for the microperc and SWL groups were 21.6% and 16.7%, respectively (P=0.498). The results of our study demonstrate that microperc provides a similar stone-free rate and a lower additional treatment rate compared with SWL in the treatment of kidney stone disease in children.

Comparing non contrast computerized tomography criteria versus dual X-ray absorptiometry as predictors of radio-opaque upper urinary tract stone fragmentation after electromagnetic shockwave lithotripsy

The objective of this study was to assess the value of dual X-ray absorptiometry (DXA) in comparison to non contrast computed tomography (NCCT) density as possible predictors of upper urinary tract stone disintegration by shock wave lithotripsy (SWL). This study included 100 consecutive patients, with solitary renal stone 0.5-2cm or upper ureteral stone up to 1cm. DXA to calculate stone mineral density (SMD) and stone mineral content (SMC) was done. NCCT was performed to measure Hounsfield units (HU). SWL was performed with an electromagnetic lithotripsy, plain X-ray documented disintegration after SWL. Successful treatment was defined as stone free or complete fragmentation after 1 or 2 sessions of SWL. The impact of patients age, sex, body mass index, stone laterality, location, volume, length, mean SMC and SMD, HU and Hounsfield density (HD), skin to stone distance (SSD) and number of shock waves were evaluated by univariate and multivariate analysis. Only 76 patients were available for follow-up. Success of disintegration was observed in 50 out of 76 patients (65.8%). On multivariate analysis, SMC and number of shock wave were the significant independent factors affecting SWL outcome (p=0.04 and p=0.000, respectively). SMC as detected by DXA is a significant predictor of success of stone disintegration by SWL. SMC measured by DXA is more accurate than HU measured by CT. Patients with high stone mineral content (SMC greater than 0.65g) should be directly offered another treatment option.

1825 INTRAVENOUS GLUCOSE TOLERANCE TEST ASSESSMENT OF GLUCOSE-INSULIN KINETICS FOLLOWING TREATMENT OF THE KIDNEY WITH A SUPRA-MAXIMAL DOSE OF SHOCK WAVES IN A PORCINE MODEL OF METABOLIC SYNDROME

INTRODUCTION AND OBJECTIVES: In our continuing efforts to determine whether shock wave lithotripsy (SWL) is a risk factor for the development of diabetes mellitus, we treated the kidney of metabolic syndrome (MetS) pigs with a supra-maximal dose of shock waves (SWs) and assessed the SWL effect on the glucose-insulin kinetic response to an intravenous glucose tolerance test (IVGTT). METHODS: Adult female Ossabaw pigs (9-month-old) were fed an excess calorie atherogenic diet to induce MetS. At 15 months of age, the MetS pigs underwent SWL treatment (4000 SWs, 24 kV at 120 SWs/min using the HM-3 lithotripter; n 7). SWs were targeted to the upper pole calyx of the left kidney because of its close association with the tail of the pancreas?a segment rich in insulin containing -cells. IVGTTs were performed on conscious, fasting MetS pigs before SWL and at 1-month and 2-months post-SWL with frequent blood samples taken for glucose and insulin measurement. RESULTS: Pigs fed an excess calorie atherogenic diet developed features of MetS: obesity, dyslipidemia, insulin resistance and glucose intolerance. Fasting levels of plasma glucose and insulin, as well as their response profile to IVGTTs, were similar before and after SWL. Estimates of insulin resistance, glucose tolerance and pancreatic beta cell function derived from the glucose-insulin kinetics calculated from IVGTTs were not significantly altered following SWL. CONCLUSIONS: The pig?s MetS status was unchanged following overtreatment of the kidney with 4000 high-energy SWs. These findings do not support a single session of SWL in MetS patients as a risk factor for the onset of diabetes mellitus?at least in the short-term.

The Effect of Tamsulosin on Pain and Clearance According to Ureteral Stone Location After Shock Wave Lithotripsy

BackgroundMedical expulsion therapy has shown encouraging results in facilitating spontaneous clearance of ureteral stones after extracorporeal shock wave lithotripsy. However, no other study has yet determined the benefit of medical expulsion therapy for stones in different ureteral locations. ObjectiveThe aim of the study was to evaluate tamsulosin as adjunctive therapy to extracorporeal shock wave lithotripsy (SWL) in terms of pain clearance of stones in the upper, middle, and lower ureter. MethodsBetween June 2008 and July 2011, patients with a solitary ureteral stone that was ≥6 mm up to 15 mm and located in the upper, middle, or lower ureter undergoing SWL were evaluated. The patients were randomly allocated to a conservative treatment (group 1) and a tamsulosin treatment group (group 2). Administration of the drug was started immediately after SWL and was continued for a maximum of 28 days. Patients were evaluated for stone clearance, time to stone clearance, and number of SWL sessions. The pain intensity was evaluated by visual analog scale. ResultsThere were 64 patients in the control group and 59 in the tamsulosin group. The average stone sizes were 10.70 (3.20) mm and 11.40 (3.01) mm (P = 0.24). Group 1 and group 2 received 2507 (984) and 2759 (775) shock waves (P = 0.86), 1.53 (0.8) and 1.49 (0.75) sessions (P = 0.85), respectively. Mean visual analog scale scores and times to clearance were 3.81 (2.74) and 2.73 (2.28) (P = 0.00) and 12.59 (8.63) days and 8.34 (7.60) days (P = 0.00), respectively, for all stones in groups 1 and 2. Only the clearance time of upper ureteral stones between groups showed statistical significance (13.54 [8.32] days vs 7.10 [6.40] days; P = 0.00). ConclusionsTamsulosin may help in the treatment of all ureteral stones after SWL, particularly stones in the upper ureter, with a shorter time to clearance and less need for analgesic drugs.

Extracorporeal shockwave lithotripsy for renal stones in pediatric patients: A multivariate analysis model for estimating the stone‐free probability

To define factors affecting the stone-free rate of extracorporeal shockwave lithotripsy in the treatment of pediatric renal calculi, and to establish a regression model for pretreatment prediction of stone-free probability. From January 1999 through February 2012, 207 children with mean age 6.4 ± 3.8 years underwent shockwave lithotripsy with Dornier Lithotripter S for treatment of renal stones. The stone-free rate was evaluated 3 months after the last shockwave lithotripsy session with non-contrast computed tomography. Treatment success was defined as complete clearance of the stones with no residual fragments. Multivariate logistic regression analysis was used to identify independent risk factors and to predict the probability of being stone free. The mean length of the stone was 11.6 ± 4 mm. The stone-free rate was 71%. Independent factors that adversely affect stone-free rate were increasing stone length and calyceal site of the stone. Relative risks for not being free of stones were 1.123 for stone length, 2.673 for stones in the upper or middle calyx and 4.208 for lower calyx stones. Stone length and location are prognostic factors determining stone-free rate after shockwave lithotripsy for renal calculi in pediatric patients. Based on our analysis, shockwave lithotripsy should be recommended for renal pelvis stones up to 24 mm, upper or middle calyceal stones up to 15 mm and lower calyceal stones up to 11 mm.

Kidney Stone Size and Hounsfield Units Predict Successful Shockwave Lithotripsy in Children

To define the preoperative kidney and stones characteristics on noncontrast-enhanced computed tomography that affect the success of extracorporeal shockwave lithotripsy (SWL) for treatment of renal calculi in pediatric patients. From 2005 to 2011, 57 children (age<16 years) with documented preoperative noncontrast-enhanced computed tomography scans underwent SWL for treatment of renal stones and were included in the present study. Stone size, site, multiplicity, average skin-to-stone distance, stone attenuation value, and kidney morphology were determined from the preoperative noncontrast-enhanced computed tomography scans. Success was defined as radiographically stone-free status at the 3-month follow-up examination after a single lithotripsy session without the need for additional sessions or ancillary procedures. After a single session of SWL, 24 children (42.1%) were stone free on the 3-month follow-up imaging study without the need for additional SWL sessions. Treatment failed in 33 patients (57.9), with residual fragments in 30 children, of whom 29 required repeat SWL, and 3 with stones that were considered unchanged and were finally treated with percutaneous nephrolithotomy. Logistic regression analysis revealed that stone attenuation in Hounsfield units (HU) and stone length were the only significant predictors of success. When the HU were stratified into 2 groups of≤600 and >600 HU, the SWL success rate was 82.1% and 20%, respectively (P=.023). When length was stratified as≤12mm and >12mm, the stone-free rate was 58.6% and 25.1%, respectively (P= .016). Stone attenuation≤600 HU and stone length≤12mm were significant independent predictors of SWL success in children.

Shock Wave Lithotripsy of Vesical Stones in Patients With Infravesical Obstruction: An Underused Noninvasive Approach

To evaluate the effectiveness and safety of shock wave lithotripsy in the management vesical stones in patients with infravesical obstruction. From March 2007 to April 2010, 59 male patients with infravesical obstruction were treated using the Dornier Compact Delta II Lithotriptor for urinary bladder stones. The indications for shock wave lithotripsy included patients refusing invasive procedures or those with orthopedic malformations hindering the lithotomy position. The mean age was 61.6 ± 8.6 years (range 44-78), and the mean body mass index was 29 ± 5.1 kg/m(2) (range 20.5-45). The mean stone diameter was 26.6 ± 9.8mm (range 12-50). All patients underwent an initial session and were re-evaluated using ultrasonography and urinary tract plain radiography at 2-week intervals. All patients were treated in the supine position. The number of shocks ranged from 1910 to 9500. Of the 59 patients, 47 and 11 were cleared by 1 or 2 sessions, respectively; 1 patient required a third session to be cleared of stones. All patients develop mild hematuria and started to pass gravel in the first void after the shock wave lithotripsy session. All patients were rendered stone free within 6 weeks. During follow-up, only 2 male patients developed temporary acute urine retention necessitating urethral catheter fixation. Both patients had a neurologic insult. Extracorporeal shock wave lithotripsy is an effective, noninvasive approach to disintegrate vesical stones in patients with infravesical obstruction with adequate fragment clearance.

The Influence of Stone Size, Skin to Stone Distance and Hydronephrosis on Extracorporeal Shock Wave Lithotripsy Session and Shock Wave Numbers in Ureteral Stones

Background : To evaluate the impact of stone size, grade of hydronephrosis induced by the stone and skin to stone distance (SSD) on the shock wave lithotripsy (SWL) outcome in terms of SWL session and shock wave (SW) numbers in patients with ureteral stones. Methods: Between June 2011 and December 2011, data of 80 patients undergoing SWL for ureteral stones were retrospectively reviewed. Patients were classified into three groups according to hydronephrotic grades (group 1, grade 1 hydronephrosis; group 2, grade 2 hydronephrosis; group 3, grade 3 hydronephrosis) and into two groups according to stone size (group 1, stone size = or &lt; 10 mm and group 2, stone size &gt; 10 mm). The effect of hydronephrotic grade, SSD and stone size on SWL sessions and SW rates were studied. The impact of the stone size on hydronephrosis was also analyzed. Result: Of the 80 patients undergoing SWL, 24 were female and 56 were male. The mean age, stone size, number of sessions, SW rate and SSD were 37.7 (16 - 73), 9.6 mm (6 - 19), 1.65 (1 - 4), 3,812 (1,200 - 8,500) and 9.6 cm (5 - 15) respectively. Thirty-five patients had grade 1, 29 grade 2 and 16 grade 3 hydronephrosis. Twenty-eight patients had upper, 19 mid and 33 lower ureteral stones. There were significant correlation between stone size and SW number (r = 0.513, P &lt; 0.001), and between stone size and session number (r = 0.609, P &lt; 0.001). The correlation between hydronephrotic grade, SW and session numbers was also significant (r = 0.472, P &lt; 0.001 and r = 0.441, P &lt; 0.001). There was no correlation between SSD and SW and session numbers. Four patients with stone size more than 10 mm and grade 2-3 hydronephrosis had unsuccessful SWL outcome. Conclusion: The grade of hydronephrosis and stone size are independent predictive factors for SW and SWL session numbers and indirectly for treatment outcome. SSD was not found to be predictive. World J Nephrol Urol. 2013;2(2):60-64 doi: http://dx.doi.org/10.4021/wjnu127w

Relationship Between Patient Position and Pain Severity During Shock Wave Lithotripsy for Renal Stones With the MODULITH SLX-F2 Lithotripter: A Matched Case-Control Study

PurposeWe evaluated the association between shock wave lithotripsy (SWL)-related pain and patient positioning during SWL.Materials and MethodsWe retrospectively reviewed the medical records of 162 patients who underwent their first SWL session for single renal stones from May 2010 to August 2011. One hundred thirteen patients underwent SWL in the supine position and 49 did so in the lateral position. To evaluate an unbiased estimation of the positional effect on pain severity during SWL, both groups (supine vs. lateral) were matched according to sex, age, body mass index, stone location, and stone size. Thirty-four patients from each group were selected for analysis. Pain was evaluated with an average visual analogue scale (VAS-avg) and maximum visual analogue scale (VAS-max). Analgesic usage was also compared between the groups.ResultsAll patients (n=34) in the supine group had radio-opaque stones compared with only 47.1% of the patients in the lateral group (n=16). The VAS-avg and VAS-max of the lateral group were significantly lower than those of the supine group (1.2±1.0 and 3.1±1.7 for VAS-avg and 2.5±1.8 and 4.7±1.9 for VAS-max, respectively, p<0.05). However, analgesic usage between groups did not differ significantly (17.6% in the supine group vs. 5.9% in the lateral group, p=0.259). In a subgroup analysis confined to patients with radio-opaque stones, the supine group still suffered more pain.ConclusionsPatients with renal stones suffered more SWL-related pain in the supine position than in the lateral position. During SWL, positioning of patients should be considered a predictive factor for SWL-related pain.

Shock wave lithotripsy versus ureteroscopy for ureteral calculi: a prospective assessment of patient-reported outcomes

To compare patient-reported outcomes (PROs) with objective outcomes after shock wave lithotripsy (SWL) and ureteroscopic surgery (URS) for ureteral calculi (UC). We prospectively evaluated 160 consecutive patients who underwent SWL (n = 65) or URS (n = 95) for a single radiopaque UC ranging from 4 to 15 mm. For patients who underwent URS, a 6-Fr double-J stent was routinely placed for 2 weeks after surgery. To examine PRO, we used a self-administered nonvalidated questionnaire evaluating overall satisfaction and PRO in four domains (pain, hematuria, voiding symptom, and time to return to routine activity) and willingness to undergo the treatment procedure again. Propensity-score matching analysis was performed to adjust for potential confounding by discrepancy of pretreatment parameters between groups. Stone-free rates (SFRs) and complications were also compared. SFRs after the first, second, and third sessions of SWL were 61.5, 81.0, and 93.5%, respectively. SFR after URS was 100%, which was significantly better than SFRs for third-session SWL (p = 0.023). Complications were comparable. By propensity-score matching analysis, overall satisfaction was similar between groups, whereas PRO for voiding symptom and time to return to routine activity were significantly better in the SWL group (all p < 0.05). The two groups were not different in willingness to undergo the same procedure again. Despite significantly higher SFR after URS for UC, overall patient satisfaction was comparable after SWL and URS, meanwhile PRO of the SWL group was better than URS for voiding symptom and time to return to routine activity. In addition of objective treatment outcomes, PROs should be considered in counseling treatment methods for UC.

Predictive Factors and Management of Steinstrasse After Shock Wave Lithotripsy in Pediatric Urolithiasis—A Multivariate Analysis Study

To define the predictive factors for the formation of steinstrasse (SS) after shock wave lithotripsy (SWL) and determine the treatment strategies for this complication in pediatric urolithiasis. We retrospectively reviewed the data of 341 renal units (RUs) treated with SWL for urolithiasis. The stone location, stone burden, auxiliary procedures, energy level, and number of shock waves were recorded. Statistical analysis was performed to detect the predictive factors for the formation of SS. In addition, the treatment of children with SS was evaluated. The mean age of the children was 8.31 years (range 1-17). Episodes of SS developed in 26 RUs (7.6%). Of the 26 RUs, 20 (77%) were localized in the lower, 5 (19%) in the upper, and 1 (4%) in multiple locations in the ureter. The stone burden was the only statistically significant factor predicting the formation of SS on logistic regression analysis (P = .001). Of the 26 RUs, 17 (65.4%) were successfully managed by repeat SWL monotherapy, 4 (15.4%) were managed with ureteroscopy after failure of SWL, 1 (3.8%) was managed by ureteroscopy monotherapy, and 4 (15.4%) were monitored with conservative management with antispasmodic drug plus hydration therapy. The mean number of SWL sessions was 1.72. The incidence of SS development in children after SWL treatment was similar to that in adult series. Our results suggest that the stone burden is a significant predictive factor for the development of SS after SWL in pediatric urolithiasis. Most children with SS could be easily and safely treated by repeat SWL.

Effect of Extracorporeal Shock Wave Lithotripsy on Kidney Growth in Children

We investigated whether shock wave lithotripsy affects kidney growth in children. This prospective controlled study included 150 children with renal stones who presented for shock wave lithotripsy between March 2005 and February 2010 (group A). The control arm included 100 children without any urological problems who were enrolled in the study after obtaining written maternal consent (group B). All children in both groups underwent abdominal ultrasound to assess renal size (bipolar renal length), which was repeated after 6 months for group A and after 1 year for both groups. Bipolar renal size in group A increased significantly at 6 months and 1 year after shock wave lithotripsy. Renal growth did not differ based on patient age at shock wave lithotripsy (p = 0.472), number of shock wave lithotripsy sessions (p = 0.65) or number of stones (p = 0.405). There was no significant difference between the rate of kidney growth in children who underwent shock wave lithotripsy during the year of the study and normal controls. Shock wave lithotripsy has no deleterious effect on the normal rate of renal growth in children. This outcome is not affected by either the number of stones or the age of the child at shock wave lithotripsy.

The effect of citrate replacement in hypocitraturic cases on the results of SWL: a preliminary prospective randomized study

To evaluate the possible effects of citrate replacement on the efficacy of shockwave lithotripsy (SWL) in the management of kidney stones in cases with hypocitraturia. Forty hypocitraturic cases with renal pelvic stones were randomized into two groups; while citrate replacement has been done before and at the time of SWL in Study Group I (n: 20), SWL was performed without any additional specific management for hypocitraturia in Study Group II (n: 20). Twenty normocitraturic cases were also chosen as the control group (Group III). Data of the patients were evaluated comparatively. Patient, stone, and urinary pH characteristics of the groups were similar. Pre-SWL urinary citrate levels were 0.71 (0.1-1.3), 0.86 (0.1-1.4), and 3.12 (1.8-4.4) mmol/24 h in Group I, II, and III, respectively. Urinary citrate value increased from 0.71 (0.1-1.3) to 1.96 (1.6-4.1) mmol/24 h following replacement therapy (before and at the time of SWL) in Group I. Mean number of SW (p = 0.461), rate of stone-street formation (p = 0.146), and Double-J placement (p = 0.291) were similar in Group I and Group II. While the mean number of SWL sessions (2.27 ± 0.71 in Group I vs. 2.94 ± 0.59 in Group II; p = 0.027), and time to stone-free status [29.1 (16-47) days in Group I vs. 38.4(21-63) days in Group II; p = 0.043], was significantly different between study groups, these parameters were found similar between Group I and Group III. In our study, the patients with hypocitraturia, who did receive replacement therapy, tended to require lower number of SWL sessions and became stone free in a shorter period than the others who underwent SWL without any specific management of hypocitraturia.

Adjuvant alpha adrenergic blockers: Are they equally efficient for renal and upper ureteral calculi disintegrated by shock wave lithotripsy?

Abstract Objectives To evaluate the effects of tamsulosin on stone clearance and analgesic requirements after shock wave lithotripsy (SWL) for solitary renal and upper ureteral calculi. Patients and methods A prospective randomized placebo controlled study was carried out on 126 patients who underwent SWL for solitary radio-opaque renal or upper ureteral calculi ≤20 mm. Patients were randomized into two groups receiving either 0.4 mg of tamsulosin (GT) or placebo (GP). SWL was performed 3-weekly until patients became stone-free or for a maximum of 3 months. Analgesics were used on demand and pain was evaluated by a visual pain scale. Results Renal stones represented 55.6% and 66.7% for GT and GP, respectively ( p = 0.27). Mean renal and ureteral stone size were (12.3 ± 1.8 mm vs. 11.5 ± 2.3 mm, p = 0.14) and (9.7 ± 2.6 mm vs. 8.6 ± 1.7 mm, p = 0.1) for the GT and GP, respectively. GT required fewer SWL sessions for ureteral (1.2 vs. 1.6, p = 0.02) and renal stones (1.8 vs. 2.3, p = 0.08). Stone-free rate (SFR) was higher in GT for upper ureteral stones (96.4% vs. 66.7%, p = 0.01) and renal pelvis stones at a cutoff size >10 mm ( p = 0.01). The mean time of stone clearance was significantly lower in GT (4.2 ± 1.9 weeks vs. 7.5 ± 2.3 weeks, p = 0.001) for ureteral stones. Attacks of renal colic were more frequent in GP (82.5% vs. 44.4%, p = 0.04) with increased demand for analgesia ( p = 0.04). Steinstrasse was recorded in 3 and 7 patients of the GT and GP, respectively ( p = 0.32). Conclusion Tamsulosin facilitates clearance of upper ureteral stone fragments after SWL and decreases the analgesic requirements. These effects were not similarly evident for renal stones.

PEDIATRIC UROLOGY Large stone clearance in 2-year-old child with staghorn and calyceal stones using SWL monotherapy

Treatment of pediatric urolithiasis requires a thorough metabolic and urological evaluation on an individual basis.The objective of our case report was to determine the efficiency and the role of shockwave lithotripsy (SWL) in the treatment of pediatric urolithiasis.In this case report we reported our own experience in the management of staghorn and calyceal stones in both kidneys with SWL.In our case, clearance of multiple staghorn stones and a calyceal stone was obtained without any complications after 7 sessions of SWL over 2 months.

The Effect of Tamsulosin and Combination of Terpenes (Rowatinex) on the Clearance of Renal Stone Gravels After Single Session of Extracorporeal Shock Wave Lithotripsy (ESWL)

The Effect of Tamsulosin and Combination of Terpenes (Rowatinex) on the Clearance of Renal Stone Gravels After Single Session of Extracorporeal Shock Wave Lithotripsy (ESWL)

Monitoring the Coupling of the Lithotripter Therapy Head With Skin During Routine Shock Wave Lithotripsy With a Surveillance Camera

With lithotripters today the shock waves are typically transmitted into the body via water filled bellows using coupling gel to make contact with the skin. Usually the coupling zone is not visible to the operator. We investigated coupling quality during routine clinical shock wave lithotripsy and the associated effect on shock wave disintegration efficiency. During 30 routine shock wave lithotripsy treatments the coupling zone was continuously monitored by a video camera integrated into a DoLi SII lithotripter (Dornier MedTech, Wessling, Germany). However, it was not shown to the blinded operator to resemble the standard clinical situation. We used 3 coupling gels, including LithoClear®, Sonogel® and a custom-made gel of low viscosity. The ratio of air in the relevant coupling area was measured. Lithotripter disintegration efficiency was evaluated by in vitro model stone tests at an air ratio of 0%, 5%, 10% and 20%. Only in 10 of 30 treatments was good coupling achieved with an air ratio of less than 5%. In 8 treatments the ratio was greater than 20%. The best coupling conditions were achieved with low viscosity gel. The mean ± SD number of shock waves needed for complete fragmentation in the model stone tests was 100 ± 4 for bubble-free coupling, and 126 ± 3 for 5%, 151 ± 8 for 10% and 287 ± 5 for 20% air bubbles. At 20 of 30 shock wave lithotripsy sessions there was imperfect coupling, accompanied by significant loss of disintegration capability. A surveillance camera is useful to monitor and improve coupling.