Shock Wave Lithotripsy In Management Research Articles

Effect of JJ Stent on Outcomes of Extracorporeal Shockwave Lithotripsy of Renal Stones around 2 cm

Abstract Background Urolithiasis is a common problem in Egypt as it lies within the stone belt region extending from Indonesia to Egypt. Economic and dietary factors, dehydration, exposure to heat and possible genetic factors. Urolithiasis is one of the most common problems encountered by urologists. Many factors affect Stone formation like geographical, climatic, ethnic, dietary and genetic factors. The recurrence rate is determined by the primary etiology of stones formation. Aim of the Work Evaluation of the role of JJ stent in enhancing the passage of fragments in patients undergoing extracorporeal shockwave lithotripsy (ESWL) for renal stones with size around 2 cm. Patients and Methods This randomized controlled clinical trial was conducted on 90 patients in the period from December 2021 to July 2022 with age ranged from 24 – 60 years with mean±SD of 44.21 ± 10.99 years; they were 28 females (31.1%) and 62 males (68.9%) and randomly divided into two groups: Group (I): Patients without JJ stent consists of 45 patients & Group (II): Patients with JJ stent consists of 45 patients. Results The analysis of our study results showed no statically significant difference between the two groups regarding SFRs (95.6% in group I & 93.3% in group II), time to SFRs (mean±SD 1.05 ± 0.55 month in group I & 1.20 ± 0.59 month in group II), number of sessions of ESWL (2.11 for group I & 2.37 for group II), auxillary procedures (Two patients in group I (4.4%) 1 patient had PCNL & 1 patient had URS due to steinStrasse 2.2%) & Three patients in group II (6.7%) failed ESWL and had PCNL), number of ER visits (in group I 46.7% & in group II 40 % had attended at least once for the ER, analgesics consumption (In group I 77.8% & In group II 84.4%) & laboratory tests changes like Hb drob between pre & post ESWL in the two groups (-0.02 ± 0.04 & -0.11 ± 0.08 in group I & group II respectively) & the amount of increase in serum creatinine level (post – pre) was found 0.07 ± 0.03 in patients without JJ stent and 0.03 ± 0.04 in patient with JJ stent. Conclusion Routine JJ stent fixation before extracorporeal shock wave lithotripsy in management of renal stones around 2cm is unnecessary because it doesn’t improving free stone rate or enhancing the passage of the fragments during ESWL.

Uretroscopy with Laser vs ESWL in Management of Upper Ureteric Stones

Background Although SWL and Laser remain the most common modalities for the treatment of proximal ureteral stones, there is still an ongoing debate among the academicians and medical practitioners regarding the best treatment modality. Objective To compare the efficacy of ureteroscopy using holmium: YAG laser lithotripsy versus shock wave lithotripsy in management of proximal ureteric stones (≤10 mm) regarding surgical efficacy, safety and cost effectiveness. Patients and Methods This study was performed to compare ureteroscopy using holmium: YAG laser lithotripsy versus shock wave lithotripsy in management of proximal ureteric stones (≤10 mm) regarding surgical efficacy, safety and cost effectiveness. It included 52 patients with proximal ureteral stones and it was done in the period starting from September 2021 to February 2022. Results There was a statistically significant difference between the both modalities in favor of SWL as regarding the anesthesia, the overall procedural time and overall cost as SWL group were treated as an outpatient cases. There was a significant difference in used anesthesia (sedation for SWL and general anesthesia for Laser). Regarding Overall procedural time (hours), it was 4.55 ± 1.94 and was 36.88 ± 5.38 for SWL and Laser groups respectively. Overall cost; even if patients underwent three sessions of SWL, the cost between the two options was still significantly different. The overall cost of Laser was 15000 EP, with an efficiency of 80 %, while overall cost of SWL was (2500 EP), with an efficiency of 49.9 %. Conclusion Laser is more effective, has the advantage of the higher SFR from the first session without need of multiple hospital visits and prolonged radiation exposure time. SWL has lower treatment costs, while complications were comparable in both groups, so treatment decision depends on not only stone characteristics but also cost-effectiveness ratio and this should be considered when counseling the patient with proximal ureteric stone. Larger sample size is required for more convenience data.

Flexible Ureterorenoscopy versus Shockwave Lithotripsy in Management of Residual Stone Fragments after Percutaneous Nephrolithotomy

Flexible Ureterorenoscopy versus Shockwave Lithotripsy in Management of Residual Stone Fragments after Percutaneous Nephrolithotomy

Flexible Ureteroscopy with Laser Lithotripsy versus Extracorporeal Shock Wave Lithotripsy in Management of Ureteric Stones in Pediatric Age Group

Flexible Ureteroscopy with Laser Lithotripsy versus Extracorporeal Shock Wave Lithotripsy in Management of Ureteric Stones in Pediatric Age Group

Role of Extracorporeal Shock Wave Lithotripsy in Management of Upper Ureteric Stones

IntroductionThe treatment options for upper ureteric stones range from open surgeries to minimally invasive and non invasive techniques. Presently the two most frequently used options for upper ureteric calculi that require intervention are extracorporeal shock wave lithotripsy (ESWL) and ureterorenoscopy (URS) with contact lithotripsy applied by attaining endoscopic access to the calculi. ObjectiveThe objective of this study is meant to evaluate ESWL in the treatment of upper ureteric stones ≤2 cm in terms of stone free rates, complications and procedure time. Patients and methodSeventy six patients were subjected to ESWL as primary modality for treatment of upper ureteric stone. ESWL group had mean stone size of 10.58 mm. The stone free rate was 93.4% for ESWL. The sample size was adequate as it was determined by statistician by applying pertinent formulas. ResultsIt was observed that the stone free rate in ESWL group was higher (97.7%) when the stone size was ≤10 mm and when the duration of symptoms was <1 month. ESWL was advantageous in terms of procedural time with no requirement of anaesthesia. The complications in ESWL were minor in nature and were not statistically significant. ConclusionIn conclusion, this study shows that ESWL is an important modality in treating upper ureteric calculi ≤2 cm in size and we strongly recommend ESWL as the first choice of procedure in solitary upper ureteric calculi ≤10 mm size.

Flexible Ureteroscopy with Laser Lithotripsy versus Extracorporeal Shock Wave Lithotripsy in Management of Ureteric Stones in Pediatric Age Group

Background: pediatric stone disease is one of the most common urological issues in pediatric urology practice. The incidence of urinary stone disease is increasing in children in last decades. Aim of the Work: determination of the efficacy and outcome of flexible ureteroscopy using holmium Yttrium aluminium garne laser lithotripsy and compare its results with that of Extracorporeal shock wave lithotripsy EWSL in management of ureteric stones in pediatric age group. Patients and Methods: this study included 40 patients in pediatric age group. Complaining of upper ureteric stones less than (1cm). Patients underwent either ESWL or Flexible Ureteroscopy randomly according to 1: 1 ratio. The procedures were done at Eldemerdash hospital and National Institute of Urology and Nephrology. The patients were divided into two groups. Group A: Patients undergone extracorporeal shock wave lithotripsy (ESWL). Group B: Patients received flexible ureteroscopy and laser lithotripsy. Results: there was no statistically significant difference found between the two studied groups regarding age, sex, size and BMI, and stone free rate. Also there was highly statistically significant difference as regard hospital stay. The SWL group required a shorter period of hospitalization and there was highly statistically significant difference between the two groups regarding duration of the procedure which is more prolonged in flexible group. Conclusion: flexible URS lithotripsy and laser are considered a safe, highly efficient, minimally invasive, and reproducible surgery technique -with a higher stone free rates and less postoperative complications, after a single procedure, when compared to ESWL- for management of upper ureteric calculi in children after failure of ESWL.

Flexible Ureteroscopy with Laser Lithotripsy versus Extracorporeal Shock Wave Lithotripsy in Management of Ureteric Stones in Pediatric Age Group

Background: pediatric stone disease is one of the most common urological issues in pediatric urology practice. The incidence of urinary stone disease is increasing in children in last decades. Aim of the Work: determination of the efficacy and outcome of flexible ureteroscopy using holmium Yttrium aluminium garne laser lithotripsy and compare its results with that of Extracorporeal shock wave lithotripsy EWSL in management of ureteric stones in pediatric age group. Patients and Methods: this study included 40 patients in pediatric age group. Complaining of upper ureteric stones less than (1cm). Patients underwent either ESWL or Flexible Ureteroscopy randomly according to 1: 1 ratio. The procedures were done at Eldemerdash hospital and National Institute of Urology and Nephrology. The patients were divided into two groups. Group A: Patients undergone extracorporeal shock wave lithotripsy (ESWL). Group B: Patients received flexible ureteroscopy and laser lithotripsy. Results: there was no statistically significant difference found between the two studied groups regarding age, sex, size and BMI, and stone free rate. Also there was highly statistically significant difference as regard hospital stay. The SWL group required a shorter period of hospitalization and there was highly statistically significant difference between the two groups regarding duration of the procedure which is more prolonged in flexible group. Conclusion: flexible URS lithotripsy and laser are considered a safe, highly efficient, minimally invasive, and reproducible surgery technique -with a higher stone free rates and less postoperative complications, after a single procedure, when compared to ESWL- for management of upper ureteric calculi in children after failure of ESWL.

Retrograde Intrarenal Surgery Versus Percutaneous Nephrolithotomy Versus Extracorporeal Shockwave Lithotripsy for Treatment of Lower Pole Renal Stones: A Meta-Analysis and Systematic Review

The optimal treatment of patients with lower pole renal stones continues to be a dilemma for urologists. Retrograde intrarenal surgery (RIRS), percutaneous nephrolithotomy (PCNL), and extracorporeal shockwave lithotripsy (SWL) all constitute viable therapeutic options in selected patients. The aim of this study was to assess the efficacy and safety of RIRS, PCNL, and SWL in management of lower pole renal stones. A literature search was performed in July 2014 using PubMed, Embase, and Web of Science databases. Literature reviewed included meta-analysis and randomized and nonrandomized controlled studies to identify relevant studies for the meta-analysis. Six randomized and eight nonrandomized studies were identified for analysis. PCNL provided a significantly higher stone-free rate (SFR) compared with RIRS and SWL. Furthermore, no statistical significant difference was found when PCNL was compared with RIRS and SWL for complication rate. Compared with the other two treatments, RIRS had a longer operative time and PCNL had a longer hospital stay. SWL was associated with significantly higher re-treatment rate compared with RIRS and PCNL, whereas there were no significant differences in auxiliary procedure rates among the three treatment techniques. RIRS offers a relative higher SFR while it has a longer operative time. PCNL is associated with the highest SFR at the expense of the longest hospital stay. SWL is performed as an outpatient procedure with a relative shorter operative time; however, it has lower a SFR and higher re-treatment rate. The categories of complications vary while the overall complication rates are comparable among the three treatment techniques.

Efficacy of shock wave lithotripsy in management of kidney stones in infants

Introduction and objectivesDespite being uncommon, infantile kidney stone remains a major health problem due to its higher recurrence rate and morbidity. The parents usually notice that their infants have recurrent fever and failure to thrive of unknown origin. Those patients comprise a big challenge for the urologist in management. Therefore, this study aimed to evaluate the outcome of shockwave lithotripsy (SWL) in management of renal stones in infants. Subjects and methodsA retrospective analysis of prospectively collected data performed between January 2009 and December 2012 for infants underwent SWL for single radio-opaque renal stones ≤15mm at a single stone center. SWL was performed with Dorneir S lithotripter with a maximum of 1500 shocks per session. A single session was indicated for each infant, but a second session was performed when satisfactory disintegration was not achieved. Follow-up based on urinalysis, urine culture and sensitivity, plain X-ray kidney ureter bladder (KUB) and abdominal ultrasonography (US) was carried out 2 weeks post SWL and monthly for 3 successive months. Multislice Computed tomography (MSCT) was performed 3-months post-SWL to confirm the stone-free status. ResultsA total of 87 infants, less than 24 months of age were enrolled in this research. SWL success was defined as absence of any residual fragments on MSCT 3-months after the last session. Stone free rate was 93.1% after the first SWL session and reached 100% after the second session. Rate of retreatment with second session of SWL was 6.9%. Urinary tract infection (UTI) was detected in 10.3%, transient renal obstruction with low grade fever in 4.6% of infants and no major complication had been recorded. ConclusionThe new generation of SWL technology with a precise focal area seems to be safe and effective in management of kidney calculi in infants.

Reply

Interest in modifying the usual practice of shock wave lithotripsy, to allow better stone fragmentation while minimizing renal injury, has been increasing. It has been suggested that “preconditioning” with low-voltage shock waves might both improve fragmentation 1 Zhou Y. Cocks F.H. Preminger G.M. et al. The effect of treatment strategy on stone comminution efficiency in shock wave lithotripsy. J Urol. 2004; 172: 349-354 Abstract Full Text Full Text PDF Scopus (69) Google Scholar , 2 Maloney M.E. Marguet C.G. Zhou Y. et al. Progressive increase in lithotriptor output produces better in-vivo stone comminution. J Endourol. 2006; 20: 603-606 Crossref Scopus (47) Google Scholar , 3 McAteer J.A. Baird T. Williams J.C. et al. Voltage-stepping during SWL influences stone breakage independent of total energy delivered: In vitro studies with model stones. J Urol. 2003; 169: 487A Abstract Full Text Full Text PDF Scopus (94) Google Scholar , 4 Demirci D. Sofikerim M. Yalçin E. et al. Comparison of conventional and step-wise shockwave lithotripsy in management of urinary calculi. J Endourol. 2007; 21: 1407-1410 Crossref Scopus (45) Google Scholar and minimize renal injury. 5 Willis L.R. Evan A.P. Connors B.A. et al. Prevention of lithotripsy-induced renal injury by pretreating kidneys with low-energy shock waves. J Am Soc Nephrol. 2006; 17: 663-673 Crossref Scopus (91) Google Scholar , 6 Connors BA, Evan AP, Blomgren PM, et al. Effect of initial shock wave voltage on shock wave lithotripsy-induced lesion size during step-wise voltage ramping. BJU Int. Epub 2008 Aug 1. Google Scholar Shock Wave Lithotripsy: A Randomized, Double-blind Trial to Compare Immediate Versus Delayed Voltage EscalationUrologyVol. 75Issue 1PreviewTo present a randomized trial investigating immediate vs delayed voltage escalation during shock wave lithotripsy (SWL). SWL efficiency is affected by the energy setting of the lithotripter, the consumption level of the electrode, and the rate of shock wave administration. Preliminary data have suggested that delaying voltage escalation for SWL might both improve fragmentation and minimize renal injury. Full-Text PDF Editorial CommentUrologyVol. 75Issue 1PreviewThe usual technique of shock wave lithotripsy (SWL) is to begin at a low voltage level and increase the voltage in increments for a few hundred shocks until a target voltage has been reached. The goals are to minimize pain (and thereby minimize patient movement), enhance safety, and possibly enhance fragmentation.1-3 However, does voltage escalation amount to wasting several hundred shocks at too low a power? This randomized, double-blind SWL trial compared immediate vs delayed voltage escalation using the Phillips LithoTron lithotripter. Full-Text PDF

Effect of Escalating Versus Fixed Voltage Treatment on Stone Comminution and Renal Injury During Extracorporeal Shock Wave Lithotripsy: A Prospective Randomized Trial

ESWL is a minimally invasive, efficacious therapy for most renal stones. However, an optimal voltage treatment protocol ensuring effective stone comminution while minimizing tissue injury is not well established. We performed a prospective, randomized trial of the stone-free rate and renoprotective effect of an escalating vs a fixed voltage treatment strategy during ESWL. Between February 2006 and June 2008 we enrolled 45 patients undergoing ESWL for a renal stone in this institutional review board approved trial. A Dornier DoLi 50 lithotriptor was used. Patients were randomized to receive the escalating strategy of 500 shocks at 14k V, 1,000 at 16 kV and 1,000 at 18 kV or the fixed strategy of 2,500 shocks at 18 kV. Abdominal x-ray was done to determine the stone-free rate at 1 month. Voided urine was analyzed for beta2-microglobulin and microalbumin before, immediately after and 1 week after ESWL to evaluate renal damage. Median patient age was 48 years. Median stone size was 8 mm. Of patients in the escalating group 81% were stone-free vs 48% in the fixed group (p <0.03). There was a significant difference between microalbumin and beta2-microglobulin 1 week after the procedure (p = 0.046 vs 0.045). There was trend toward a difference in microalbumin and beta2-microglobulin immediately after the procedure (p = 0.17 and 0.25, respectively). This prospective, randomized study shows that an escalating voltage treatment strategy produces better stone comminution than a fixed strategy. The study suggests that there may be a protective effect against damage caused by ESWL with an escalating treatment strategy.

Solo extracorporeal shock wave lithotripsy for management of upper ureteral calculi with hydronephrosis.

The aim of this study was to evaluate extracorporeal shock wave lithotripsy (SWL) outcomes as a solo therapy in patients with upper ureteral calculi and varying degrees of hydronephrosis. Eighty patients with upper ureteral calculi and a body mass index between 19.5 kg/m2 and 22.5 kg/m2 were included. They were categorized into 4 groups according to the severity of hydronephrosis as seen on ultrasonography and intravenous urography: group 1, no dilatation; group 2, mild dilatation; group 3, moderate dilatation; and group 4, severe dilatation of the pyelocaliceal system. The size of calculi, time to calculus clearance, success rate of solo SWL, and the need for additional therapeutic methods were recorded and compared between the four groups of patients. The median size of the calculi was 13.5 mm, and the mean time to calculus clearance was 56.0 +/- 24.2 days. In 71.3% of the patients, solo SWL was successful in the treatment of the calculi. Twenty-three patients required other therapies including double-J stenting, ureteroscopy, and nephrolithotomy. The patients without hydronephrosis and those with severe hydronephrosis (groups 1 and 4) showed a significant difference in the days to clearance of the calculus (mean, 31.7 days versus 85.6 days; P < .001). Patients with upper ureteral calculi and mild hydronephrosis can be effectively treated with solo SWL therapy. In those with moderate hydronephrosis, clearance takes longer or requires secondary interventions. In patients with severe hydronephrosis, we recommend alternative/adjunctive procedures.

Comparison of Conventional and Step-Wise Shockwave Lithotripsy in Management of Urinary Calculi

In this clinical study, our aim was to evaluate the results of conventional and step-wise shockwave lithotripsy (SWL) in the management of urinary calculi. Fifty consecutive patients seen in our outpatient urology clinic were included and randomized in the clinical study. SWL was performed using a Dornier Compact Delta instrument. Treatment energy was set on 13 kV in the conventional group. In the step-wise SWL group, the patients were subjected to gradually increased (with every 500 shocks) output voltage as 11, 12, and 13 kV, respectively. The SWL session was completed with 13 kV thereafter. The maximum number of shocks in both groups was limited to 3,000. Twenty-five patients in the conventional group and 25 patients in the step-wise SWL were included. The mean ages in the step-wise SWL group and the conventional group were 39.9 and 41.4 years (P > 0.05), respectively. The mean stone size was 0.83 +/- 0.51 cm in the step-wise SWL group and 0.70 +/- 0.41 cm in the conventional group (P > 0.05). There was no difference between the two groups as to the localization of stones in the ureter or kidney. Also, no statistical difference was observed in the number of lithotripsy treatments between the two groups. When we compared the results of two treatment procedures 8 weeks after the initial treatment, the success rate was significantly higher in the step-wise SWL group than in the conventional group (stone-free rate 96% (24/25) v 72% (18/25), P < 0.05)). Step-wise SWL yielded better outcomes than conventional SWL without increased morbidity. Stepwise SWL can be considered as a management option for urinary calculi.

Primary extracorporeal shockwave lithotripsy in management of large bladder calculi.

Large bladder calculi are often outside the range of treatment with conventional endoscopic lithotrites because of either anatomic factors or the mechanical limits of available instruments. Alternative methods of cystolithotripsy: ultrasonic, electrohydraulic, or laser, can prove time-consuming or even hazardous, so that open surgery is often the most expeditious option. We report our experience using Dornier HM3 extracorporeal shockwave lithotripsy (SWL) for initial bladder stone reduction preparatory to transurethral litholapaxy and definitive treatment of any underlying obstructive pathology. Primary cystolitholapaxy was judged impractical in these 24 patients (21 adults and 3 children) presenting 31 large bladder stones (mean size 35.6 mm). In all patients, primary transpelvic SWL was followed immediately by endoscopic evacuation of stone debris or cystolitholapaxy. In addition, 10 of the 24 patients (42%) underwent a definitive endoscopic operation for treatment of an underlying obstructive lesion at either the same or a follow-on session. Morbidity was minimal, and the mean hospital stay after the initial SWL treatment was 3.5 days. In our experience, Dornier SWL has proved invaluable in enabling cystolitholapaxy of very large bladder calculi that would otherwise require protracted and difficult endoscopic manipulation or open surgery.

A Comparison of Anatrophic Nephrolithotomy and Percutaneous Nephrolithotomy with and without Extracorporeal Shock Wave Lithotripsy for Management of Patients with Staghorn Calculi

A retrospective study was conducted comparing anatrophic nephrolithotomy (10 cases), percutaneous nephrolithotomy alone (4 cases) or percutaneous nephrolithotomy combined with extracorporeal shock wave lithotripsy (23 cases) for the treatment of large staghorn calculi. A comparison based on collecting system anatomy demonstrated that anatrophic nephrolithotomy resulted in a greater stone-free rate, shorter hospitalization and lower costs while complication rates were similar. Anatrophic nephrolithotomy should still be considered a viable treatment option, especially for patients with large branched calculi in complex collecting systems.

Anatrophic Nephrotomy and Plastic Calyrhaphy

SummaryA technique of nephrotomy is described in which the kidney is not bivalved, rather the nephrotomy incision is placed between the junction of the anterior and posterior arterial segments. A new method utilizing vertical mattress sutures and water-tight closure is discussed. Correction of calyceal stenosis is achieved by calycoplasty. The results of this procedure in 138 patients as it has evolved in the last 12 years are reviewed.