Shock Wave Lithotripsy In Patients Research Articles

Impact of Pretreatment Hydronephrosis on the Success Rate of Shock Wave Lithotripsy in Patients with Ureteral Stone.

PurposeTo evaluate predictors of the success rate for one session of shock wave lithotripsy (SWL), focusing on the relationships between pretreatment hydronephrosis grade and one-session SWL success rates.Materials and MethodsThe medical records of 1824 consecutive patients who underwent an initial session of SWL for treatment of urinary stones between 2005 and 2013 were reviewed. After exclusion, 700 patients with a single, 4–20 mm diameter radiopaque calculus were included in the study.ResultsThe mean maximal stone length (MSL) and skin-to-stone distance were 9.2±3.9 and 110.8±18.9 mm, respectively. The average values for mean stone density (MSD) and stone heterogeneity index (SHI) were 707.0±272.1 and 244.9±110.1, respectively. One-session success rates were 68.4, 75.0, 75.1, 54.0, and 10.5% in patients with hydronephrosis grade 0, 1, 2, 3, and 4, respectively. Patients were classified into success or failure groups based on SWL outcome. Multivariate logistic regression analyses revealed that MSL [odds ratio (OR) 0.888, 95% confidence intervals (CI): 0.841–0.934, p<0.001], MSD (OR 0.996, 95% CI: 0.995–0.997, p<0.001), SHI (OR 1.007, 95% CI: 1.005–1.010, p<0.001), and pretreatment hydronephrosis grade (OR 0.601, 95% CI: 0.368–0.988, p=0.043) were significantly associated with one-session success.ConclusionPretreatment grades 3 or 4 hydronephrosis were associated with failure of SWL in patients with a single ureteral stone. In the presence of severe hydronephrosis, especially hydronephrosis grade 4; physicians should proceed cautiously in choosing and offering SWL as the primary treatment for ureteral stone.

Últimos avances en pancreatitis crónica

This article summarizes some of the recent and clinically relevant advances in chronic pancreatitis. These advances mainly concern the definition of the disease, the etiological diagnosis of idiopathic disease, the correlation between fibrosis degree and pancreatic secretion in the early stages of chronic pancreatitis, the treatment of the disease and of pain, the clinical relevance of pancreatic exocrine insufficiency, and the diagnosis of autoimmune pancreatitis. A new mechanistic definition of chronic pancreatitis has been proposed. Genetic testing is mainly of help in patients with relapsing idiopathic pancreatitis. A significant correlation has been shown between the degree of pancreatic fibrosis as evaluated by elastography and pancreatic secretion of bicarbonate. New data supports the efficacy of antioxidants and simvastatin for the therapy of chronic pancreatitis. The pancreatoscopy-guided intraductal lithotripsy is an effective alternative to extracorporeal shock wave lithotripsy in patients with chronic calcifying pancreatitis. The presence of pancreatic exocrine insufficiency in patients with chronic pancreatitis is associated with a significant risk of cardiovascular events. Fine needle biopsy and contrast enhanced harmonic endoscopic ultrasonography are of help for the diagnosis of autoimmune pancreatitis and its differential diagnosis with pancreatic cancer.

A practical formula to predict the stone-free rate of patients undergoing extracorporeal shock wave lithotripsy

ObjectivesWe studied patients who underwent extracorporeal shock wave lithotripsy (SWL) to investigate the factors influencing the outcome, and built a logistic regression model to estimate the stone-free rate (SFR) after SWL. Material and methodsFrom January 2013 to December 2013, we retrospectively reviewed the clinical status of 641 patients with a solitary urinary calculus who underwent SWL in our hospital. Univariate logistic regression was used to identify the factors leading to a high SFR, and significant factors were further analyzed by multivariate logistic regression. After the optimal model had been developed, we placed it on the website so others could calculate the SFR at their institutions. ResultsThe overall SFR for all patients, patients with ureteral stones, and patients with renal stones were 54.8%, 67.8%, and 46.7%, respectively. Multivariate logistic regression showed that body mass index (BMI), stone length, stone width, and stone location were the independent factors that affected the overall successful rate. Stone length was the only significant factor to predict SFR for ureteral stones. BMI, stone length, and stone width were significant SFR predictors for renal stones. A logistic regression model was designed to estimate SFR, which has a sensitivity of 77.8% and specificity of 75.5%. ConclusionBMI, stone length, stone width, and kidney and ureteral stones were all prognostic factors influencing the outcome of SWL. We built a logistic regression formula to predict the SFR, which helps urologists to select patients for SWL.

Ureteral stenting can be a negative predictor for successful outcome following shock wave lithotripsy in patients with ureteral stones.

PurposeTo evaluate ureteral stenting as a negative predictive factor influencing ureteral stone clearance and to estimate the probability of one-session success in shock wave lithotripsy (SWL) patients with a ureteral stone.Materials and MethodsWe retrospectively reviewed the medical records of 1,651 patients who underwent their first SWL. Among these patients, 680 had a ureteral stone measuring 4–20 mm and were thus eligible for our study. The 57 patients who underwent ureteral stenting during SWL were identified. Maximal stone length (MSL), mean stone density (MSD), skin-to-stone distance (SSD), and stone heterogeneity index (SHI) were determined by pre-SWL noncontrast computed tomography.ResultsAfter propensity score matching, 399 patients were extracted from the total patient cohort. There were no significant differences between stenting and stentless groups after matching, except for a higher one-session success rate in the stentless group (78.6% vs. 49.1%, p=0.026). In multivariate analysis, shorter MSL, lower MSD, higher SHI, and absence of a stent were positive predictors for one-session success in patients who underwent SWL. Using cutoff values of MSL and MSD obtained from receiver operator curve analysis, in patients with a lower MSD (≤784 HU), the success rate was lower in those with a stent (61.1%) than in those without (83.5%) (p=0.001). However, in patients with a higher MSL (>10 mm), the success rate was lower in those with a stent (23.6%) than in those without (52.2%) (p=0.002).ConclusionsUreteral stenting during SWL was a negative predictor of one-session success in patients with a ureteral stone.

Impact of ureteric stent on outcome of extracorporeal shockwave lithotripsy: A propensity score analysis.

IntroductionExtracorporeal shockwave lithotripsy (SWL) is one of the most frequently performed procedures in patients with urolithiasis. For ureter-localized stones, SWL is often preceded by a double J stent insertion. However, fear of serious complications, including sepsis associated with stents, is often expressed. The following study assessed the impact of stent insertions on the results of SWL in patients with ureteric stones.Material and methodsThe study group consisted of 411 ureteric stone patients who were treated with SWL from January 2010 to December 2014. In 60 cases, treatment was preceded by ureteric stent insertion. A propensity scoring system was used to pair non-stented patients with the stented group. Success rates were assessed and compared using the chi-squared test. Multivariate logistic regression analysis was used to evaluate the influence of particular variables on the stone-free rate.ResultsThe overall success rate was 82.2%. After matching, the success rate of the stented group was not significantly different from the control group (85.0% vs. 83.3% respectively, p = 0.80). The mean number of sessions was higher in the stented group (1.88 per patient). Stones located in the lower part of the ureter have the greatest chance of being successfully treated.ConclusionsThe double J stent has no influence on the outcome of SWL treatment. In view of the greater likelihood of having additional sessions, this approach should be reserved for selected cases.

Últimos avances en pancreatitis crónica

This article summarizes some of the recent and clinically relevant advances in chronic pancreatitis. These advances mainly concern the early diagnosis of the disease, the treatment of symptoms and complications, mainly pain and pancreatic exocrine insufficiency, and the diagnosis and therapy of autoimmune pancreatitis. The multimodal dynamic endoscopic ultrasound-guided secretin-stimulated evaluation of the pancreas provides relevant morphological and functional information for the diagnosis of chronic pancreatitis at early stages. Extracorporeal shock wave lithotripsy in patients with calcifying pancreatitis and endoscopic pancreatic stent placement are effective alternatives for pain therapy in patients with chronic pancreatitis. Presence of pancreatic exocrine insufficiency in patients with chronic pancreatitis is associated with a significantly increase of mortality rate. Despite that, pancreatic enzyme replacement therapy is not prescribed in the majority of patients with pancreatic exocrine insufficiency, or it is prescribed at a low dose. The newly developed and commercialized needles for endoscopic ultrasound-guided pancreatic biopsy are effective in retrieving appropriate tissue samples for the histological diagnosis of autoimmune pancreatitis. Maintenance therapy with azathioprine is effective and safe to prevent relapses in patients with autoimmune pancreatitis.

MP38-08 DETERMINANTS OF HEALTH-RELATED QUALITY OF LIFE FOR PATIENTS AFTER URINARY LITHOTRIPSY: URETEROSCOPIC VERSUS SHOCK WAVE LITHOTRIPSY

You have accessJournal of UrologyStone Disease: Surgical Therapy IV1 Apr 2015MP38-08 DETERMINANTS OF HEALTH-RELATED QUALITY OF LIFE FOR PATIENTS AFTER URINARY LITHOTRIPSY: URETEROSCOPIC VERSUS SHOCK WAVE LITHOTRIPSY Shuzo Hamamoto, Takahiro Yasui, Naoko Okuda, Satoshi Koiwa, Atsushi Okada, Hiroyuki Kamiya, Yoshihiro Hashimoto, Keiichi Tozawa, Yutaka Iwase, and Kenjiro Kohri Shuzo HamamotoShuzo Hamamoto More articles by this author , Takahiro YasuiTakahiro Yasui More articles by this author , Naoko OkudaNaoko Okuda More articles by this author , Satoshi KoiwaSatoshi Koiwa More articles by this author , Atsushi OkadaAtsushi Okada More articles by this author , Hiroyuki KamiyaHiroyuki Kamiya More articles by this author , Yoshihiro HashimotoYoshihiro Hashimoto More articles by this author , Keiichi TozawaKeiichi Tozawa More articles by this author , Yutaka IwaseYutaka Iwase More articles by this author , and Kenjiro KohriKenjiro Kohri More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1383AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Shock wave lithotripsy (SWL) and ureteroscopic lithotripsy (URSL) are well-established procedures for fragmentation of stones using a lithotripter; however, the morbidity, hospitalization, and days lost from daily work can negatively affect the health-related quality of life (HRQoL) of patients. Recently, there has been increasing recognition that the selection of therapeutic modality for urinary lithotripsy should be based not only on the stone free rate, but also on the future HRQoL. Thus, we here aimed to compare longitudinal HRQoL between SWL and URSL patients after surgical intervention, and to evaluate the factors affecting the HRQoL of these patients. METHODS In this institutional review board-approved study we prospectively interviewed 262 consecutive patients who underwent SWL (n=61) or URSL (n=201) for treatment of upper urinary tract calculi between June 2012 and October 2013. All patients were prospectively administered the Short-Form 36-item survey (SF-36) to assess the HRQoL at discharge, 1 month, and 6 months after lithotripsy. The stone-free rate, hospital stay, complications, and analgesia requirements were evaluated to compare the effects of surgery on the HRQoL between the groups. RESULTS At the day of discharge, patients in the URSL group had significantly lower mean scores on 6 different subscales of the SF-36 questionnaire, namely physical functioning, role-physical, body pain, social functioning, role-emotional, and mental health. The stone-free rate at 3 months after lithotripsy was significantly lower in the SWL group (72.1% vs. URSL, 93.0%; p<0.01). The hospital stay was shorter in the SWL group (2.1 ± 0.07 vs. URSL, 4.1 ± 0.13 days; p<0.001), and the analgesia requirements were also lower in the SWL group (0.3 ± 0.08 vs. URSL, 0.9 ± 0.20; p<0.001). The multivariate analyses identified several variables that were significantly associated with the low HRQoL after lithrotripsy, including age (p=0.04) and the use of analgesic agents. CONCLUSIONS The post-lithotripsy HRQoL is better for SWL than URSL patients, despite the lower stone-free rate of SWL. The higher postoperative pain appear to be responsible for the lower HRQoL in URSL. For the appropriate decision regarding the treatment approach, it is important to understand not only the surgical outcomes and recurrence rates, but also the HRQoL associated with each treatment strategy. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e449 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shuzo Hamamoto More articles by this author Takahiro Yasui More articles by this author Naoko Okuda More articles by this author Satoshi Koiwa More articles by this author Atsushi Okada More articles by this author Hiroyuki Kamiya More articles by this author Yoshihiro Hashimoto More articles by this author Keiichi Tozawa More articles by this author Yutaka Iwase More articles by this author Kenjiro Kohri More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Ureteral wall thickness at the impacted ureteral stone site: a critical predictor for success rates after SWL.

The aim of the study was to determine the possible predictive value of certain patient- and stone-related factors on the stone-free rates and auxiliary procedures after extracorporeal shock wave lithotripsy in patients with impacted proximal ureteral calculi. A total of 111 patients (86 male, 25 females M/F: 3.44/1) with impacted proximal ureteral stones treated with shock wave lithotripsy were evaluated. Cases were retrieved from a departmental shock wave lithotripsy database. Variables analyzed included BMI of the case, diameter of proximal ureter and renal pelvis, stone size and Hounsfield unit, ureteral wall thickness at the impacted stone site. Stone-free status on follow-up imaging at 3 months was considered a successful outcome. All patients had a single impacted proximal ureteral stone. While the mean age of the cases was 46 ± 13 years (range 26-79 years), mean stone size was 8.95 mm (5.3-15.1 mm). Following shock wave lithotripsy although 87 patients (78.4%) were completely stone-free at 3-month follow-up visit, 24 (21.6%) cases had residual fragments requiring further repeat procedures. Prediction of the final outcome of SWL in patients with impacted proximal ureteral stones is a challenging issue and our data did clearly indicate a highly significant relationship between ureteral wall thickness and the success rates of shock wave lithotripsy particularly in cases requiring additional procedures. Of all the evaluated stone- and patient-related factors, only ureteral wall thickness at the impacted stone site independently predicted shock wave lithotripsy success.

C160: Evaluation of efficacy of the extracorporeal shockwave lithotripsy in patients with and without stent in the ureter

C160: Evaluation of efficacy of the extracorporeal shockwave lithotripsy in patients with and without stent in the ureter

Multiple ureterolithiasis resembling steinstrasse: An unusual presentation

Steinstrasse or “stone street” is an expected complication after extracorporeal shock wave lithotripsy in patients with high stone burden. However, there are published reports of multiple ureterolithiasis resembling steinstrasse in patients with distal renal tubular acidosis. Here we report an uncommon case of a 60-year-old woman who presented with right renal calculi. Her right ureter was studded with multiple calculi up to the vesicoureteric junction. The affected right kidney was nonfunctional and was managed by nephroureterectomy.

Immediate and long-term high levels of plasma homocysteine after extracorporeal shock wave lithotripsy in patients with renal stone disease.

Plasma homocysteine levels increase in patients with chronic renal failure. Numerous studies have demonstrated that kidney function is one of the most important determinants of plasma total homocysteine (tHcy) concentration. In this study we aimed to evaluate the relationship between tHcy levels and extracorporeal shock wave lithotripsy (ESWL) for patients with renal stones and to see if the change in homocysteine levels continued if renal dysfunction improved. The study consisted of 20 patients who underwent first-time ESWL for renal stones. Every patient gave 3 blood samples at 24 h before surgery and at 2 days and at 3 months after ESWL for measurement of plasma levels of tHcy, creatinine, vitamin B6, and vitamin B12. The 20 patients (12 male, 8 female) had a mean age of 42.8 ± 11.7 years. tHcy levels showed a statistically significant increase from 9.4 ± 1.4 to 18 ± 4.8 and 11.2 ± 2.1 at 2 days and at 3 months, respectively. Serum creatinine also showed a statistically significant increase compared to baseline at 2 days and at 3 months after ESWL. After first-time ESWL, the increase in serum levels of creatinine and tHcy due to renal injury, such as ischemia/reperfusion injury, may be severe and continue for a long period, such as 3 months. According to baseline levels, the increase in homocysteine levels as an indicator of oxidant stress was more severe than the creatinine levels after ESWL for renal stones. Our patients were first-time ESWL patients; however, in patients who undergo EWSL more than once long-term high tHcy levels should also be considered as renal.

Incidence of Infectious Complications after Extracorporeal Shock Wave Lithotripsy in Patients Without Associated Risk Factors

We determined the incidence of infectious complications (asymptomatic bacteriuria, urinary tract infection and urosepsis) in patients without associated risk factors treated with extracorporeal shock wave lithotripsy. We performed an observational, prospective cohort study between October 2010 and June 2013. We included all patients without risk factors who were treated with extracorporeal shock wave lithotripsy for kidney or ureteral lithiasis. All patients underwent urine culture 5 days before the procedure. Another urine culture was performed 7 days after lithotripsy. No patient received antibiotics. Initially 366 patients with a mean ± SD age of 53 ± 13 years were enrolled in the study. A total of 64 patients (17.5%) underwent extracorporeal shock wave lithotripsy with a previously placed Double-J® stent. After lithotripsy urine culture was positive in 20 patients (5.8%), of whom 4 (1.2%) presented with symptomatic urinary infection and the remaining 4.6% showed no symptoms. Urosepsis did not develop in any case. In our study patient age was anindependent risk factor for bacteriuria after lithotripsy. The incidence of infectious complications after extracorporeal shock wave lithotripsy in patients without risk factors is low. This leads us to conclude that without defined risk factors antibiotic prophylaxis is not justified. Also, elderly patients were more at risk for bacteriuria after extracorporeal shockwave lithotripsy and, thus, for a possible infectious complication.

817 Urgent extracorporeal shockwave lithotripsy in patients with obstruction solitary or both kidneys

817 Urgent extracorporeal shockwave lithotripsy in patients with obstruction solitary or both kidneys

Management Patterns of Medicare Patients Undergoing Treatment for Upper Urinary Tract Calculi

We conducted this study to identify differences in the re-treatment rates and ancillary procedures for the two most commonly utilized stone treatment procedures in the Medicare population: ureteroscopy (URS) and shock wave lithotripsy (SWL). A retrospective claims analysis of the Medicare standard analytical file 5% sample was conducted to identify patients with a new diagnosis of urolithiasis undergoing treatment with URS or SWL from 2009-2010. Outcomes evaluated: (1) repeat stone removal procedures within 120 days post index procedure, (2) stent placement procedures on the index date, 30 days prior to and 120 days post index date, and (3) use of general anesthesia. We identified 3885 eligible patients, of which 2165 (56%) underwent SWL and 1720 (44%) underwent URS. Overall, SWL patients were 1.73 times more likely to undergo at least one repeat procedure than URS patients, and twice as likely to require multiple re-treatments compared to URS. Among those with ureteral stones, SWL patients were 2.27 times more likely to undergo repeat procedures. The difference was not statistically significant in renal stone patients. Overall, SWL patients were 1.41 times more likely than URS patients to have a stent placed prior to index procedure, and 1.33 times more likely to have a stent placed subsequent to the index procedure. The majority of URS patients (77.8%) had a stent placed at the time of index procedure. There was no significant difference in anesthetic approaches between SWL and URS. Patients undergoing SWL are significantly more likely to require re-treatments than URS patients. SWL patients are also significantly more likely to require ureteral stent placement as a separate event. SWL and URS patients have similar rates of general anesthesia.

127 MANAGEMENT PATTERNS OF MEDICARE PATIENTS UNDERGOING TREATMENT FOR UPPER URINARY TRACT CALCULI

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness (I)1 Apr 2013127 MANAGEMENT PATTERNS OF MEDICARE PATIENTS UNDERGOING TREATMENT FOR UPPER URINARY TRACT CALCULI Brian Matlaga, Lisa Meckley, Thomas Byrne, and Jessica Perhanidis Brian MatlagaBrian Matlaga Baltimore, MD More articles by this author , Lisa MeckleyLisa Meckley Marlborough, MA More articles by this author , Thomas ByrneThomas Byrne Marlborough, MA More articles by this author , and Jessica PerhanidisJessica Perhanidis Marlborough, MA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1506AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Given the rising prevalence of stone disease in the United States coupled with the fact that Medicare is the single largest healthcare payer in the United States, a better understanding of resource utilization in stone management within the Medicare population is urgently needed. At present, ureteroscopy (URS) and shock wave lithotripsy (SWL) are the two most commonly performed stone management procedures; yet our understanding of the re-treatments and ancillary procedures is limited and dated. We conducted this study to identify differences in resource utilization for SWL and URS in a recent sampling of the Medicare population. METHODS A retrospective claims analysis of the Medicare 5% sample was conducted to identify patients undergoing treatment of renal or ureteral calculi with a principal diagnosis of urinary lithiasis between 2009 and 2010. The index date was the date of first fragmentation procedure. Patients were excluded if they had a prior stone treatment within 6 months of the index stone treatment or prior uric acid or cystine stone disease. Outcomes evaluated were (1) a subsequent stone removal procedure within 120 days post index procedure, and (2) stent placement procedures 30 days prior to and 120 days post index date, as well as on the index date. Treatment groups were compared using Chi-Squared tests, T-tests, and relative risks. RESULTS We identified 3885 Medicare eligible patients, of which 2165 (56%) underwent SWL and 1720 (44%) underwent URS. SWL patients were 1.73 times (p=<.0001) more likely to undergo at least one repeat procedure than URS patients, and twice as likely (p=<.0001) to require multiple re-treatments compared to URS. SWL patients were 1.41 times (p=<.0001) more likely than URS patients to have a stent placed prior to index procedure, and 1.33 times (p=0.003) more likely to have a stent placed subsequent to the index procedure. The majority of URS patients (77.8%) had a stent placed at the time of index procedure. CONCLUSIONS Medicare patients undergoing SWL are significantly more likely to require multiple treatments than those undergoing URS. SWL patients are also significantly more likely to require ureteral stent placement as a separate event. As the Medicare program transitions from a volume to value driven system, these procedural trends will be subject to increasing scrutiny. This analysis of Medicare claims data demonstrates the need to characterize optimal treatment patterns, and better understand their economic effects. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e51 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Brian Matlaga Baltimore, MD More articles by this author Lisa Meckley Marlborough, MA More articles by this author Thomas Byrne Marlborough, MA More articles by this author Jessica Perhanidis Marlborough, MA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Morbidity and Efficacy of Ureteroscopic Stone Treatment in Patients with Neurogenic Bladder

There is a lack of information on the safety and efficacy of ureteroscopy in the neurogenic bladder population. We hypothesized that ureteroscopy in patients with neurogenic bladder would be associated with an increased risk of complications and a lower stone clearance rate than in patients without neurological impairment. We reviewed a local registry of patients with ICD-9 codes for urolithiasis between 2004 and 2012. The study cohort was assembled from all eligible patients with neurogenic bladder and a randomly selected control group that had undergone ureteroscopy. Statistical analysis of demographic variables and surgical outcomes was performed. Complications were classified according to the Clavien system. Clearance was defined by computerized tomography, renal/bladder ultrasound or direct ureterorenoscopy. Ureteroscopy was performed a total of 173 times in 127 controls and a total of 45 times in 20 patients with neurogenic bladder. There was no difference between presenting episodes by gender (p = 1.0), race (p = 0.654) or body mass index (p = 0.519). Bacteriuria was associated with the stone episode in 16.4% of controls and 67% of neurogenic bladder cases (p <0.001). Median operative time was significantly longer in those with neurogenic bladder (80.5 minutes, IQR 50-110.5 vs 52, IQR 33-78, p = 0.0003). The proportion of complications was significantly different (p = 0.013). Stones cleared in 86.6% of controls compared to 63% of neurogenic bladder cases (p = 0.004). Patients with neurogenic bladder have increased morbidity after ureteroscopy for upper tract calculi compared to neurologically unaffected controls. Infection has a role in this morbidity. The clearance rate is lower but the stone burden is more significant in those with neurogenic bladder.

Complications prophylaxis in extracorporeal shock wave lithotripsy in patients with nephrolithiasis

The aim of the study was to improve the results of extracorporeal shock wave lithotripsy (ESWL) by preventing the complications of the treatment. Therefore the fitodrug “Porlit-septo” (Indonesia) was given to the patients before performing ESWL. It was found out that this drug significantly reduces the time of the fragments discharge from the urinary tract, reduces the frequency of renal colic, and decreases the likelihood of an active inflammatory process in the kidney after ESWL

Residual Fragments Following Ureteroscopic Lithotripsy: Incidence and Predictors on Postoperative Computerized Tomography

Residual fragments following ureteroscopy for calculi may contribute to stone growth, symptoms or additional interventions. We reviewed our experience with ureteroscopy for calculus disease to define the incidence and establish factors predictive of residual fragments. Records associated with 667 consecutive ureteroscopic lithotripsy procedures for upper urinary calculi were reviewed. In 265 procedures (40%) computerized tomography was done between 30 and 90 days postoperatively. They comprised the study group. Residual fragments were defined as any residual ipsilateral stone greater than 2 mm. Included in the study were 121 men and 127 women with a mean age of 47 years. Mean target stone diameter was 7.6 mm. The stone location was the kidney in 30% of cases, ureter in 50%, and kidney and ureter in 20%. Residual fragments were detected on computerized tomography after 101 of 265 procedures (38%). Pretreatment stone size was associated with residual fragments at a rate of 24%, 40% and 58% for stones 5 or less, 6 to 10 and greater than 10 mm, respectively (p <0.001). Additionally, stone location in the kidney (p <0.001) or the kidney and ureter (p = 0.044), multiple calculi (p = 0.003), longer operative time (p = 0.008) and exclusive use of flexible ureteroscopy (p = 0.029) were associated with residual fragments. In a multivariate model only pretreatment stone diameter greater than 5 mm was independently associated with residual fragments after ureteroscopy (diameter 6 to 10 and greater than 10 mm OR 2.03, p = 0.03 and OR 3.74, p = 0.003, respectively). Of patients who underwent ureteroscopic lithotripsy for calculi 38% had residual fragments by computerized tomography criteria, including more than 50% with stones 1 cm or greater. Such data may guide expectations regarding the success of ureteroscopy in attaining stone-free status.

Stone clearance after extracorporeal shockwave lithotripsy in patients with solitary pure calcium oxalate stones smaller than 1.0 cm in the proximal ureter, with special reference to monohydrate and dihydrate content

Objective. The aim of this study was to assess stone-free rates following extracorporeal shockwave lithotripsy (ESWL) of pure calcium oxalate (CaOx) stones in the proximal ureter. Material and methods. The investigators retrospectively examined 53 patients with 5–10 mm pure CaOx stones in the proximal ureter from the medical archives of 593 consecutive patients treated with ESWL. The compositions of calcium oxalate monohydrate (COM) and dihydrate (COD) in a given stone were determined by infrared spectrometry. Stone size, attenuation number and stone-to-skin distance (SSD) were measured using plain radiography and computed tomography (CT). ESWL success was evaluated by stone-free status after the first single session. Results. On average, calculi were 8.0 × 5.3 mm in size, with an SSD of 11.0 cm. The mean CT attenuation value was 740.1 HU. Attenuation numbers correlated significantly with stone diameter (r = 0.49), but had no correlation with the stone content of COM or COD. A negative correlation was observed between COM and COD content (r = –0.925). With regard to patients' physical characteristics and COM and COD content, no differences were found between study subgroups with stone-free and residual status (n = 38 and 15, respectively). There were also no differences in clinical features between patient subgroups with COM- or COD-predominant stones (n = 22 and 31, respectively). Conclusion. The findings indicated that the differences in COM and COD content of CaOx stones had no impact on stone clearance after ESWL and that a favorable stone-free rate of the stones treated with ESWL may be achieved independently of CaOx hydration.

Antibiotic Prophylaxis for Shock Wave Lithotripsy in Patients with Sterile Urine Before Treatment May be Unnecessary: A Systematic Review and Meta-Analysis

We evaluated the efficacy of antibiotic prophylaxis for shock wave lithotripsy in patients with proven sterile urine before treatment. A systematic search of PubMed®, Embase® and the Cochrane Library was performed to identify all randomized controlled trials that compared the effects of antibiotic prophylaxis with placebo or no treatment for patients undergoing shock wave lithotripsy who had preoperative sterile urine. The outcomes included symptoms, fever, positive urine culture, urinary tract infection and risk factors. The Cochrane Collaboration Review Manager software (RevMan 5.1.4) was used for statistical analysis. The study inclusion criteria were met by 9 trials (3 placebo controlled and 6 no treatment controlled) involving 1,364 patients. The synthesized data from these randomized controlled trials indicated that there were no significant differences between the prophylactic group and the control group in symptoms, rate of fever (RR 0.36, 95% CI 0.07-2.36, p = 0.31), rate of positive urine culture (RR 0.77, 95% CI 0.54-1.11, p = 0.17) and incidence of urinary tract infection (RR 0.54, 95% CI 0.29-1.01, p = 0.05). Antibiotic prophylaxis had no potentially beneficial effect on the prevention of infection in patients with a temporary ureteral catheter related to shock wave lithotripsy. Prophylactic antibiotics could not improve symptoms, and decreased neither the rate of fever and positive urine culture, nor the incidence of urinary tract infection after shock wave lithotripsy. Antibiotic prophylaxis is not necessary for shock wave lithotripsy, especially when no or low risk factors are presented.