Shock Wave Lithotripsy Sessions Research Articles

PD15-02 THE EFFECT OF ALTERNATING BIDIRECTIONAL APPROACH DURING SHOCK WAVE LITHOTRIPSY FOR UPPER LUMBAR URETERIC STONES. A RANDOMIZED CONTROLLED TRIAL

INTRODUCTION AND OBJECTIVE: to compare the outcome of shock wave lithotripsy (SWL) for upper lumbar ureteric stones using the alternating bidirectional approach versus the standard approach during the first session. METHODS: Our study was a randomized controlled trial (NCT03243682) including patients with single radio-opaque upper lumbar ureteric stone less than 1cm. SWL was conducted using electromagnetic Dornier Gemini Lithotripter. In group1, patients were treated with the alternating under and over-table approach during the first session only and if another one or more sessions were needed, the standard under-table approach was used. In group 2, patients were treated with the standard under-table approach during all sessions. The efficacy of stone disintegration after the first session was assessed by kidney-ureter-bladder (KUB) x-ray, renal ultrasonography (US). Noncontrast computed tomography was done for patients with no residual detected by KUB and US. Stone disintegration was classified as no (no change from basal by KUB X-ray or US imaging), partial (fragmented and >4-mm residual fragments), and complete (≤4-mm residual fragments). The incidence and severity of complications were evaluated. RESULTS: Forty eight patients in each group with comparable demographics and stone characteristics (table 1). Complete disintegration was achieved in 41.7% of patients in group 1 versus 18.8% in group 2 (p=0.021), while stone-free rate was 58.3% and 20.8% in group 1 and 2 respectively (p=0.001) (table 2). Stone length and width ≥8.5 mm and stone density ≥1135 HU significantly indicate disintegration failure in alternating bidirectional approach. CONCLUSIONS: For upper lumbar ureteric stones, stone disintegration and stone-free rate after the first SWL session are higher when using the alternating bidirectional approachSource of Funding: No

Effect of Stepwise Voltage Escalation on Treatment Outcomes following Extracorporeal Shock Wave Lithotripsy of Renal Calculi: A Prospective Randomized Study.

In this study we assessed the effects of a ramping protocol in patients undergoing extracorporeal shock wave lithotripsy of renal stones. In this prospective study patients with renal stones were randomized to receive shock wave lithotripsy delivered using a ramping protocol in group 1 (first 1,000 shocks at energy level 5 followed by 1,000 shocks at energy level 6 and 1,000 final shocks at energy level 7) and a fixed voltage protocol in group 2 (all 3,000 shocks at energy level 7). Treatment was administered using a Modulith® SLX-F2. The primary outcome was treatment success 12 weeks after a single shock wave lithotripsy session, defined as lack of a stone or a less than 4 mm stone fragment on computerized tomography. Other outcomes included the stone-free rate and the perinephric hematoma incidence. A total of 300 patients (150 per group) were recruited between February 2016 and June 2018. The 2 groups did not differ in baseline parameters. Group 1 received 14.8% lower energy than group 2, which was significant (p <0.001). The treatment success rate in groups 1 and 2 was 67.8% and 73.6%, respectively, which did not statistically differ (group 1 crude OR 0.753, 95% CI 0.456-1.244, p=0.268). The stone-free rate in groups 1 and 2 was 36.6% and 41.9%, respectively, which did not differ statistically between the groups. However, in groups 1 and 2 perinephric hematoma developed in 23.8% and 43.8% of patients, respectively, which was a statistically significant difference (p <0.001). The fixed voltage shock wave lithotripsy and ramping protocols provided similar treatment success rates for renal stones. However, the ramping protocol reduced the incidence of perinephric hematoma after shock wave lithotripsy.

Evaluation of the urinary podocalyxin and nephrin excretion levels to determine a safe time interval between two sessions of SWL for renal stones: a non randomized exploratory study.

We aimed to evaluate the role of nephrin and podocalyxin in determining the intervals between shock wave lithotripsy (SWL) sessions and how soon the kidney damage was recovered. This work was a prospective study that included 30 patients with unilateral kidney stones. The patients' midflow urine samples were collected before SWL and 1h, 1day and 1week after the procedure. Nephrin and podocalyxin levels in the urine samples were measured by the enzyme-linked immunosorbent assay method. Among the 30 patients who underwent SWL, 19 were males and 11 were females. The mean age of the SWL group was 34.7 ± 13.2. Both biomarkers did not correlate with age, creatinine values, body mass index, stone side, stone size, energy, frequency and shock numbers. Nephrin and podocalyxin levels were significantly higher at the pre-SWL point (p < 0.05). After the procedure, a significant decrease was observed in both biomarker levels (p < 0.05). At the end of first day, these levels started to increase progressively up to the end of the first week (p > 0.05). Nephrin and podocalyxin may help to determine early period kidney damage associated with SWL. Post-SWL podocalyxin and nephrin values may be used to determine the interval between SWL sessions.

Small renal pelvis stones: Shock wave lithotripsy or flexible ureteroscopy? A match-pair analysis.

Kidney stones in renal pelvis may be treated using various methods. For larger stones, percutaneous nephrolitotomy (PNL) is the first choice of option; where for smaller stones, shock wave lithotripsy (SWL) or flexible ureteroscopy (F-URS) could be more suitable options. In this article we aimed to compare the outcomes of F-URS and SWL on the treatment of renal pelvis stones <10 mm. Files of patients treated with SWL and F-URS for renal pelvis stones <10 mm between March 2013 and May 2016 in our clinic were analyzed. For comparison, a match-pair analysis was designed. Complete stone removal was considered success. Forty patients were treated using F-URS (Group 1) and 40 patients underwent SWL (Group 2). Patients were assessed the day after the last session of the procedure. The early stone-free rates were 70% (28/40) in Group 1, and 15% in Group 2 (p<0.05). The same analysis was performed after three months. Stone-free rates were 100% and 92.5% in Groups 1 and 2, respectively (p=0.079). Three patients in Group 2 were not stone free after 3 sessions of SWL and considered unsuccessful. They were all successfully treated by F-URS. Even though there is no statistical difference among groups, our data may be interpreted as having better outcomes and tolerability with F-URS than SWL. We believe F-URS may have a great treatment prospect in this particular patient group.

Optimal non-invasive treatment of 1–2.5 cm radiolucent renal stones: oral dissolution therapy, shock wave lithotripsy or combined treatment—a randomized controlled trial

To evaluate the efficacy of oral dissolution therapy (ODT), shock wave lithotripsy (SWL), and combined SWL and ODT for medium-sized radiolucent renal stone (RLS). A randomized controlled trial for patients with medium-sized RLS, 1-2.5cm, ≤ 500 Hounsfield unit (HU). The ODT patients were counseled for oral potassiumsodium-hydrogen citrate (Uralyt-U®). The 2nd group underwent SWL and the last group had combined SWL and ODT. The primary outcome, stone-free rate (SFR) at 3months, was assessed by non-contrast computed tomography (NCCT). We defined complete response (success) if no residual fragment were detected by NCCT; partial response (failure) if there was a decrease in stone size, but presence of residual stones; no response if there was no change or increase in stone size (failure). 150 patients completed follow-up. The SFR at 1st month and 3rd month were, respectively; 16% and 50% in the ODT group, 10% and 46% in the SWL group, and 35% and 72% patients in combined group with (p = 0.03 and 0.003, respectively. The overall SFR for all groups was 66%. Combined treatment and initial response in first month follow-up were independent factors predicting SFR. In addition, combined treatment significantly decreased the overall stone volume (p = 0.03) and the need for additional stone management procedures after 3months (p = 0.01). Combined ODT and SWL treatment constitutes the most rapid and effective therapeutic approach for medium-sized RLS, decreasing overall stone volume as well as the number of SWL sessions needed in comparison to SWL therapy, alone.

Percutaneous nephrolithotomy versus shock wave lithotripsy for high-density moderate-sized renal stones: A prospective randomized study.

Context:The management of renal stones of high density (>1000 Hounsfield units) on non-contrast computed tomography (NCCT), and moderate sized (15-25 mm) is still debatable.Aims:The aim of this study was to compare the outcomes of percutaneous nephrolithotomy (PCNL) and shock wave lithotripsy (SWL) for the high-density and moderate-sized renal stones regarding the stone-free rate (SFR), morbidity, and patients' quality of life.Settings and Design:This is a prospective randomized study.Patients and Methods:Eighty consecutive patients with renal stones, excluding those with lower calyceal stones, were randomized to receive either PCNL or SWL (40 in each arm). Patients were followed up by abdominal ultrasound and plain X-ray (NCCT if indicated) till clearance of stone. Outcomes, complications, costs, and SF-8 Health Survey scoring were recorded for each group.Statistical Analysis:We used Stata software, version 9.2 (Intercooled STATA®; StataCorp LP College Station, Texas, USA). Comparison of the two groups was made with regard to patient and stone criteria and the procedure details. Continuous variables were compared using the Mann–Whitney U-test with values shown as the median and interquartile range. Categorical variables were compared using the Pearson's Chi-square/Fisher's exact test. Multivariate logistic regression analysis was used to identify variables independently associated with the stone clearance after two sessions of SWL. P < 0.05 was considered statistically significant.Results:The basic characteristics of both groups were comparable. After a single treatment session, the SFR was 80% and 27.5% for PCNL and SWL, respectively (P < 0.001). The overall 3-month SFR was 87.5% versus 90%, respectively (P = 0.723). The median number of the required maneuvers was 1 (range: 1–3) for PCNL versus 2 (range: 1–4) for SWL (P < 0.001). The complication rate was 10% and 7.5%, respectively (P = 0.692). The cost of SWL was significantly lower (P < 0.001). On multivariate analysis, a single stone was an independent predictor for stone clearance after two sessions of SWL (odds ratio: 7.26, 95% confidence interval: 1.13–46.62, P = 0.037).Conclusions:PCNL for the dense, and moderate-sized renal stone provides higher initial success and lower re-treatment rates compared with SWL with comparable outcome after 3 months of therapy. However, SWL is an alternative, especially for a single stone.

Factors that affect outcome of pediatric shock waves lithotripsy with sedoanalgesia.

Introduction:Performing shock wave lithotripsy (SWL) under intravenous sedoanalgesia and the ability to predict the effectiveness of SWL is essential in determining the most appropriate treatment for patients.Patients and Methods:This study consisted of 56 children aged between 1 and 16 years mean age 6.7 ± 4.3 years with renal and ureteric stones who underwent SWL. Incomplete child data were excluded from the study, leaving 47 patients. The procedure was performed under sedoanalgesia with diazepam and ketamine was given intravenously during SWL session. We study the effect of the following factors (age, site, size, opacity of stone, degree of pelvicalyceal dilation, previous urological surgery, number of shock waves, and number of sessions) on stone clearance after SWL.Results:Forty-seven children range from 1 to 16 years, mean age 6.7 ± 4.3 years. There were 39 (83%) with renal stone and 8 (17%) with ureteric stone. The mean size of stone was 12.2 ± 4.4 mm ranging 6–25 mm. Of 47 children, 36 (76.6%) were stone-free. Age below 6 years, pelvic stones, children without surgery, number of shock waves, and number of sessions were significant factors that affect the stone-free rate after SWL, while the stone size, opacity, and calyceal system dilatation were not statistically significant factors.Conclusions:The present analysis shows that stone-free status for children with urolithiasis depends on the age of presentation, previous history of ipsilateral stone treatment, stone location, and number of sessions. Pediatric lithotripsy under intravenous sedoanalgesia is feasible, general anesthesia is not mandatory, and any anesthetic complications were not encountered.

Comparative study of shockwave lithotripsy for the treatment of large pediatric renal stones with and without stenting

Objective Pediatric urolithiasis is an important renal disease encountered in clinical practice. So, this study was designed to assess the safety and efficacy of shockwave lithotripsy (SWL) in the treatment of large pediatric renal stones. Patients and methods Eighty-four children with large renal stones (2–3 cm) were enrolled with a range of age between 1 and 16 years. Patients underwent SWL and were divided into two groups according to the presence of JJ stent (J shaped stent); 44 underwent SWL sessions without prior stenting and 40 patients underwent SWL after JJ sent insertion. Regular follow-up was done at 2, 6, and 12 weeks after the SWL session by urinalysis and renal bladder ultrasound. Results It was noticed that all baseline characteristics had no significant differences between both groups with exception of stone bilaterally that was significantly higher in the case stented group (35 vs. 4.5%;P Conclusion SWL is a highly effective and safe modality for the treatment of children with large renal stones (2–3 cm) and could be used as an alternative to the more invasive stone therapy approaches.

Conversion from Cystine to Noncystine Stones: Incidence and Associated Factors

Patients with cystinuria are often treated with medical alkalization and shock wave lithotripsy, although each treatment is hypothesized to increase the risk of calcium phosphate stones. We performed a multicenter retrospective review to evaluate whether stones of another composition develop in patients with cystinuria and with what frequency. We retrospectively reviewed the records of a multi-institutional cohort of patients with cystinuria. We assessed medications, stone analyses, 24-hour urinalyses and types of procedures. We compared patients who formed only cystine stones vs those with noncystine stones. We identified 125 patients from a total of 5 institutions who were followed a mean of 5.2 years (range 0 to 26). Stones with noncystine components weresubmitted by 37 patients (29.6%). Potassium citrate medication was not associated with a noncystine composition (p = 0.1877). Regarding surgical management 18 patients (13%) underwent at least 1 shock wave lithotripsy session (range 0to9) and 79 (63%) underwent percutaneous nephrolithotomy at least once (range 0 to 10). When stratified based on pure cystine vs converted stones, the average total number of shock wave lithotripsy and percutaneous nephrolithotomy procedures was higher in the group with cystine and subsequent noncystine stone compositions (0.94 vs 0.10, p <0.0001, and 1.7 vs 1.5, p = 0.0053, respectively). On logistic regression male gender (OR 3.1, p = 0.0280) and the number of shock wave lithotripsy sessions (OR 3.0, p = 0.0170) were associated with an increased likelihood of the development of stones with a noncystine composition. Stones with noncystine components develop in more than 25% of patients with cystinuria, underscoring the importance of continued stone analysis. In this study prior shock wave lithotripsy was associated with conversion to a noncystine stone composition while urinary alkalization therapy was not associated.

Can intervals in extracorporeal shock wave lithotripsy sessions affect success in the treatment of upper ureteral stones?

IntroductionManaging upper ureteral stones with shock wave lithotripsy (SWL) has been done for many years. However, no conclusive data have been found on the intervals required between repeated SWL sessions.AimTo identify the most optimal intervals between SWL sessions.Material and methodsBetween September 2015 and December 2016, 80 patients undergoing elective outpatient lithotripsy who required repeated SWL sessions for ureteral stones were evaluated. These patients were categorised into two groups according to different SWL session intervals. The intervals between SWL sessions (n = 40) for the first group lasted one day, whereas those for the second group (n = 40) lasted 1 week. The data recorded during SWL included visual analogue scale (VAS) scores, total number of shocks, total energy used and number of sessions. The stone clearance rates, number of urinary tract infections, complication rates and VAS scores were compared between the two groups.ResultsAll patients’ clinical outcomes after SWL therapy are shown in Table I. The stone clearance rate for group 1 was 70%, whereas that for group 2 was 72.5% (p = 0.805). Additionally, the number of urinary tract infections, complications and VAS scores were similar for both groups. In group 1, 3 patients had steinstrasse, two suffered from severe renal colic, and one had a urinary tract infection. In group 2, 3 patients endured steinstrasse, and 2 patients experienced severe renal colic during the study.ConclusionsShort-interval SWL sessions are safe and effective for treating upper ureteral stones, and such sessions do not increase complication rates.

Lunar cycle may have an effect on Shock Wave Lithotripsy related pain outcome

We tried to investigate the effects of lunar phase on Shock Wave Lithotripsy (SWL) related pain. In addition, correlation of various clinical parameters with the pain perception during SWL procedure, were also investigated. A total of 378 patients who underwent first SWL sessions for renal or ureteral stones were prospectively enrolled in the study. The degree of pain perception during the procedure was evaluated with 10-point visual analog scale (VAS) and pain questionnaires. The date of SWL was allocated to dates and times of lunar phases as: newmoon, waxing crescent, first quarter, waxing gibbus, fullmoon, waning gibbus, last quarter and waning gibbus. Mean VAS scores in first quarter (2,41±1,06) were significantly lower when compared to mean VAS scores in waning crescent (3,58±1,83) and waning gibbus (3,42±1,98) (p=0,005 and 0,041, respectively). No statistically significant differences were observed when other lunar phases were compared between each other. Mean pain scores were not affected from gender, age, body mass index (BMI) and stone characteristics (stone laterality, burden and location). SWL procedure performed in first quarter of the lunar phase may become less painful. To the best of our knowledge, this is the first study which evaluated the effect of lunar phase on post-SWL pain outcome. Thus, additional randomized studies with larger series may be more informative.

Increased Risk of New-Onset Hypertension After Shock Wave Lithotripsy in Urolithiasis: A Nationwide Cohort Study.

Although shock wave lithotripsy is minimally invasive, earlier studies argued that it may increase patients' subsequent risk of hypertension and diabetes mellitus. This study evaluated the association between shock wave lithotripsy and new-onset hypertension or diabetes mellitus. The Taiwanese National Health Insurance Research Database was used to identify 20 219 patients aged 18 to 65 years who underwent the first stone surgical treatment (shock wave lithotripsy or ureterorenoscopic lithotripsy) between January 1999 and December 2011. A Cox proportional model was applied to evaluate associations. Time-varying Cox models were applied to evaluate the association between the number of shock wave lithotripsy sessions and the incidence of hypertension or diabetes mellitus. After a median follow-up of 74.9 and 82.6 months, 2028 and 688 patients developed hypertension in the shock wave lithotripsy and ureterorenoscopic lithotripsy groups, respectively. Patients who underwent shock wave lithotripsy had a higher probability of developing hypertension than patients who underwent ureterorenoscopic lithotripsy, with a hazard ratio of 1.20 (95% confidence interval, 1.10-1.31) after adjusting for covariates. The risk increased as the number of shock wave lithotripsy sessions increased. However, the diabetes mellitus risk was similar in the shock wave lithotripsy and ureterorenoscopic lithotripsy groups. Furthermore, the hazard ratio did not increase as the number of shock wave lithotripsy sessions increased. Shock wave lithotripsy consistently increased the incidence of hypertension on long-term follow-up. Therefore, alternatives to urolithiasis treatment (eg, endoscopic surgery or medical expulsion therapy) could avoid the hypertension risk. Furthermore, avoiding multiple sessions of shock wave lithotripsy could also evade the hypertension risk.

85 - Can extracorporeal shock wave lithotripsy (SWL) session intervals affect success in the treatment of upper ureteral stone?

85 - Can extracorporeal shock wave lithotripsy (SWL) session intervals affect success in the treatment of upper ureteral stone?

Factors Affecting the Number of Shock Wave Lithotripsy Session in Children with Renal Stones: Are age and Radiolucency the Predictors of Success?

Factors Affecting the Number of Shock Wave Lithotripsy Session in Children with Renal Stones: Are age and Radiolucency the Predictors of Success?

Combination of Extracorporeal Shockwave Lithotripsy and Ureteroscopy for Large Staghorn Calculi in a Pediatric Patient: Case Report

Background: Extracorporeal shockwave lithotripsy (SWL) is a procedure commonly performed to treat nephrolithiasis, with promising results in pediatric patients. However, increasing renal calculi size is directly related to worsening stone-free rates. There are few reports in the literature of >2-cm staghorn calculi that expound on the exact mechanism of treatment in the pediatric population.Case Presentation: We present a case report of a 3-year-old boy who presented with a large 3-cm staghorn calculi effectively treated with one session of SWL followed by a planned staged ureteroscopy for definitive treatment.Conclusion: Despite the numerous studies limiting the use of SWL to treat stones <2 cm, if used in softer composition stones, coupled with the larger focal volume involved with smaller patients, SWL when used in combination with adjunctive ureteroscopy is a safe and effective treatment option.

MP62-02 VARIATION COEFFICIENT OF STONE DENSITY: A NOVEL PREDICTOR OF TREATMENT OUTCOME FOLLOWING EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY.

You have accessJournal of UrologyStone Disease: Shock Wave Lithotripsy1 Apr 2017MP62-02 VARIATION COEFFICIENT OF STONE DENSITY: A NOVEL PREDICTOR OF TREATMENT OUTCOME FOLLOWING EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY. Shimpei Yamashita, Yasuo Kohjimoto, Takashi Iguchi, Akinori Iba, and Isao Hara Shimpei YamashitaShimpei Yamashita More articles by this author , Yasuo KohjimotoYasuo Kohjimoto More articles by this author , Takashi IguchiTakashi Iguchi More articles by this author , Akinori IbaAkinori Iba More articles by this author , and Isao HaraIsao Hara More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1933AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Although previous studies have indicated that stone heterogeneity can affect shock wave lithotripsy (SWL) outcomes, there is no established measurement of stone heterogeneity on non-contrast computed tomography (NCCT) imagery. We investigated whether variation coefficient of stone density (VCSD) can predict shock wave success. METHODS We conducted a retrospective review of 245 patients with urinary calculi who had undergone SWL for upper urinary tract calculi. We compared discriminative powers for treatment success using receiver operating characteristics ROC analyses among three indices based on CT attenuation of the stone, i.e., mean stone density (MSD), standard deviation of stone density (SDSD) and VCSD. We also performed logistic regression analysis to identify factors contributing to treatment success. Treatment success was determined as absence or residual fragments <4mm using NCCT within three months after a first session of SWL. RESULTS Treatment success rate was 47.8% (117/245 cases). From ROC analyses for treatment success, AUC of VCSD (0.71) was larger than that of MSD (0.64, p=0.09) and SDSD (0.54, p<0.01) (Figure). Multivariate analysis revealed that MDS (p=0.028) and VCSD (p<0.001) independently predicted the outcome (Table). Categorized by stone location, VCSD was the independent significant predictor for SWL outcomes in both kidney (p=0.047) and ureteral calculi (p<0.001). CONCLUSIONS We found that variation coefficient of stone density can be a novel predictor of SWL success. The development of nomograms or scoring systems including VCSD can assist in the decision process for patients and minimize unnecessary delay in treatment of urolithiasis. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e827-e828 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Shimpei Yamashita More articles by this author Yasuo Kohjimoto More articles by this author Takashi Iguchi More articles by this author Akinori Iba More articles by this author Isao Hara More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

External Validation and Evaluation of Reliability and Validity of the Triple D Score to Predict Stone-Free Status After Extracorporeal Shockwave Lithotripsy.

The Triple D scoring system is defined as novel and simple nomogram using the main parameters (skin-to-stone distance, stone density, and volume) to indicate most appropriate patients for extracorporeal shockwave lithotripsy (SWL). We aimed to evaluate the accuracy of the Triple D scoring system in predicting SWL success rates. In two tertiary academic centers, charts were retrospectively analyzed of patients who had, between January 2014 and May 2016, been treated by SWL for radiopaque kidney stones. A total of 200 patients were enrolled into the study. Parameters were calculated for each of the three specified variables. Since one point was assigned for any parameter that was less than the cutoff value, Triple D scores ranged from 0 (worst) to 3 (best). Stone-free status was achieved in 115 patients (57.5%), and 85 patients had one or more residual fragments (42.5%). Differences in stone characteristics, including stone location, density, and volume, were statistically significant in patients whether SWL achieved stone-free status or not (p < 0.001, p < 0.001, and p < 0.001, respectively). Triple D scores were significantly higher in patients treated with SWL compared with patients in whom SWL failed (p < 0.001). Triple D scores of 0, 1, 2, and 3 correlated with stone-free rates of 41.7%, 33.7%, 69.4%, and 97%, respectively. The multivariate analyses revealed that Triple D score and stone location were identified as independent factors affecting SWL success (p < 0.001 and p = 0.008, respectively). The mean number of SWL sessions was significantly higher in patients with SWL failure (p = 0.003). Our study externally validates that the Triple D scoring system is associated with SWL success in the treatment of renal and ureteral stones. Further studies are warranted to assess clinical usefulness and the accuracy of this nomogram in different patient groups.

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.

Hypovolemic Shock Caused by Massive Renal Hematoma After a Third Consecutive Extracorporeal Shockwave Lithotripsy Session: A Case Report

Extracorporeal shockwave lithotripsy (SWL) is a commonly used technique for treating urinary calculi. Although noninvasive, highly effective, and widely accepted, SWL is not without complications. Next to fragmenting the calculi, the surrounding tissue is damaged, which can result in renal hematoma, a well-described complication. In most cases, the collateral tissue damage is mild and resolves with conservative treatment. However, rarely, severe complications may arise. Here we present a case of a 46-year-old male who developed a massive hematoma, both subcapsular and retroperitoneal, after a third consecutive SWL session, resulting in hypovolemic shock. Different probable causes are proposed, of which one cause, the length of the interval between SWL sessions, is not yet studied properly. Probably, short intervals keep the damaged tissue from healing sufficiently, as proposed in our case. Possibly, life-threatening situations can be avoided if more evidence-based guidelines are available.

Do JJ Stents Increase the Effectiveness of Extracorporeal Shock Wave Lithotripsy for Pediatric Renal Stones?

Purpose: We aimed to evaluate the effects of preoperative urinary catheterization in nephrolithiasis treatment with extracorporeal shock wave lithotripsy (SWL). Methods: Patients admitted to the Department of Pediatric Surgery for renal stones between June 2012 and June 2014 were evaluated retrospectively. Patients were divided into 2 groups based on JJ stent placements. Group 1 did not receive JJ stents, while group 2 did. The recorded demographic data for each group included age, gender, stone size, location, sessions, and complications. The Elmed Complit ESWL system was used with 11-13 kV, and 1,000-1,200 shots in patients 2-4 years of age, and 11-14 kV, and 1,000-1,500 shots for patients over 4 years. Results: In group 1, 18 sessions of SWL were performed on 8 female and 2 male children with a mean age of 4.5 (range 2-12) years and stone diameter of 9 (range 7-15) mm. The locations of the renal stones were in the upper pole in 1 patient, 7 in the lower pole, and 2 in the pelvis renalis. Postoperatively, 1 patient had hematuria, 2 had dysuria, and one had a stone in the external urethral meatus. Eighty percent of patients were stone free; there were no fragmentations in 2 patients, and 1 patient discontinued treatment. In group 2, 15 SWL sessions were performed on 5 female and 5 male children aged 4 (range 3-5) and the stone diameter was 9 (range 7-16) mm. The locations of the renal stones were in the upper pole in 6 patients, in the lower pole in 3 patients, and in the ureteropelvic junction in one patient. JJ stents were placed in all patients preoperatively. Postoperatively, 3 patients had hematuria and one had dysuria. At the end of the study, all of the patients were stone free. Statistically, there were no differences in age, gender, stone size, location, and the number of sessions. Conclusions: Our results indicate that SWL without preoperative ureteral stenting is an effective and safe procedure that can be carried out in the pediatric population. Preoperative JJ stenting is unnecessary in patients, especially in those with smaller stone diameters.