The Predictive Role of Abdominal Fat Parameters and Stone Density on SWL Outcomes

2020 ◽  
Vol 16 (1) ◽  
pp. 80-87
Author(s):  
Coskun Kaya ◽  
Yurdaer Kaynak ◽  
Aral Karabag ◽  
Aykut Aykaç
Keyword(s):  
Predictive Factors ◽  
Renal Stones ◽  
Renal Calculi ◽  
Abdominal Fat ◽  
Ureteral Stones ◽  
Stone Size ◽  
X Ray ◽  
Extracorporeal Shock Wave ◽  
Stone Density

Background: Our aim was to detect the role of radiological abdominal fat parameters by tomography and stone density by plain X-ray on extracorporeal Shock Wave Lithotripsy (SWL) stone-free rate. Methods: The patients who had undergone SWL for a single opaque renal stone < 2 cm in diameter and proximal ureteric stone < 1 cm in diameter were collected retrospectively. The characteristics of patients and stones were recorded. The stone attitude, HU, abdominal fat parameters, paraperirenal fat area, perirenal infiltration and severity of hydronephrosis with pre-treatment Non- Contrast Computed Tomography (NCCT) and stone density with radiography were evaluated by a radiologist. Four weeks after the last SWL; all patients were evaluated by plain X-ray and categorized as Stone Free (SF) and Residual Fragment (RF) group. Results: 51 patients with renal stones and 88 patients with proximal ureteral stones were included in the study. 24 (47%) and 63 (71%) patients were classified as SFfor renal and ureteral stones respectively. Only stone size was an independent predictor for stone-free rates after SWL for renal and proximal ureteral stones on multivariate analysis. The Receiver Operating Characteristic (ROC) curves for renal calculi revealed that creatinine level, stone size, stone attitude, Houns-Field Unit (HU) and Skin-to-Stone Distance (SSD) were the predictive factors for the SWL outcome (p< 0.05). The ROC curve for ureteral calculi demonstrated that HU, stone size and attitude were the predictive factors (p< 0.05). Conclusion: All abdominal fat parameters and the stone density were not related to SWL failure. A large follow-up with more patients is essential to confirm the role of radiological parameters on the outcome of SWL.

scholarly journals Comparison of an electromagnetic and an electrohydraulic lithotripter: Efficacy, pain and complications

2018 ◽  
Vol 90 (3) ◽  
pp. 169-171 ◽  
Author(s):  
Grazia Bianchi ◽  
Diego Marega ◽  
Roberto Knez ◽  
Stefano Bucci ◽  
Carlo Trombetta
Keyword(s):  
Emergency Room ◽  
Incomplete Data ◽  
Renal Stones ◽  
Ureteral Stones ◽  
Intractable Pain ◽  
X Ray ◽  
Extracorporeal Shock Wave ◽  
Analgesia Requirement ◽  
Lost To Follow Up

Introduction. We analyzed efficacy and complications of extracorporeal shock wave lithotripsy (SWL) and analgesia requirement during the treatment in two groups of patients treated with different lithotripters. Materials and methods. The patients treated were 189, 102 between September 2016 and April 2017 with HMT Lithotron® LITS 172, electrohydraulic, and 87 between May and September 2017 with Storz Medical Modulith® SLK, electromagnetic. The main differences between the lithotripters are: type of energy source, patient position, frequency and number of shock waves. All the patients underwent sonography before and four to eight weeks after the treatment. The targeting was sonographic for renal stones and X-ray for ureteral stones. All the patients received Ketorolac before the treatment with a supplement of Pethidine if needed. People lost to follow-up and with incomplete data were excluded. Results. We enrolled 173 patients, 94 treated with the electrohydraulic lithotripter and 79 with the electromagnetic one. 43 patients (54%) in the electromagnetic group and 31 (33%) in the electrohydraulic group were stone free or presented clinically insignificant residual fragments (CIRFs), defined as asymptomatic, noninfectious, ≤ 3 mm. The association between CIRFs and the kind of lithotripter was statistically significant (p = 0.004). An increased need for analgesia was found in 14.9% of patients in the electromagnetic group and in 81% of patients in the electrohydraulic group (p < 0.001). The access to emergency room (intractable pain, kidney failure, fever, Steintrasse) after the treatment was similar in the two groups (p = 0.37). Conclusions. The best results in stones fragmentation and less analgesia requirement were demonstrated in the electromagnetic lithotripter group. No differences were demonstrated considering the need for emergency room after the treatment

scholarly journals Percutaneous nephrolithotomy through superior calyceal approach - our experience

Pulse ◽  
1970 ◽  
Vol 3 (1) ◽  
pp. 4-6
Author(s):  
AU Shaikh ◽  
R Biswas ◽  
NUM Arif ◽  
N Miah ◽  
W Zaman
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Renal Stone ◽  
Invasive Procedure ◽  
Renal Stones ◽  
Renal Calculi ◽  
Stone Size ◽  
Stone Clearance ◽  
X Ray ◽  
Percutaneous Punctures ◽  
Main Complication

Introduction: Percutaneous Nephrolithotomy (PCNL) is considered the treatment of choice for large (> 2 cm size) renal stones at present. Aim of this study was to evaluate the results of PCNL as monotherapy in our centre which were done through superior calyceal approach.Materials and Methods: Seventy five patients with three bilateral renal stone (total 78 renal units) that underwent PCNL through superior calyceal approach at Apollo Hospitals Dhaka from May 15, 2005 to December 15, 2007 were included in this retrospective study. Selected patients had renal stones more than 2 cm in size (average stone size 35 mm and surface area 750 mm2). Ultrasonogram, intravenous urogram and in some selected cases CT scan were done to detect the location and size of the stone. Urologist performed percutaneous punctures through superior calyx in prone position under fluoroscopic guidance and general anaesthesia were employed in all cases. Post-operative stone clearance was documented on plain X-ray KUB and ultrasonogram KUB.Results: PCNL was successfully (complete stone clearance and insignificant residue) carried out in 68 patients (69 renal units). Average stone clearance was 88.46%. No second look procedures were needed. Uro-sepsis was the main complication, occurred in 9 renal units (11.53 %) while urinary leakage/ fistula in 6.41%, significant bleeding in 6 renal units (7.69 %) and pleural breach with fluid in pleural cavity (hydrothorax) in 2 (2.6 %) cases. Mean blood transfusion was 1.2 units and mean hospital stay was 67 hours.Conclusion: Monotherapy with PCNL is highly effective in the treatment of large volume renal calculi and staghorn calculi using superior calyceal supracostal and subcostal approach. As a minimally invasive procedure, it is quite safe in experienced hand.Keywords: Percutaneous nephrolithotomy, Renal stone, Superior calyceal puncture, Staghorn calculiDOI: 10.3329/pulse.v3i1.6543Pulse Vol.3(1) July 2009 p4-6

scholarly journals Efficacy of electromagnetic lithotriptor in the treatment of renal and upper ureteral stones

2018 ◽  
Vol 8 (2) ◽  
pp. 82-85
Author(s):  
Sadrollah Mehrabi ◽  
Esmat Rasoli ◽  
Hamidreza Ghafarian Shirazi ◽  
Amir Mehrabi
Keyword(s):  
Shock Waves ◽  
Success Rate ◽  
Electromagnetic Waves ◽  
Ureteral Stones ◽  
Stone Size ◽  
X Ray ◽  
Extracorporeal Shock Wave ◽  
Urinary Tract Stones ◽  
Mean Size ◽  
The Mean

Introduction: The innovation of outpatient extracorporeal shock wave lithotripsy (ESWL) has created a revolution in the treatment of urinary tract stones. Objectives: The aim of this study was to evaluate the success rate of electromagnetic lithotriptor, in the treatment of renal and upper ureteral stones. Patients and Methods: In this study, 84 patients aged over 10 years, with renal and upper ureteral stones less than 20 mm, were considered for ESWL. Patients were randomly assigned into two groups. In all patients, using ultrasound and fluoroscopy, stone was localized and using an electromagnetic machine by standard method, ESWL was performed with electromagnetic waves. ESWL started with 12 kV and was increased to18 kV, up to a maximum of 3500 shock waves. Two weeks later a kidney, ureter, and bladder (KUB) X-ray and ultrasonography was conducted and the success rate of lithotripsy according to the crushing of stones and decrease in stone size was measured and recorded. Results: In this study, 61.9% of patients were male. The mean age of patients was 46.62 ± 13.12 years. The mean size of stones in both groups was 13.4 ± 2.5 mm. Around 56.3% of patients had opaque stones and 43.8% had non-opaque stones. A total of 63.5% of patients received up to 3000 shock waves and 37.5% of patients received more than 3000 shock waves. Complete efficacy and clearance of renal and ureteral stones was observed in 54.8% and 59.1% of cases, respectively (P>0.05). Conclusion: This study showed a similarity in the success and efficacy of electromagnetic lithotriptor in the treatment of renal and upper ureteral stones. Additionally, the success rate of opaque and non-opaque stones have no significant differences, while stone size and proportion of shock waves will not increase the efficacy of the electromagnetic lithotriptor in crushing the stones.

scholarly journals Efficacy of Percutaneous Nephrolithotomy in the Treatment of Renal Calculi of 10 to 20 MM Size: A Comparison With Extracorporeal Shock Wave Lithotripsy

2020 ◽  
Vol 21 (2) ◽  
pp. 98-104
Author(s):  
Muhammad Mahmud Alam ◽  
Mohammad Rezaul Karim ◽  
Mohammad Ohiduzzaman Khan ◽  
Mohammad Mukhlesur Rahman ◽  
Mahfuja Asma ◽  
...  
Keyword(s):  
Shock Wave ◽  
Percutaneous Nephrolithotomy ◽  
Extracorporeal Shock Wave Lithotripsy ◽  
Shock Wave Lithotripsy ◽  
Renal Stones ◽  
Renal Calculi ◽  
Post Procedure ◽  
Extracorporeal Shock Wave ◽  
Significant Difference

Background: Stones in the urinary tract is a common medical problem in the general population. At present, the great expansion in minimally invasive techniques has led to the decrease in open surgery. Extracorporeal shock wave lithotripsy (ESWL) has been introduced as an alternative approach which disintegrates stones in the kidney and upper urinary tract through the use of shock waves. Nevertheless, as there are limitations with the success rate in ESWL, other minimally invasive modalities for kidney stones such as percutaneous nephrolithotomy (PCNL) is also widely applied. There is a trend of using ESWL for treatment of renal stones smaller than 1 cm and PCNL in those with stones greater than 2 cm. Nevertheless, no consensus regarding treatment of renal stones between 1 to 2 cm stones. The objective of this prospective study was to compare the results of ESWL and PCNL for treatment of 1 to 2 cm renal stones. Method : This is a quasi experimental study. This study was conducted to compare the efficacy and safety of percutaneous nephrolithotomy (PCNL) and extracorporeal shock wave lithotripsy (ESWL) in treating 10 to 20 mm sized renal stone among the Bangladeshi population. This prospective study conducted between the periods of September, 2011 to August, 2012 in the department of urology, Bangabandhu Sheikh Mujib medical university (BSMMU) Hospital. All the patients attending the urology outpatient clinic with 10 to 20mm renal calculi were the study population. A total of 70 subjects were enrolled for this study and they were equally divided into two groups so that each group had 35 subjects. The one group received PCNL whereas the other group received ESWL. Statistical analyses of the results were obtained by using window based computer software devised with Statistical Packages for Social Sciences (SPSS-15). Results: There is no statistically significant difference in regarding age, sex, stone side(lt. or rt.), the distribution of stone (upper, middle and lower calyx) and size between the groups (p>0.05). At 3 month follow up among the patients in ESWL group stone cleared and not cleared were 25(71.4%) and 10(28.6%) respectively and at 3 month follow up among the patients in PCNL group stone cleared and not cleared were 33(94.3%) and 2(5.7%)respectively. There is statistically significant difference in stone clearance rate at 3 month follow up between the groups (p<0.05). All patients in ESWL group developed post procedure haematuria 35(100.0%). Other post procedure complications among the ESWL group pain, fever and steinstrasse were 12(34.3%), 07(20.0%) and 03(08.6%) respectively. Common post procedure complications among the patients of PCNL group pain, haematuria and fever were 11(31.4%), 33(94.3%) and 13(37.1%) respectively. Other post procedure complications in PCNL group were vomiting (8.6%), urinary leakage (5.7%), wound infection (11.4%) and urinary cutaneous fistula (5.7%). There was no statistically significant difference post procedure pain, haematuria and fever between the groups (p>0.05), but statistically significant difference observed in steinstrasse and wound infection between the groups (p<0.05). Mean±SD of hospital stay among the patients of ESWL group and PCNL group was 1.37±0.65 and 4.34±1.43 days respectively. There is statistically significant difference in hospital stay between the groups (p<0.05). Conclusion: Though some specific complications which can be treated conservatively are more in PCNL group it may be concluded that the treatment with PCNL is better option than ESWL among the patients having renal calculi 10 to 20 mm. Bangladesh Journal of Urology, Vol. 21, No. 2, July 2018 p.98-104

scholarly journals Do stone size and impaction influence therapeutic approach to proximal ureteral stones?

2009 ◽  
Vol 66 (2) ◽  
pp. 129-133 ◽  
Author(s):  
Slobodan Radulovic ◽  
Aleksandra Vuksanovic ◽  
Dragica Milenkovic-Petronic ◽  
Bozo Vavic
Keyword(s):  
Therapeutic Approach ◽  
Ureteral Stone ◽  
Treatment Success ◽  
Ureteral Stones ◽  
Stone Size ◽  
Extracorporeal Shock Wave ◽  
Group I ◽  
Significant Difference ◽  
Group Ii ◽  
Proximal Ureteral Stone

Background/Aim. Primary therapeutic approach to lumbar ureteral stones is still contraversial. The aim of the study was to investigate the influence of stone impaction and size on the effectiveness of proximal ureteral stone lithotripsy. Methods. A total of 123 patients with proximal ureteral stones were investigated in this prospective study performed in a 10- month period. The patients were divided into the group I - 86 patients treated with extracorporeal shock wave lithotripsy (ESWL) and the group II - 37 patients treated with 'Swiss' Lithoclast. In the group I, 49 stones (57%) were classified as impacted, while 20 stones (23.3%) were larger than 100 mm2. In the group II, 26 stones (70.3%) were impacted, and 11 stones (29.7%) were larger than 100 mm2. Stones were defined as impacted by the radiographic, echosonographic as well as endoscopic findings in the group II of patients. Stone size was presented in mm2. Chemical composition of stones were almost the same in both groups of the patients. Results. Generally, there was no statistically significant difference in the treatment success between the groups. However, stones larger than 100 mm2 were statistically more successfully treated endoscopically, while there was no statistical difference in the treatment success of impacted stones between these two groups. Conclusion. ESWL can by considered as primary first therapeutic approach in treatment of all proximal ureteral stones except for stones larger than 100 mm2 that should primarily be treated endoscopically.

scholarly journals Predictors of Success after Extracorporeal Shock Wave Lithotripsy (ESWL) for Renal Calculi Between 20—30 mm: A Multivariate Analysis Model

2006 ◽  
Vol 6 ◽  
pp. 2388-2395 ◽  
Author(s):  
Ahmed El-Assmy ◽  
Ahmed R. El-Nahas ◽  
Mohamed E. Abo-Elghar ◽  
Ibrahim Eraky ◽  
Mahmoud R. El-Kenawy ◽  
...  
Keyword(s):  
Surface Area ◽  
Renal Stones ◽  
Renal Calculi ◽  
Analysis Model ◽  
Stone Surface ◽  
Chi Square ◽  
Renal Anomalies ◽  
Extracorporeal Shock Wave ◽  
Stone Free Rate ◽  
Free Rate

The first-line management of renal stones between 20—30 mm remains controversial. The Extracorporeal Shock Wave Lithotripsy (ESWL) stone-free rates for such patient groups vary widely. The purpose of this study was to define factors that have a significant impact on the stone-free rate after ESWL in such controversial groups. Between January 1990 and January 2004, 594 patients with renal stones 20—30 mm in length underwent ESWL monotherapy. Stone surface area was measured for all stones. The results of treatment were evaluated after 3 months of follow-up. The stone-free rate was correlated with stone and patient characteristics using the Chi-square test; factors found to be significant were further analyzed using multivariate analysis.Repeat ESWL was needed in 56.9% of cases. Post-ESWL complications occurred in 5% of cases and post-ESWL secondary procedures were required in 5.9%. At 3-month follow-up, the overall stone-free rate was 77.2%. Using the Chi-square test, stone surface area, location, number, radiological renal picture, and congenital renal anomalies had a significant impact on the stone-free rate. Multivariate analysis excluded radiological renal picture from the logistic regression model while other factors maintained their statistically significant effect on success rate, indicating that they were independent predictors. A regression analysis model was designed to estimate the probability of stone-free status after ESWL. The sensitivity of the model was 97.4%, the specificity 90%, and the overall accuracy 95.6%.Stone surface area, location, number, and congenital renal anomalies are prognostic predictors determining stone clearance after ESWL of renal calculi of 20—30 mm. High probability of stone clearance is obtained with single stone ≤400 mm2 located in renal pelvis with no congenital anomalies. Our regression model can predict the probability of the success of ESWL in such controversial groups and can define patients who would need other treatment modality.

Infrared Analysis of Renal Calculi: A Comparison with Conventional Techniques

1983 ◽  
Vol 20 (1) ◽  
pp. 20-25 ◽  
Author(s):  
Cathryn M Corns
Keyword(s):  
Diffraction Analysis ◽  
Renal Calculi ◽  
Complete Analysis ◽  
Infrared Analysis ◽  
X Ray Diffraction ◽  
X Ray ◽  
Calcium Magnesium ◽  
Combination Of Methods ◽  
Infrared Methods

The analysis of renal calculi is an oft-neglected corner of clinical biochemistry. This study compares results obtained by the conventional qualitative methods with results from quantitative and infrared methods and also investigates the role of x-ray diffraction analysis. Infrared spectroscopy, using a KBr disc technique, was found to be the single most useful method, being fast, simple to learn, using little sample, and in general permitting positive identification of most of the components found in renal calculi. A major advantage is that this method has approximately equal sensitivity for oxalate and phosphate, unlike the wet chemical methods. Infrared analysis is also useful in identifying the spurious materials sometimes submitted as renal calculi. X-ray diffraction analysis is not a technique that is routinely available, but it does provide information not given by other methods, eg, distinguishing Ca(COO)2·H2O from Ca(COO)2·2H2O. For complete analysis a combination of methods was adopted; carbonate is tested for using a microchemical technique, calcium, magnesium, and phosphate are quantitated by routine methods, and infrared analysis is used to detect oxalate and organic components. It must be emphasised that any method is only as good as the sample used, and different areas of the calculus must be analysed separately if useful results are to be obtained.

scholarly journals Extracorporeal Shockwave Lithotripsy with Tamsulosin in Clearance of Upper Ureteral Calculi- A Randomized Control Clinical Trial

2020 ◽  
Vol 23 (1) ◽  
pp. 36-42
Author(s):  
Md Safiul Alam Babul ◽  
Md Waliul Islam ◽  
Shariful Islam Khan ◽  
Mohammad Habibur Rahman ◽  
Anup Roy Chowdhury ◽  
...  
Keyword(s):  
Clearance Rate ◽  
Ureteral Stones ◽  
P Value ◽  
Ureteric Stone ◽  
Stone Size ◽  
Stone Clearance ◽  
Extracorporeal Shock Wave ◽  
Group A ◽  
Randomized Control ◽  
Group B

Background of the study: Urolithiasis has an incidence in the world of about 5% and the probability of a recurrence within 5–7 years is 50% (Parmar, 2004). Exact data about its prevalence is not known in Bangladesh but it is quite common as seen in outpatient department. It is more common in northern part of the country, male suffer more than female (M:F: 3:1) (Salam, 2002). Symptomatic ureteral calculi represent the most common condition encountered by an urologist in an emergency setting (Pak, 1998). Intervention is recommended for individuals with larger stones, especially greater than 5 mm (Kupeli et al., 1998). The treatment of this pathology was revolutionized with the introduction, in the late 1980s, of extracorporeal shock wave lithotripsy (ESWL), a non-invasive technology that has become one of the primary treatments for urinary stones. Its success rates vary depending on stone size and location and by the type of lithotripter employed. Medical expulsion therapy (MET) can play a key role in support of ESWL: specifically, expulsion is done by diuretics, calcium antagonists, anti-edema agents, and alpha-blockers. A few studies have reported their effectiveness (Borghi et al., 1994, Cervenakov et al., 2002, Porpiglia et al., 2002,Dellabella et al., 2003). Objective: This study is carried out to find out the role of Tamsulos in stone clearance in patientswith upper ureteral stone after extracorporeal shock wave lithotripsy (ESWL). Methods & Material: This randomized control clinical trialwas performed in Department of Urology, National Institute of Kidney Diseases and Urology, Sher-EBangla Nagar, Dhaka during the period from July 2015 to June 2017. A total of 70 cases with upper ureteric stone were included during the study period. Patients were selected randomly in every alternate sequence, odd numbers for experimental group, Tamsulosin+ ESWL, group A & even numbers for control group, only ESWL, group B. Stone clearance rate, number of ESWL session and stone expulsion time were evaluated. Results: In this study showed complete stone clearance one month after ESWL in Group A was 16(89%) and Group B was 16(84.21%) for stone size 6 to 10 mm. Comparison of clearance rate between two groups in stone size 6 to 10 mm was not statistically significant (p value >.05). Complete stone clearance one month after ESWL in Group A was 13(76%) and Group B was 07(43.75%) for stone size 11 to 15 mm. Comparison of clearance rate between two groups in stone size 11 to 15 mm was statistically significant (p value <.05). In this study requirement of number of ESWL sessions according to the stone size showed, in case of 6 to 10 mm stone size, average ESWL sessions 1.28±0.5 in Group A and 1.53±0.7 in Group B and in case of 11to 15 mm stone size, average ESWL sessions 1.29±0.5 in Group A and 1.62±0.7 in Group B. Comparison of ESWL sessions between two groups were statistically significant (p value <.05). In this study mean expulsion time of stone in Group A was 22.34±12.23 days and in Group B was 32.34±21.96 days. Comparison of stone expulsion time between two groups were statistically significant (p value <.05). Conclusion: Tamsulosin results in increased stone-free rates and in lower percentages of patients requiring re-treatment. Tamsulosin can be self-administered and can play a key role in the choice between tamsulosin after ESWL and only ESWL for upper ureteric stone disease treatment. Use of tamsulosin makes the expulsive medical therapy suitable for improving overall outcomes of ESWL treatment for upper ureteral stones. Tamsulosin helps in clearance of upper ureteral stones after ESWL. Bangladesh Journal of Urology, Vol. 23, No. 1, January 2020 p.36-42

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