scholarly journals Extracorporeal Shock Wave Lithotripsy and Combined Therapy in Children: Efficacy and Long-Term Results

2021 ◽  
Vol 9 ◽  
Author(s):  
Laura Burgos Lucena ◽  
Beatriz Fernández Bautista ◽  
Alberto Parente Hernández ◽  
Ruben Ortiz Rodríguez ◽  
Jose María Angulo Madero
Keyword(s):  
Shock Wave ◽  
Urinary Tract ◽  
Extracorporeal Shock Wave Lithotripsy ◽  
Shock Wave Lithotripsy ◽  
Combined Therapy ◽  
Percutaneous Approach ◽  
Stone Clearance ◽  
Extracorporeal Shock Wave ◽  
Free Status

Background: Extracorporeal shock wave lithotripsy (ESWL) is nowadays the first choice for the treatment of upper urinary tract stones smaller than 2 cm, considering its low complications and high success rate.Aim: To present an update of the current situation of ESWL treatment and to analyse our series of patients and the efficacy of combined lithiasis treatment in different locations and sizes.Patients and Method: Retrospective study including patients with urolithiasis treated with ESWL between 2007 and 2019. Collected data included: gender and age at treatment, presentation symptoms, imaging studies, stone location and size, complications and stone clearance. Success was defined as stone-free status or the presence of clinically insignificant residual fragments (<4 mm after 3 months follow-up). Patients with residual stones larger than 4 mm after 3 months were programmed for another ESWL session or received a combined sandwich therapy, followed by URS or percutaneous approach.Results: Between 2007 and 2019, 37 patients presented a total of 41 lithiasis episodes that were treated with ESWL sessions. Median age at first procedure was 9 years old (1–17) and median follow-up time was 6 years (3–12). Stones were located in the renal pelvis, followed by the lower, middle and upper calyx, proximal ureter, and 51% of our patients had multiple lithiasis. Median stone size was 12 mm (5–45), the main component being calcium oxalate (34%). During immediate postoperative period, 8 patients (19%) presented complications: renal colic, hematuria and urinary tract infection. After the first ESWL, 41% of the patients (n = 17) were stone-free. Out of the 24 residual lithiasis episodes (58%), three patients (7%) underwent a second ESWL session. In the remaining 19 patients, ESWL was combined with URS or percutaneous approach to achieve complete stone clearance. Overall stone free status after combined therapy was 95% (n = 39).Conclusion: These data support that ESWL is an effective minimally invasive technique, with low cost and morbidity, reproducible and safe for the treatment of stone disease in children. Even though lithiasis size seems to be a significant factor in ESWL success, in combination with other lithotripsy procedures it can reach very high rates of stone clearance.

scholarly journals UPPER URETERIC STONES

2018 ◽  
Vol 25 (01) ◽  
pp. 10-15
Author(s):  
Khalid Hussain ◽  
Attiqur Rehman Khan ◽  
Maria Tariq ◽  
Imran Ameen ◽  
Muhammad Khalid Butt
Keyword(s):  
Shock Wave ◽  
Extracorporeal Shock Wave Lithotripsy ◽  
Shock Wave Lithotripsy ◽  
Pneumatic Lithotripsy ◽  
Extracorporeal Shock Wave ◽  
Male Preponderance ◽  
Dj Stent ◽  
Risk Of Treatment ◽  
Free Status

Objectives: Compare the efficacy of Extracorporeal Shock Wave Lithotripsy withPneumatic Lithotripsy in the management of upper ureteric stones. Settings: Department ofUrology, Lahore General Hospital, Lahore. Duration of Study: From November 2008 to August2009. Results: In our study, the patients were divided into two groups ie; Extracorporeal ShockWave Lithotripsy group (ESWL) and Pneumatic Lithotripsy group (PnL). The mean age inPneumatic Lithotripsy (PnL) was 39+15.23 years, whereas mean age was 40.6+14.62 years inExtracorporeal Shock Wave Lithotripsy group (ESWL). In Extracorporeal Shock Wave Lithotripsygroup (ESWL), 38(76%) patients were male and 12(24%) patients were female while numberwas 34(68%) and 16(32% in Pneumatic Lithotripsy group (PnL) respectively. In both groups,there was male preponderance. In ESWL group, majority of patients were treated as outdoorpatients. 95% of them received intramuscular analgesia where as 5% required intravenoussedation. All patients were followed at two weekly interval up till 6 weeks. Fifty patients requiredmore than 125 sessions of ESWL with mean shock waves 2960+222.23 at at mean energy6.46+0.503kv, 2952+327.77 at 6.45+0.504 kv and 2842+410.03 at 6.76 0.436 kv at 2, 4 and 6weeks respectively. The partial clearance was achieved in 34 patients at 2 weeks, 26 patientsat 4 weeks and 5 patients at 2 weeks. Stone free status at 2 weeks, 4 weeks and 6 weeks were18%, 40% and 84% respectively. In Pneumatic Lithotripsy group (PnL) all of the 50 patientswere given general anesthesia. DJ stent was placed in all patients after the procedure for sixweeks follow up. 42(84%) of patients received shots of Pneumatic Lithotripsy on pulse modewhile in 8(16%) patients, shots were on continuous mode. The partial clearance was achieved in5(10%), 3(6%) and 2(4%) patients at 2, 4 and 6 weeks respectively. Stone free status was 48%,52% and 54% at 2, 4 and 6 weeks respectively. In 20(40%) patients, stone migrated into calyces.Only in 1(2%) patients, there was no effect on stone. All patients in both groups were neededtwo weekly follow up till six weeks. Stone clearance was 84% in Extracorporeal Shock WaveLithotripsy (ESWL) group while it was 54% in Pneumatic Lithotripsy group (PnL), p<0.001.Conclusion: Extracorporeal Shock Wave Lithotripsy offers higher stone free rates with minimalinvasiveness and high safety compared to Pneumatic Lithotripsy, which provides immediatehigh stone free rates, but with high risk of treatment failure.

scholarly journals Emergency “Hot” Shock Wave Lithotripsy

2020 ◽  
Vol 3 (2) ◽  
pp. e16-e19
Author(s):  
Musaab Yassin ◽  
Abigail Cressey ◽  
Louise Goldsmith ◽  
Ben Turney ◽  
John Reynard
Keyword(s):  
Shock Wave ◽  
Urinary Tract ◽  
Effective Treatment ◽  
Extracorporeal Shock Wave Lithotripsy ◽  
Shock Wave Lithotripsy ◽  
Urinary Stones ◽  
Invasive Therapy ◽  
Non Invasive ◽  
Extracorporeal Shock Wave

Ureteroscopy and extracorporeal shock wave lithotripsy (ESWL) are two widely used methods for the treatment of ureteric and pelviureteric junction (PUJ) stones. ESWL remains the only non-invasive therapy modality for the treatment of urinary stones. Extracorporeal shock wave lithotripsy (ESWL) is a non-invasive, safe and effective treatment for urinary tract lithiasis Ureteroscopy and extracorporeal shock wave lithotripsy (ESWL) are two widely used methods for the treatment of ureteric and pelviureteric junction (PUJ) stones. ESWL remains the only non-invasive therapy modality for the treatment of urinary stones. Extracorporeal shock wave lithotripsy (ESWL) is a non-invasive,safe and effective treatment for urinary tract lithiasis ObjectivesTo evaluate the effectiveness of emergency “hot” shock wave lithotripsy in treating symptomatic ureteric/ PUJ stones. Materials and MethodsA retrospective study looking at the emergency referrals for shock wave lithotripsy to the Churchill Hos-pital between June 2013 to Dec 2017. The Lithotripsy Database and patients’ electronic records were used to complete this project. Emergency referrals triaged by the on-call urology team and go through a renal colic clinic. ResultsIn total, 201 patients underwent emergency shock wave lithotripsy for ureteric/PUJ stones.The mean stone size was 7.7mm (SD 2.9). 12.4% (25) were PUJ, 45.3% (91) proximal and 42.3% (85) distal ureteric stones. 1% (2) were bilateral ureteric stones. 9% (18) had previous lithotripsy treatment before being referred.The number of shocks used was 4000 in 52.7%, >=3000 in 40.3%, >=2000 in 4.5% and >=1000 in 2.5%. The median shock frequency was 2 Hz. The median number of treatments for the targeted stone was 2. Stone fragmentation was visible in 27.4% (55), possible in 30.8% (62) and not visible in 41.8% (84).In terms of follow up, 48.3% (97) were discharged stone-free, while 17.4% (35) were discharged with residual fragments. 21.8% (44) had further clinic follow up while 12.4% (25) had no follow-up information available, possibly because they were referred from different hospitals. 19.9% (40) needed ureteroscopy, while 7% (14) needed further lithotripsy sessions. ConclusionsEmergency extracorporeal lithotripsy can be offered as an effective and safe treatment for patients with symptomatic stones.

scholarly journals Study of factors predicting clinical outcomes of extracorporeal shock wave lithotripsy in Indian patients with upper urinary tract calculi

2018 ◽  
Vol 5 (4) ◽  
pp. 1532
Author(s):  
Panchal P. G. ◽  
Mahesh Krishnaswamy ◽  
Dhammdeep C. Dabhade ◽  
Onkar C. Swami
Keyword(s):  
Shock Wave ◽  
Urinary Tract ◽  
Clinical Outcomes ◽  
Extracorporeal Shock Wave Lithotripsy ◽  
Shock Wave Lithotripsy ◽  
Upper Urinary Tract ◽  
Stone Size ◽  
Extracorporeal Shock Wave ◽  
Urinary Tract Calculi ◽  
Free Status

Background: Extracorporeal shock wave lithotripsy (ESWL) is an effective non-invasive method for managing urinary tract calculi. Present study was undertaken to evaluate factors that may influence ESWL clinical outcomes in Indian patients with urinary tract calculi.Methods: This prospective study was conducted at Department of Urology, Medical Trust Hospital Cochin, India in the period from September 2006 to March 2009. Sixty patients with upper urinary tract lithiasis having stone size between 5 to 25 mm were included and patients with ˃2 calculi, distal ureteric obstruction (not relieved), renal anomalies were excluded. All patients were treated with DIREX medical system lithotripter. Clinical outcome of ESWL was assessed by factors like site, size, density and skin-to-stone distance. After statistical analysis, p-value ≤0.05 was taken as the level of significance.Results: The overall success of ESWL was 82%. The final success of ESWL for sites like ureter, pelvis, mid or upper and lower calyx were 94.1%, 84%, 85.7% and 58% respectively (p = 0.095). The rate of fragmentation of stone after one session of ESWL for stone size ≤10 mm, 11 mm - 20 mm and ≥21 mm was 76.5%, 68.4% and 16.7% respectively (p=0.009). For stone density 751-1000 HU, 22.2% patients required ≥2 sessions to achieve stone free status (p<0.0005). Around 15.6% patients in skin-to-stone distance (SSD) ≤10cm required ≥2 sessions to achieve stone free status (p = 0.27).Conclusions: ESWL should be considered a primary modality of treatment in patients with calculi size ≤20 mm, density ≤ 1000 HU, pelvic, ureteric and upper and/or middle calyceal calculi and for SSD ≤10 cm.

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 Ultrasound-guided Paravertebral Block Versus Intravenous Sedative Analgesic using Midazolam /Fentanyl in Patients Undergoing Extracorporeal Shock Wave Lithotripsy

2021 ◽  
pp. 1-10
Author(s):  
Fatma M. Elaiashy ◽  
Mohamed M. Abu Elyazd ◽  
Ahmed A. Eldaba ◽  
Tarek A. Gameel
Keyword(s):  
Shock Wave ◽  
Success Rate ◽  
Extracorporeal Shock Wave Lithotripsy ◽  
Shock Wave Lithotripsy ◽  
Renal Stone ◽  
Paravertebral Block ◽  
Ultrasound Guided ◽  
Stone Clearance ◽  
Extracorporeal Shock Wave ◽  
Fentanyl Group

Background: Thoracic paravertebral block (TPVB) produces ipsilateral somatic and sympathetic nerve blockade in multiple contiguous dermatomes both above and below the site of injection.  The Aim of This Study: was to compare the effectiveness of ultrasound-guided TPVB versus intravenous (IV) sedative analgesic using midazolam / fentanyl in patients undergoing extracorporeal shock wave lithotripsy (ESWL) procedure. Patients and Methods: This prospective, randomized study was carried out on sixty patients aged 20-60 years, with radio-opaque renal stone not more than1.5cm. TPVB group (30 patients) received ipsilateral ultrasound-guided TPVB at the level T9-T10 using bupivacaine 0.25% (20 mL) about 30 minutes before the ESWL. Midazolam/fentanyl group (30 patients) received sedatives analgesic drugs using IV midazolam (0.05 mg / kg) and fentanyl (1 µg/kg) about 5 min before the ESWL. The VAS score during and 30 min post procedure, total dose of rescue analgesic consumption during ESWL procedure, the success rate of ESWL, the time needed to stone clearance, patient and operator satisfaction scores were recorded. Result: During and after ESWL procedure, the VAS scores were significantly higher in midazolam/fentanyl group than TPVB group (P < 0.05). The number of patients required rescue analgesic during ESWL was significantly higher in midazolam/fentanyl group compared to TPVB group (P < 0.05).The success rate of ESWL was insignificantly different between both groups (P > 0.05). The time needed to stone clearance was significantly shorter in TPVB group compared to midazolam/fentanyl group (P < 0.05). Conclusions: Ultrasound-guided TPVB provided more effective analgesia with reduced number of ESWL sessions and shorter time to renal stone clearance than IV midazolam/fentanyl.

Hypertension after Extracorporeal Shock Wave Lithotripsy: Long Term Follow Up

1994 ◽  
pp. 529-531
Author(s):  
G. Zanetti ◽  
A. Trinchieri ◽  
E. Montanari ◽  
A. Guarneri ◽  
E. Austoni ◽  
...  
Keyword(s):  
Shock Wave ◽  
Extracorporeal Shock Wave Lithotripsy ◽  
Shock Wave Lithotripsy ◽  
Extracorporeal Shock Wave ◽  
Long Term Follow Up
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