Outcome of Extracorporeal Shockwave Lithotripsy as Monotherapy in Upper Urinary Tract Lithiasis

Introduction: Due to its non-invasive nature, extracorporeal shockwave lithotripsy (ESWL) is the preferred treatment modality for uncomplicated renal and ureteral stone < 20 mm in diameter. The success rate of it ranges from 46% to 91% depending on various factors. Objective: To assess the outcome of ESWL as monotherapy in uncomplicated solitary renal and upper ureteric calculus ranging from 10mm to 20mm. Methods: In this retrospective study, the records of 34 patients who underwent Extracorporeal shockwave lithotripsy ESWL inBirat Medical College – Teaching Hospital over a period of one and a half years were reviewed to assess the outcome in terms of stone free rate and complication rate. Results: Mean age of the patients was 30.57±8.44 years and mean calculus size was 14.47±2.68 mm (range 10-20mm). The male and female ratio was 2:1. The success rate was higher for pelvic (83.33%) and upper calyceal (75%) and upper ureteric calculi (75%) compared to other calyces. Clinically significant residual fragment (CSRF) was the most common problem after ESWL (23.33%) at three months after the procedure. Conclusions: The outcome of ESWL as monotherapy for upper urinary tract calculi is acceptable in selected cases three months after the procedure. Keywords: Extracorporeal shockwave lithotripsy; outcome; upper urinary tract calculi.

The Musculoskeletal Applications of Extracorporeal Shockwave Therapy for Foot and Ankle Disorders: A Systematic Review and Meta-Analysis

BACKGROUND: Extracorporeal Shockwave Therapy (ESWT) was first introduced into clinical practice in 1982 and has proved to be a beneficial adjuvant in the non-invasive treatment of numerous orthopaedic pathologies. However, clinical evidence reporting the use of ESWT in treating musculoskeletal disorders of the foot and ankle remain limited and a general consensus on its efficacy has not been achieved. Therefore, we reviewed the available literature and analysed any reported evidence in order to determine the benefits of ESWT in this cohort. METHODS: PubMed, EMBASE and Cochrane Library databases were systematically reviewed for any clinical studies that reported the treatment of foot and ankle disorders with ESWT. RESULTS: A total of 24 clinical studies, including 12 randomised control trials and 12 case series, were identified and included into this study. Analysis of the reported evidence indicate that ESWT can be beneficial in the symptomatic management of plantar fasciitis, calcaneal spur, Achilles tendinopathy and Morton's neuroma. However, differences in ESWT protocols used limit the generalizability of these findings and prevented an optimum treatment protocol from being determined. CONCLUSIONS: Evidence from the articles analysed in this review suggest a beneficial healing effect of ESWT in treating musculoskeletal disorders affecting the foot and ankle, with minimal side effects being reported. Thus, ESWT can be used safely in combination with other treatment modalities in order to achieve the best patient outcomes. Future studies should attempt to optimize the treatment protocols of ESWT to confirm these findings.

Comparison of the effectiveness of extensor muscle strengthening exercise by itself, exercise with polydeoxyribonucleotide injection, and exercise with extracorporeal shockwave therapy in lateral epicondylitis: a randomized controlled trial

Background: Extensor muscle strengthening exercises with counterforce bands (EX) is a conventional conservative treatment for lateral epicondylitis (LE) of the elbow. In addition, polydeoxyribonucleotide (PDRN) or extracorporeal shockwave therapy (ESWT) has been recently used for tennis elbow.Methods: Sixty-three patients with chronic LE participated in this study and randomly allocated in three groups (G1: EX, G2: EX+PDRN injection, and G3: EX+ESWT). All of the three groups were taught to perform EX at the first out-patient department (OPD) visit. Group 2 was injected with 3 mL PDRN (5.625 mg/3 mL), while group 3 received ESWT at the first OPD visit. Visual analog scale pain score, Mayo elbow performance score (MEPS), and ultrasonographic examination were checked before, 6 weeks, and 12 weeks after the treatments.Results: Overall functional scores and ultrasonographic findings in all three groups improved after treatment. The mean MEPS in group 2 improved more than groups 1 and 3 at 6 weeks (G1, 56.9>62.4; G2, 54.3>65.0; G3, 55.7>62.6), and more than group 1 at 12 weeks (G1, 56.9>67.9; G2, 54.3>73.6). The mean depth of the common extensor tendon depth (CETD) on ultrasonography in group 2 increased more than groups 1 and 3 at 6 and 12 weeks (6 weeks: G1, 0.385>0.386; G2, 0.332>0.392; G3, 0.334>0.357; 12 weeks: G1, 0.385>0.409; G2, 0.332>0.438; G3, 0.334>0.405 [cm]).Conclusions: PDRN injections combined with EX exhibited a greater improvement in mean MEPS and mean CETD compared to EX only or EX combined with ESWT for LE within the 12 weeks follow-up.