ObjectivesTo compare the efficacy and safety of shockwave lithotripsy (SWL) using a narrow focus or wide focus for renal stones.Patients and MethodsA double‐blind randomised trial included adult patients with a solitary radio‐opaque renal pelvic stone of 1–2 cm. Patients were randomised into two groups: narrow‐focus (2 mm) SWL and wide‐focus (8 mm) SWL. The stone‐free rate (SFR) and presence of complications such as haematuria, fever, pain, and peri‐renal haematoma were evaluated. Pre‐ and postoperative urinary markers (neutrophil gelatinase‐associated lipocalin [NGAL] and kidney injury molecule 1 [KIM‐1]) concentrations were compared to assess renal injury.ResultsA total of 135 patients were recruited for this study. The SFR after the first SWL session was 79.2% and 69.1% in narrow‐ and wide‐focus groups, respectively. There was a comparable rise in the median 2‐h NGAL concentration in both groups (P = 0.62). However, the rise in the median (interquartile range [IQR]) 2‐h KIM‐1 concentration was significantly higher in the narrow‐focus group at 4.9 (4.6, 5.8) ng/mL compared with the wide‐focus group at 4.4 (3.2, 5.7) ng/mL (P = 0.02). Nevertheless, the 3‐day NGAL and KIM‐1 urinary marker concentrations were significantly improved (P = 0.263 and P = 0.963, respectively). The overall SFR after three sessions was 86.6% and 86.8% in the narrow‐ and wide‐focus groups, respectively (P = 0.77). Both groups were comparable for complications, apart from the median pain score and the percentage of high‐grade haematuria, which were significantly higher in the narrow‐focus group (P < 0.001 and P = 0.03, respectively).ConclusionNarrow‐ and wide‐focus SWL were associated with comparable outcomes and re‐treatment rates. However, narrow‐focus SWL was associated with significantly higher morbidity in terms of pain and haematuria.
active research into the development of ureteral stents with surface coatings and smoothing of the surface to reduce foreign body adhesion. In this study, the novel ureteral stent coated with polydopamine (PDA), which is formed by the polymerization of dopamine and close to the substances existed in human body and so has a low recognition reaction as a foreign substance, were investigated for ability to prevent crystal (Calcium: Ca) adhesion.METHODS: The ureteral stent was incubated in artificial urine at 37 C for 3 weeks, and the amount of Ca deposition on the surface of the ureteral stent was compared between the PDA-coated stent and commercially available stents by microscopic observation and Inductively Coupled Plasma (ICP) analysis. As to in vivo study, in rat model of hypercalciuria induced by drinking ethylene glycol and ammonium chloride, stents were implanted in the bladder for one month and Ca deposition on the surface of the ureteral stent was determined.RESULTS: After immersion in artificial urine for 3 weeks, the PDA-coated ureteral stent showed less Ca deposition on the stent surface than the commercially available ureteral stent (p[0.0468). There was no significant difference in the increase in pH of the artificial urine in which the ureteral stent was immersed between the PDA-coated and commercially available ureteral stents. With respect to the rat experimental model with Ca including-urine, the PDA-coated ureteral stent had less Ca deposition on the stent surface than the commercially available stent (p[0.0412). No apparent safety-related adverse events were observed.CONCLUSIONS: Our novel PDA-coated ureteral stent showed less amount of Ca deposition on the stent surface than commercial stents in artificial urine. The experimental rat model with Ca includingurine also showed a similar data of less Ca deposition on the stent surface than commercial stent, suggesting that this novel stent is less likely to cause stent occlusion (WO/2022/176834).
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