Shockwave lithotripsy: techniques for improving outcomes

Kroczak, Tadeusz; Scotland, Kymora B.; Chew, Ben H.; Pace, Kenneth T.

doi:10.1007/s00345-017-2056-y

Cited by 33 publications

(19 citation statements)

References 58 publications

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“…[20] Recently, vasoconstriction has been reported to occur without a pause. [21] In our study, the stepwise voltage ramping technique, low frequency, and US guidance gave us acceptable results.…”

Section: Discussionmentioning

confidence: 67%

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

et al. 2019

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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.

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Section: Discussionmentioning

confidence: 67%

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

et al. 2019

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“…To maximize the e cacy and outcomes while minimizing complications of SWL, certain options regarding patient and stone characteristics have been proposed [16]. Obese patients and those with a higher body mass index (BMI) may have a larger skin to stone distance revealed during clinical examination, which could lead to unfavorable SWL success rates [12,23].…”

Section: Discussionmentioning

confidence: 99%

“…Contemporary studies have shown that the success rate of SWL for renal stones ranges from 47 to 92% [2][3][4][5][6][7]. This highly variable result is due to various crucial factors, including stone composition and size [8][9][10][11], skin to stone distance [12], lithotripter energy power [13] and frequency [14,15], patient positioning [16], and patient tolerance and respiration [16,17]. Less than half of the administered shockwaves may be accurately focused on the targeted calculus [18], and the excessive energy and shockwaves can cause damage to the parenchyma and adjacent organs.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Ultrasound-assisted and Pure Fluoroscopy-guided Extracorporeal Shockwave Lithotripsy for Renal Stones

Chang

Lin

Tsai

et al. 2020

Preprint

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Background: In this study, we aimed to compare the efficacy and clinical outcomes of shock wave lithotripsy (SWL) for patients with renal stones using pure fluoroscopy (FS) or ultrasound-assisted (USa) localization with two lithotripters.Methods: We retrospectively identified 425 patients with renal calculi who underwent SWL with either a LiteMed LM-9200 ELMA lithotripter (209 cases), which combined ultrasound and fluoroscopic stone targeting or a Medispec EM-1000 lithotripter machine (216 cases), which used fluoroscopy for stone localization and tracking. The patient demographic data, stone-free rates, stone disintegration rates, retreatment rates and complication rates were analyzed.Results: The USa group had a significantly higher overall stone-free rate (43.6 vs. 28.2%, p<0.001) and stone disintegration rate (85.6 vs. 64.3%, p<0.001), as well as a significantly lower retreatment rate (14.8 vs. 35.6%, p<0.001) and complication rate (1.9 vs. 5.5%, p=0.031) compared with the FS group. This superiority remained significant in the stone size <1cm stratified group. In the stone size >1cm group, the stone-free rate (32.4 vs. 17.8%, p=0.028), disintegration rate (89.2 vs. 54.8%, p=0.031) and retreatment rate (21.6 vs. 53.4%, p<0.001) were still significantly better in the USa group, however there was no significant difference in the complication rate. The most common complication was post-SWL-related flank pain.Conclusion: Extracorporeal SWL using ultrasound combined with fluoroscopy for stone localization and real-time tracking, provides higher stone-free rates and stone disintegration rates, as well as lower retreatment rates and fewer complications.

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“…To maximize the efficacy and outcomes while minimizing complications of SWL, certain options regarding patient and stone characteristics have been proposed [16]. Obese patients and those with a higher body mass index (BMI) may have a larger skin to stone distance revealed during clinical examination, which could lead to unfavorable SWL success rates [12,23].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Ultrasound-assisted and Pure Fluoroscopy-guided Extracorporeal Shockwave Lithotripsy for Renal Stones

Chang

Lin

Tsai

et al. 2020

Preprint

View full text Add to dashboard Cite

Background In this study, we aimed to compare the efficacy and clinical outcomes of shock wave lithotripsy (SWL) for patients with renal stones using pure fluoroscopy (FS) or ultrasound-assisted (USa) localization with two lithotripters. Methods We retrospectively identified 425 patients with renal calculi who underwent SWL with either a LiteMed LM-9200 ELMA lithotripter (209 cases), which combined ultrasound and fluoroscopic stone targeting or a Medispec EM-1000 lithotripter machine (216 cases), which used fluoroscopy for stone localization and tracking. The patient demographic data, stone-free rates, stone disintegration rates, retreatment rates and complication rates were analyzed. Results The USa group had a significantly higher overall stone-free rate (43.6 vs. 28.2%, p < 0.001) and stone disintegration rate (85.6 vs. 64.3%, p < 0.001), as well as a significantly lower retreatment rate (14.8 vs. 35.6%, p < 0.001) and complication rate (1.9 vs. 5.5%, p = 0.031) compared with the FS group. This superiority remained significant in the stone size < 1 cm stratified group. In the stone size > 1 cm group, the stone-free rate (32.4 vs. 17.8%, p = 0.028), disintegration rate (89.2 vs. 54.8%, p = 0.031) and retreatment rate (21.6 vs. 53.4%, p < 0.001) were still significantly better in the USa group, however there was no significant difference in the complication rate. The most common complication was post-SWL-related flank pain. Conclusion Extracorporeal SWL using ultrasound combined with fluoroscopy for stone localization and real-time tracking, provides higher stone-free rates and stone disintegration rates, as well as lower retreatment rates and fewer complications.

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Shockwave lithotripsy: techniques for improving outcomes

Cited by 33 publications

References 58 publications

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

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

Comparison of Ultrasound-assisted and Pure Fluoroscopy-guided Extracorporeal Shockwave Lithotripsy for Renal Stones

Comparison of Ultrasound-assisted and Pure Fluoroscopy-guided Extracorporeal Shockwave Lithotripsy for Renal Stones

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