The role of extracorporeal shock wave lithotripsy in the future of stone management

Basulto-Martínez, Mario; Klein, Itzik; Gutiérrez-Aceves, Jorge

doi:10.1097/mou.0000000000000584

Cited by 24 publications

(26 citation statements)

References 32 publications

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“…The revolution of extracorporeal shock wave lithotripsy (ESWL) provided an insight into the role of stone treatment in the current and future [ 1 , 2 ]. ESWL had kept its role as a single noninvasive treatment in stone management.…”

Section: Introductionmentioning

confidence: 99%

A clinical observational study of effectiveness of a solid coupling medium in extracorporeal shock wave lithotripsy

Chang

Lin

et al. 2022

BMC Urol

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This study aimed to investigate clinical effectiveness of stone disintegration by using isolation coupling pad (“icPad”) as coupling medium to reduce trapped air pockets during extracorporeal shock wave lithotripsy (ESWL). Patients underwent ESWL between Oct. 2017 and May 2018 were enrolled in this clinical observational study. An electromagnetic lithotripter (Dornier MedTech Europe GmbH Co., Germany) was used in this study. Patients were divided into icPad group P1, P2 and semi-gel group C by different coupling medium. The energy level and total number of shock wave (SW) for group P1 and C was set at level 2 and 3000 and group P2 at level 3 and 2500. The successful stone disintegration rate (SSDR) was determined to evaluate the treatment outcome. All patients were evaluated by KUB film and ultrasonography after 90 days. Complications during ESWL were recorded. A total of 300 patients satisfied the inclusion criteria. There were no significant differences in characteristics of patients and stone among three groups. The corresponding SSDRs for patients in group P1, P2 and C was 73.0%, 73.2% and 55.3%, respectively. The SSDR in group P1 was statistically higher than Group C. Comparing to semi-liquid gel, coupling medium using by icPad could achieve better treatment outcome of stone disintegration in ESWL.

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Section: Introductionmentioning

confidence: 99%

A clinical observational study of effectiveness of a solid coupling medium in extracorporeal shock wave lithotripsy

Chang

Lin

et al. 2022

BMC Urol

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“…Since the first procedure performed in 1980, ESWL has revolutionized the management of urolithiasis [11]. Ever since, several techniques of ESWL including shock wave generation, localization system, larger focal zone, ramping strategy, lower pulse rate, stone localization, and adequate coupling in lithotripter design have evolved to achieve better stone disintegration over the past four decades [12][13][14]. In this study, we proposed a new strategy to reduce the trapped air pockets during ESWL coupling by using a new acoustic, proprietary isolationcoupling pad (icPad).…”

Section: Discussionmentioning

confidence: 99%

Newly designed solid coupling medium for reducing trapped air pockets during extracorporeal shock wave lithotripsy_ a phantom study

Wang

Liou³

et al. 2021

BMC Urol

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Introduction Air pockets between the lithotripter head and body surface are almost inevitably generated when applying a handful of gel onto the contact portion of the treatment head and that on the patient’s skin during coupling procedure. These air pockets can compromise the transmission of acoustic energy of shock wave and may significantly affect efficacy of stone disintegration. Comparing to conventional gel, this study aims to investigate efficacy of stone disintegration by using a proprietary isolation-coupling pad (“icPad”) as the coupling medium to reduce trapped air pockets during ESWL procedure. Method In this phantom study, Dornier lithotripter (Delta-2 RC, Dornier MedTech Europe GmbH Co., Germany) was used with a proprietary gel pads (icPad, Diameter = 150 mm, Thickness = 4 mm and 8 mm). The lithotripter was equipped with inline camera to observe the trapped air pockets between the contact surface of the lithotripter head. A testing and measuring device were used to observe experimental stone disintegration using icPad and semi-liquid gel. The conventional semi-liquid gel was used as control for result comparison. Results The stone disintegration rate of icPad 4 mm and 8 mm after 200 shocks of energy at level 2 were significantly higher than that of the semi-liquid gel (disintegration rate 92.3%, 85.0% vs. 45.5%, respectively, p < 0.001). The number of shocks for complete stone disintegration by icPad of 4 mm and 8 mm at the same energy level 2 were significantly lower than that of the semi-liquid gel (the number of shocks 242.0 ± 13.8, 248.7 ± 6.3 vs. 351.0 ± 54.6, respectively, p = 0.011). Furthermore, quantitative comparison of observed air pockets under Optical Coupling Control (OCC) system showed that the area of air pockets in semi-liquid group was significantly larger than that of the group using icPad (8 mm) and that of the group using icPad (8 mm) after sliding (332.7 ± 91.2 vs. 50.3 ± 31.9, 120.3 ± 21.5, respectively, p < 0.05). Conclusion The advantages of icPad includes: (1) reduced the numbers of shock wave and increased stone disintegration rate due to icPad’s superior efficacy; (2) significantly reduce trapped air pockets in ESWL coupling. Due to the study limitation, more data are needed to confirm our observations before human trials.

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“…Finally, modifying the technique and involving urologist actively in lithotripsy unit can improve ESWL outcome. ESWL will keep its role as the single noninvasive treatment in small stone management [22].…”

Section: Discussionmentioning

confidence: 99%

Fragmentation and propulsive effect of shock wave lithotripsy in treatment of small renal calculi

Abid

Hussein

2020

Afr J Urol

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Background Small renal calculi are frequently observed in clinical practice, and chemo-lytic therapy has limited effects. The purpose of the study is to evaluate the effectiveness of extracorporeal shock wave lithotripsy (ESWL) in the treatment of small renal calculi. Methods We studied 60 patients with small renal stones from March 2017 to March 2019. After excluding eight patients with incomplete data, the remaining 52 patients were evaluated. Patients with symptomatic single or multiple stones of 6–8 mm in diameter or asymptomatic on ultrasound and kidney-ureter-bladder radiograph were eligible for inclusion. Small stones were treated by ESWL. The data were analyzed using the Statistical Packages for Social Sciences - version 25 (IBM Corporation). Results The mean age of the 52 patients was 34.5 ± 9.5 years. Forty-one (78.8%) patients were symptomatic, while 11 (21.2%) were asymptomatic. Forty-seven (90.4%) had single small renal stones, while four patients had two stones (7.7%) and only one patient had three stones (1.9%). Forty-five stones were successfully treated by ESWL, while 13 stones failed to respond. Conclusion ESWL is a useful tool for treating small renal calculi; it works either by fragmenting the stones or by acting as a pushing force. However, further large prospective studies are needed to corroborate the above conclusions.

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The role of extracorporeal shock wave lithotripsy in the future of stone management

Cited by 24 publications

References 32 publications

A clinical observational study of effectiveness of a solid coupling medium in extracorporeal shock wave lithotripsy

A clinical observational study of effectiveness of a solid coupling medium in extracorporeal shock wave lithotripsy

Newly designed solid coupling medium for reducing trapped air pockets during extracorporeal shock wave lithotripsy_ a phantom study

Fragmentation and propulsive effect of shock wave lithotripsy in treatment of small renal calculi

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