Ultrasound guided Extracorporeal Shock Wave Lithotripsy (SONO ESWL) versus fluoroscopy guided ESWL in patients with radiopaque renal stones; A comparative randomized study

Abstract

Background Radiopaque stones in the upper urinary tract can often be visualized by both ultrasonography (US) and fluoroscopy (FS) during ESWL treatment. This prospective study was performed to compare the results of ESWL when both US and FS are possible and to evaluate efficacy and safety of ultrasound guided ESWL (SONO ESWL) in patients with radiopaque renal stone. The study was limited to renal calculi, since calculi in lower urinary tract may be difficult to visualize with ultrasonography. Objective To investigate whether the localization modality (u/s or fluoroscopy) affects clinical outcomes of ESWL or not. Patients and Methods Our study was conducted on 100 Patients with renal stones planned to have ESWL sessions attending urology outpatient clinic in Ain shams university hospitals and National Institute of Urology and Nephrology from February 2018 to January 2019 and divided into two equal groups; group A (ultrasound guided ESWL) and group B (fluoroscope guided ESWL). Results Our study revealed that the localization modality on ESWL (ultrasound or fluoroscopy) didn’t affect the clinical outcomes of ESWL. Conclusion Even in patients with radiopaque renal stones, ultrasound can be used to guide extracorporeal shock wave lithotripsy as effectively as fluoroscopy, without any risk of radiation.

Comparison of outcomes between USG guided ESWL Vs Fluoroscopy guided ESWL – Our institutional Experience

“…A possible explanation for this difference might be the real-time monitoring which led to a significantly higher number of repositioning in the US group. 10 In our study, the mean FS time was 101 s and the mean DAP was 3005 mGy/cm 2 /SWL session. Patients may undergo more than one SWL session for the same stone.…”