IS THERE ANY IMPROVEMENT IN EFFICACY OF EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY THERAPY FOR TREATING RENAL STONES WITH INVENT OF NEW SHOCKWAVE MACHINES?
AbstractBackground: Renal stone disease is a very common medical problem in general population. As with invent of newer therapeutic modalities, ESWL is already losing its popularity. But we believe it as an effective way of treating renal stones. This study was conducted to evaluate any improvement in success rate of ESWL therapy for treating renal stones with latest shockwave lithotripsy machines. Methods: Study conducted from June 2016 until November 2017 in Alkhor hospital, Hamad Medical Corporation, Qatar. All patients undergoing ESWL for renal stones in mentioned period were included. Total 197 patients underwent ESWL using newer machines. Factors already studied to affect the success rate like stone size, location, consistency (measured by Hounsfield units on CT), presence of stent were taken in consideration. After a period of 3 months either complete stone clearance or stone fragments smaller than 4 mm were considered as a treatment success. These results were compared to the results from literature. Results: Patients were followed until 3 months after treatment. 170 patients (86.29%) had complete stone clearance. Eleven patients (5.58%) had residual stone less than 4 mm, thus achieving an overall success of 181 patients (91.88%). 42 patients (21.32%) needed repeat session of ESWL with a maximum number of 3 sessions. 16 patient’s (8.12%) required auxiliary procedures like flexible ureteroscopy. Post-ESWL complications were recorded in 12 patients (6.09%). Success rate was affected mainly by stone size with negligible effect of stone location. Presence of stent affected the number of sessions but has no impact on stone clearance. Conclusion: Although the stone size and to a negligible extent, the stone location and presence of stent may affect the stone clearance, nevertheless a significant improvement in success rate has been observed by use of new shockwave lithotripsy machines.Keywords: Kidney; extracorporeal shockwave lithotripsy; stone
Chaussy C, Brendal W, Schmiedt E. Extracorporeally induced destruction of kidney stones by shockwaves. Lancet 1980;2(8207):1265–8.
Panchal PG, Krishnaswamy M, Dabhade DM, Swami OC. Study of factors predicting clinical outcomes of extracorporeal shock wave lithotripsy in Indian patients with upper urinary tract calculi. Int Surg J 2018;5(4):1532–7.
Rassweiler JJ, Renner C, Chaussy C, Thuroff S. Treatment of renal stones by extracorporeal shockwave lithotripsy: an update. Eur Urol 2001;39(2):187–99.
Neilen TK, Jensen JB. Efficacy of commercialised extracorporeal shock wave lithotripsy service: a review of 589 renal stones. BMC Urol 2017;17(1):59.
Pareek G, Armenakas NA, Fracchia JA. Hounsfield units on computerized tomography predict stone-free rates after extracorporeal shock wave lithotripsy. J Urol 2003;169(5):1679–81.
Abdel-Khalek M, Sheir KZ, Mokhtar AA, Earky I, Kenawy M, Bazeed M. Prediction of success rate after extracorporeal shock-wave lithotripsy of renal stones. A multivariate analysis model. Scand J Urol Nephrol 2004;38(2):161–7.
Steinberg PL, Williams S, Hoenig DM. Adjuncts to Improve Outcomes of Shock Wave Lithotripsy. Curr Urol Rep 2010;11(2):93–7.
Gerber R, Studer UE, Danuser H. Is newer always better? A comparative study of 3 lithotriptor generations. J Urol 2005;173(6):2013–6.
Augustin H. Prediction of stone-free rate after ESWL. Eur Urol 2007:52(2):318–20.
Al-Ansari A, As-Sadiq K, Al-Said S, Younis N, Jaleel OA, Shokeir AA. Prognostic factors of success of extracorporeal shock wave lithotripsy (ESWL) in the treatment of renal stones. Int Urol Nephrol 2006;38(1):63–7.
Al-Marhoon MS, Shareef O, Al-Habsi IS, Al Balushi AS, Mathew J, Venkiteswaran KP. Extracorporeal Shock-wave Lithotripsy Success Rate and Complications: Initial Experience at Sultan Qaboos University Hospital. Oman Med J 2013;28(4):255–9.
Tan YM, Yip SK, Chong TW, Wong MY, Cheng C, Foo KT. Clinical experience and results of ESWL treatment for 3,093 urinary calculi with the Storz Modulith SL 20 lithotripter at the Singapore general hospital. Scand J Urol Nephrol 2002;36(5):363–7.
El-Nahas AR, El-Assmy AM, Madbouly K, Sheir KZ. Predictors of clinical significance of residual fragments after extracorporeal shockwave lithotripsy for renal stones. J Endourol 2016;20(11):870–4.
Obek C, Onal B, Kantay K, Kalkan M, Yalcin V, Oner A, et al. The efficacy of extracorporeal shock wave lithotripsy for isolated lower pole calculi compared with isolated middle and upper caliceal calculi. J Urol 2001;166(6):2081–4.
Sorensen CM, Chandhoke PS. Is lower pole caliceal anatomy predictive of extracorporeal shock wave lithotripsy success for primary lower pole kidney stones? J Urol 2002;168(6):2377–82.
Christian C, Thorsten B. The preferred treatment for upper tract stones is extracorporeal shock wave lithotripsy (ESWL) or ureteroscopic: pro ESWL. Urology 2009;74(2):259–62.
Gadalla KA. Success Rate of Stone Recurrence after Extracorporeal Shockwave Lithotripsy and Factors affecting Success of Treatment among Egyptian Patients. Med Sur Urol 2016;5(3):1000171.
Inoue H, Kamphausen T, Bajanowski T, Trübner K. Massive retroperitoneal haemorrhage after extracorporeal shock wave lithotripsy (ESWL). Int J Legal Med 2011;125(1):75–9.
Skolarikos A, Alivizatos G, de la Rosette J. Extracorporeal shock wave lithotripsy 25 years later: complications