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Comparative analysis of renal calculi treatment via different extracorporeal shock wave lithotripsy (ESWL) pathways

  • Urology - Original Paper
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Abstract

Objective

To compare the efficacy and safety of Extracorporeal Shock Wave Lithotripsy (ESWL) for treating renal calculi under different shock wave pathways.

Methods

This study involved a prospective analysis of clinical data obtained from 264 eligible patients with renal stones treated at the Urology Department of Shanxi Bethune Hospital between January 2021 and June 2023. Among these patients, 125 underwent ESWL via the dorsal shock wave pathway (Group A), while 139 patients underwent ESWL via the ipsilateral clavicular midline shock wave pathway (Group B). Preoperatively, all patients underwent non-contrast abdominal CT (NCCT) scans to assess stone count, diameter, CT values, and Skin-to-Stone Distance (SSD). Intraoperatively, ultrasonography was utilized to remeasure SSD and monitor stone fragmentation continuously. The ESWL procedure employed a standardized intermittent stepwise energy escalation technique until treatment completion. Various metrics, including intraoperative Visual Analog Scale (VAS) pain scores, number of shocks, total shock wave energy, stone-free rate (SFR) at 4 weeks post-operation, and postoperative complication rates, were recorded and subjected to statistical analysis.

Results

There were no statistically significant differences between the two groups regarding gender, age, BMI, stone count, stone diameter, stone CT values, intraoperative VAS pain scores, and postoperative complication rates (P>0.05). Preoperative SSD was significantly higher in Group B than in Group A (P<0.05), but there were no significant differences in intraoperative SSD between the groups (P>0.05). Group B showed significantly lower total shock wave energy and number of shocks compared to Group A (P<0.05). The stone-free rate (SFR) after 4 weeks did not exhibit significant differences between the groups (P>0.05). However, when the stone diameter was ≥1.3 cm, the SFR at 4 weeks post-operation in Group B was significantly higher than in Group A (P<0.05).

Conclusion

ESWL emerges as a safe and efficacious approach for treating renal calculi. Our findings suggest that utilizing the ipsilateral clavicular midline shock wave pathway in ESWL necessitates less shock wave energy and enhances efficiency, particularly in cases with larger stone burdens.

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Data availabiity

The data that support the findings of this study are available on request from the corresponding author.

References

  1. Stamatelou K, Goldfarb DS (2023) Epidemiology of kidney stones. Healthc (Basel) 11(3):424. https://doi.org/10.3390/healthcare11030424. (Published 2023 Feb 2.)

    Article  Google Scholar 

  2. Alić J, Heljić J, Hadžiosmanović O et al (2022) The efficiency of extracorporeal shock wave lithotripsy (ESWL) in the treatment of distal ureteral stones: an unjustly forgotten option? Cureus 14(9):e28671. https://doi.org/10.7759/cureus.28671

    Article  PubMed  PubMed Central  Google Scholar 

  3. Robinson SN, Crane VS, Jones DG, Cochran JS, Williams OB (1987) Principles and application of extracorporeal shock wave lithotripsy. Am J Hosp Pharm 44(4):805–810

    CAS  PubMed  Google Scholar 

  4. Klein J, Netsch C, Sievert KD et al (2018) Extrakorporale Stoßwellenlithotripsie [Extracorporeal shock wave lithotripsy]. Urologe A 57(4):463–473. https://doi.org/10.1007/s00120-018-0611-9

    Article  CAS  PubMed  Google Scholar 

  5. Soliman MG, Gameel T, El-Tatawy H, El-Abd AS (2020) Extracorporeal shock wave lithotripsy for distal ureteric stones: which is the ideal approach? Int Urol Nephrol 52(12):2269–2274. https://doi.org/10.1007/s11255-020-02572-1

    Article  PubMed  Google Scholar 

  6. Kamel M, Salem EA, Maarouf A, Abdalla M, Ragab A, Shahin AM (2015) Supine transgluteal vs prone position in extracorporeal shock wave lithotripsy of distal ureteric stones. Urology 85(1):51–54. https://doi.org/10.1016/j.urology.2014.08.033

    Article  PubMed  Google Scholar 

  7. Zomorrodi A, Elahian A, Ghorbani N, Tavoosi A (2007) Comparison of the effect of body position, prone or supine, on the result of extracorpreal shock wave lithotripsy in patients with stones in the proximal ureter. Saudi J Kidney Dis Transpl 18(2):200–205

    PubMed  Google Scholar 

  8. Göktaş S, Peşkircioğlu L, Tahmaz L, Kibar Y, Erduran D, Harmankaya C (2000) Is there significance of the choice of prone versus supine position in the treatment of proximal ureter stones with extracorporeal shock wave lithotripsy? Eur Urol 38(5):618–620. https://doi.org/10.1159/000020341

    Article  PubMed  Google Scholar 

  9. Abou-Farha M, El-Abd A, Gameel T, Eltatawy H, Nagla S (2022) Efficacy of extracorporeal shockwave lithotripsy, with modified position of the machine head in the treatment of lower calyceal stones in obese patients. Urol Ann 14(1):81–84. https://doi.org/10.4103/UA.UA_176_20

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Merigot de Treigny O, Bou Nasr E, Almont T et al (2015) The cumulated stone diameter a limited tool for stone burden estimation. Urology 86(3):477–481. https://doi.org/10.1016/j.urology.2015.06.018

    Article  PubMed  Google Scholar 

  11. Lee SK, Kim TB, Ko KP et al (2016) The gachon university ureteral narrowing score: a comprehensive standardized system for predicting necessity of ureteral dilatation to treat proximal ureteral calculi [published correction appears in Investig Clin Urol. 2016 Sep;57(5):372]. Investig Clin Urol 57(4):280–285. https://doi.org/10.4111/icu.2016.57.4.280

    Article  PubMed  PubMed Central  Google Scholar 

  12. Mariotto S, de Prati AC, Cavalieri E, Amelio E, Marlinghaus E, Suzuki H (2009) Extracorporeal shock wave therapy in inflammatory diseases: molecular mechanism that triggers anti-inflammatory action. Curr Med Chem 16(19):2366–2372. https://doi.org/10.2174/092986709788682119

    Article  CAS  PubMed  Google Scholar 

  13. Farrokhi MR, Lotfi M, Masoudi MS, Gholami M (2016) Effects of methylene blue on postoperative low-back pain and functional outcomes after lumbar open discectomy: a triple-blind, randomized placebo-controlled trial. J Neurosurg Spine 24(1):7–15. https://doi.org/10.3171/2015.3.SPINE141172

    Article  PubMed  Google Scholar 

  14. Esuvaranathan K, Tan EC, Tung KH, Foo KT (1991) Stones in horseshoe kidneys: results of treatment by extracorporeal shock wave lithotripsy and endourology. J Urol 146(5):1213–1215. https://doi.org/10.1016/s0022-5347(17)38048-5

    Article  CAS  PubMed  Google Scholar 

  15. Zeng G, Zhong W, Chaussy CG et al (2023) International alliance of urolithiasis guideline on shockwave lithotripsy. Eur Urol Focus 9(3):513–523. https://doi.org/10.1016/j.euf.2022.11.013

    Article  PubMed  Google Scholar 

  16. Bahílo Mateu P, Budía Alba A, Liatsikos E et al (2017) Is extracorporeal shock wave lithotripsy a current treatment for urolithiasis? A systematic review. ¿Es la litotricia extracorpórea por ondas de choque en la actualidad un tratamiento vigente para el tratamiento de la litiasis urinaria? Revis sistemática. Actas Urol Esp. 41(7):426–434. https://doi.org/10.1016/j.acuro.2017.01.011

    Article  Google Scholar 

  17. Assimos D, Krambeck A, Miller NL et al (2016) Surgical management of stones: american urological association/endourological society guideline. PART I. J Urol 196(4):1153–1160. https://doi.org/10.1016/j.juro.2016.05.090

    Article  PubMed  Google Scholar 

  18. Volkmer BG, Petschl S, Chaussy C, Köhrmann KU, Haupt G, Jocham D (2009) Okonomische aspekte der harnsteintherapie ergebnisse des konsensusmeetings der deutschen gesellschaft für stosswellenlithotrypsie (DGSWL) [economic aspects of the treatment of urinary stones. Results of the german society for shock wave lithotripsy]. Urologe A 48(10):1214–1221. https://doi.org/10.1007/s00120-009-2045-x

    Article  CAS  PubMed  Google Scholar 

  19. Martino P, Galosi AB, Bitelli M et al (2014) Practical recommendations for performing ultrasound scanning in the urological and andrological fields. Arch Ital Urol Androl 86(1):56–78. https://doi.org/10.4081/aiua.2014.1.56. (Published 2014 Mar 28)

    Article  PubMed  Google Scholar 

  20. Badawy AA, Saleem MD, Abolyosr A et al (2012) Extracorporeal shock wave lithotripsy as first line treatment for urinary tract stones in children: outcome of 500 cases. Int Urol Nephrol 44(3):661–666. https://doi.org/10.1007/s11255-012-0133-0

    Article  PubMed  Google Scholar 

  21. Yang C, Li S, Cui Y (2017) Comparison of YAG laser lithotripsy and extracorporeal shock wave lithotripsy in treatment of ureteral calculi: a meta-analysis. Urol Int 98(4):373–381. https://doi.org/10.1159/000452610

    Article  PubMed  Google Scholar 

  22. Jing S, Liu B, Lan W et al (2018) Modified Mechanical percussion for upper urinary tract stone fragments after extracorporeal shock wave lithotripsy: a prospective multicenter randomized controlled trial. Urology 116:47–54. https://doi.org/10.1016/j.urology.2017.12.024

    Article  PubMed  Google Scholar 

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Funding

This work is supported by Scientific and Technological lnnovation Proqrams of Higher Education Institutions in Shanxi, STIP (Item number:2022L164).

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Authors and Affiliations

  1. Department of Urology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China

    Shuai Yuan

  2. Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China

    Shuai Yuan

  3. Department of Pharmacology, Saveetha College of Pharmacy, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, 601205, India

    Ramaiyan Velmurugan & S. Prasanna Bharathi

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  1. Shuai Yuan
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  2. Ramaiyan Velmurugan
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  3. S. Prasanna Bharathi
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Correspondence to Shuai Yuan.

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Ethical approval

The study was approved by the Ethics Committee of Shanxi Bethune Hospital (Approval Number: SBQLL-2020-032). Written informed consent was obtained from each participant.

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Yuan, S., Velmurugan, R. & Bharathi, S.P. Comparative analysis of renal calculi treatment via different extracorporeal shock wave lithotripsy (ESWL) pathways. Int Urol Nephrol (2024). https://doi.org/10.1007/s11255-024-04025-5

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