451 CONFRONTING PERINEPHRIC HEMATOMAS COMPLICATING SHOCKWAVE LITHOTRIPSY (SWL)

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Early effects of extracorporeal shock wave lithotripsy on renal function: Assessed by nuclear scintigraphy Salem S., Mehrsai A., Baradaran N., Pourmand G. Tehran University of Medical Sciences, Urology Research Center, Dept. of Urology, Tehran, Iran Introduction & Objectives: The safety of extracorporeal shock wave lithotripsy (SWL) has been a matter of debate in recent years. Clues to more local paranchymal contusions such as hematuria or hematoma occurring in a remarkable number of patients, merits the need to further assessments. The aim of our study was to evaluate the effect of SWL on the kidney function, using glomerular filtration rate (GFR) and time to peak clearance (T max), as predictors of renal function via radionuclide imaging. Material & Methods: A total of 15 patients (9 male, 6 female) with a documented single, lower calyx stone in one kidney, underwent renal scintigraphy using 99m-technetium diethylene-tiamine-pentaacetic acid, 24 hours before, 1-3 hours after and two weeks following the SWL. GFR and T max were measured in ipsilateral (R1) and contralateral (R2) kidneys, the region where the stone was located (region of interest, R3) and also the same region in the contralateral kidney (R4).

WITHDRAWN

Results: GFR levels in R1 and R2 decreased 1-3 hours after SWL and returned to slightly higher levels in two weeks period after the procedure. The same pattern was observed in R3 and R4; however, two weeks later, the GFR level was fairly lower than pre-SWL. GFR was also observed to be lower in R3 compared to R4.Moreover, T max decreased immediately after SWL but returned to pre-SWL levels two weeks later except for R3 where a significant decline was maintained two weeks after the procedure. Conclusions: Patients with renal stones had a temporary decrement of GFR following SWL in both kidneys, which returned to the normal levels within two weeks. T max alteration also indicated an early increase in blood flow in both kidneys which could be explained by the systemic inflammatory response resulting in vasodilatation of renal vessels. The torment is more prominent in R3.



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Confronting perinephric hematomas complicating shockwave lithotripsy (SWL) Cooper A., Chachashvilli A., Sabler I.M., Lang E., Siegel Y. Assaf Harofeh Medical Center, Dept. of Urology, Zerifin, Israel Introduction & Objectives: We report a strategy implemented to reduce Post SWL perinephric/subcapsular hematomas. Material & Methods: During 01.2004-06.2008 we treated 1818 patients with SWL for kidney and ureteral stones. All treatments were provided with the Siemens modularis lithostar, under sedation. We recorded prospectively all patients with perinephric hematomas. From 01.2004 till 12.2004 we employed an initial SWL Protocol-A: 2000 shocks at a frequency of 90Hz and energy level of 4 (Siemens scale) after 100 shockwaves. We then embarked on a prospective randomized study to evaluate if an increment energy strategy would decrease perinephric hematomas. The protocol studied From 01.2005 – 07.2005 (Protocol B) was constructed as follows: first set of 600 shockwaves at energy of 1.7, the next set of 600 shocks at 2.2 and the last 800 at maximal energy of 2.7. From there on till 06.2008 Protocol B was adopted.

WITHDRAWN

Results: Between 01.2004 – 07.2005 (Period a) 458 patients (including prospective study patients- 45) were treated with Protocol A and 11 perinephric hematomas cases occurred, of which, 2 within the study population (incidence: overall – 2%, Study population - 4.4%), Non of protocol B patients (N=46) suffered from perinephric hematomas. The study was discontinued and protocol B was implemented from then onwards. During 08.2005 – 06.2008 (Period b), 1314 patients were treated and 6 patients suffered from perinephric hematomas, incidence of 0.45% (P=0.006). Conclusions: The SWL protocol at our center had been altered as a result of our experience. The rate of perinephric hematomas was reduced significantly by lowering energy level and applying incremental intensity.

Eur Urol Suppl 2009;8(4):233