769 A PROSPECTIVE MULTIVARIATE ANALYSIS OF FACTORS PREDICTING STONE DISINTEGRATION BY EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY (SWL): VALUE OF HIGH RESOLUTION NONCONTRAST COMPUTED TOMOGRAPHY (NCCT)

769

A prospective multivariate analysis of factors predicting stone disintegration by extracorporeal shock wave lithotripsy (SWL): Value of high resolution noncontrast computed tomography (NCCT) El-Nahas A.1, El-Assmy A.1, Mansour O.2, Sheir K.1

770

Pancreatic injury as collateral damage following extracorporal shock wave lithotripsy for kidney and proximal ureter stones? Wendt-Nordahl G., Krombach P., Michel M.S., Alken P., Knoll T. University Hospital Mannheim, Urology, Mannheim, Germany

Urology and Nephrology Center, Urology, Mansoura, Egypt, Urology and Nephrology Center, Radiology, Mansoura, Egypt 1



2

Introduction & Objectives: To assess the value of NCCT in determination of possible predictors of renal stone disintegration by SWL. Material & Methods: The study included 120 consecutive patients (71 males and 49 females with mean age 42.6 years) with a solitary renal stone of 0.5-2.5 cm in length. NCCT was performed using multidetector row CT scanner at 120 KV and 240 mA; utilizing 1.25 mm collimation. Then bone window was used to measure stone attenuation values. SWL was performed with the electromagnetic DoLi S. Failure of disintegration was defined as no fragmentation of the stone after 3 sessions. The impact of patients’ sex, age, body mass index (BMI) and stones laterality, site, volume, mean attenuation value and skin to stone distance on disintegration were evaluated by univariate and multivariate statistical analyses. Results: Failure of disintegration was observed in 15 patients (12.5%). BMI and stone density >1000 HU were the significant independent predictors of failure (P= 0.04 and 0.02 respectively). The success rate of ESWL at 3 months was 87.5% (105 of 120 patients) as 90 patients were stone free and 15 had residual fragments <4mm. The only significant predictor of residual fragments was stone density (P<0.00).

Introduction & Objectives: Recently, the development of diabetes mellitus has been suggested to be a late complication of extracorporal shock wave lithotripsy (SWL) for treatment of kidney and proximal ureter stones. A possible injury of pancreatic tissue caused by the shock waves leading to an insufficiency of its endocrine function has been proposed to explain this effect. While alterations of exocrine pancreas function have been described, no data is available for islet cell function. We performed a study to determine if SWL for proximal ureteric or kidney stones cause an immediate measurable injury to the pancreas in humans. Material & Methods: The study was performed on 10 patients treated with SWL for proximal ureter or kidney stones (5 left, 5 right) using a third generation lithotripter (Modulith SLX, Storz Medical, Switzerland; maximal energy 0.69mJ/mm2; frequency 90Hz, 4,000 shocks). Exclusion criteria were any known pancreatic disease or pre-existing diabetes mellitus. To evaluate pancreatic tissue injury caused by the shock waves we determined blood parameters known to indicate pancreatic cell damage. Therefore, blood samples were taken before, after 2,000 shocks, immediately after, 1 hour after and 24 hours after treatment to determine the serum levels of amylase, lipase, insulin, glucose, c-peptide and glucagon. 10 patients treated by SWL for distal ureter stones were evaluated in the same way and served as control group. The study was approved by the appropriate ethics committee. Results: The two groups did not differ in age (range 18-71 years) while the mean stone size was smaller in the group treated for distal ureter stones (4.8±0.8 vs. 8.3±2.8mm). In both groups all measured parameters were within their normal laboratory limits at baseline. In the group treated for kidney and proximal ureter stones the values of c-peptide, known to indicate islet cell damage, were 0.99±0.33, 0.99±0.29, 0.98±0.30, 0.9±0.30 and 1.13±0.26nmol/l for before, while, after, one hour after and 24 hours after SWL, respectively. In the control group the values for c-peptide were not significantly different and also showed no increase. Levels of 1.23±0.69, 0.85±0.47, 0.97±0.54, 1.44±0.54 and 0.82±0.40nmol/l were found in the same time course. Neither the other parameters indicating damage of islet cells, insulin and glucagon nor those indicating damage of exocrine pancreas cells, amylase and lipase showed a significant change in the evaluated time course in both groups.

Conclusions: Obesity and increased stone density on NCCT are significant predictors of failure to fragment renal stones by SWL. An alternative treatment should be advised for obese patients with stone density >1000 HU.

Conclusions: Our study could not demonstrate an immediate effect on the serum levels of parameters indicating exocrine or endocrine pancreatic tissue damage caused by SWL for proximal ureter or kidney stones. The used third generation lithotripter therefore seems not to cause an injury to the pancreas in this setting.





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772

Shockwave Lithotripsy: Dose-Related Effects on Plasma Concentrations of Endothelin and Nitric oxide

Pediatric ESWL – single center experience with 100 patients

Hiroš M.1, Jasminko H.2, Selimović M.1, Sadović S.1, Spahović H.1, Junuzović D.1

Chaussy C., Bergsdorf T., Thüroff S.

Clinical Center University Sarajevo, Urology Clinic, Sarajevo, Bosnia and Herzegovina, 2Medical School, Institut for Physiology, Sarajevo, Bosnia and Herzegovina 1

Background and Purpose: ESWL is effective and minimal invasive treatment for the most urinary stones, but also with significant acute renal injuries and long-term complications.It is known that ESWL increased plasma levels of vasoactive substances, such as endothelin-1,potent vasoconstricting peptid, and nitric oxide(NO) with vasodilatation properties.This prospective study aimed to determine the influence of number of delivered SW-s and used kV on the plasma concentration of these both vasoactive substances. Patients & Methods: Total of 45 patients, both male and female, age ranged from 22-58years(average 42,7years) undergoing ESWL for renal stones, size5-10mm, were included in this study.Patients were divided in two groups:Group l (N=21) received 2000SW-s;kV 0-2(0,5kV on each 500SWs)Group ll (N=24) received 4000SW-s;kV 0-4(0,5kV on each 500SWs)Peripheral blood samples were analyzed for endothelin before, 1,3 and 5 days after ESWL and for NO before, immediately after, 30 and 60 minutes and 24 hours after ESWL. Results: Plasma endothelin-1 concentration were elevated after ESWL in both group of patients but significantly in patientes group ll. The same finding is with the NO. Plasma NO levels were higher than baseline in all assigned terms, but significantly in the patients group ll. Conclusions: This data support the idea that the number of delivered SW-s and used kV is in direct correlation with plasma concentration of endothelin1, the same as NO concentration.

Krankenhaus Germany

Muenchen-Harlaching,

Urological

Department,

Muenchen,

Introduction & Objectives: Extracorporeal shockwave lithotripsy plays a major role for the treatment of urolithiasis in children. ESWL-treatments of the last 18 years have been analyzed, to consider, whether ESWL is furthermore a competitive therapy option for pediatric urolithiasis. Material & Methods: 100 children (0 -16 years) have been treated by means of ESWL between 1988 and 2006. In total, 151 ESWL-treatments were performed with three different lithotripsy systems (electrohydraulic: DORNIER MFL 5000, electromagnetic: SIEMENS Multiline / SIEMENS Modularis). All relevant data have been recorded and analyzed in a MS Access database. Results: The average age was 8,2 years; 18 % of the children were recurrent stone formers, 15 % had additional renal / congenital anomalies. Stones were located three times more often in the kidney than ureter, 10 % of stones were bigger than 20 mm (av. size 10 mm). 64 % of patients were treated in general anesthesia, the remaining 36 % in analgosedation. The average treatment time was reduced with lithotripsy systems of newer generation (65 minutes / electrohydraulic versus 45 minutes / electromagnetic). Retreatment rate was 28 % with an average of 1,5 treatments / patient. 96 % of ureteric stone patients and 90 % of children with kidney stones without renal / congenital anomalies became completely stonefree. In presence of renal / congenital anomalies, 45 % of the patients were rendered stonefree; but all of these patients became symptom-free. Auxiliary procedures before ESWL were necessary in 20 % of patients, but only 2 % of the children needed additional endoscopic procedures after shockwave-therapy. Conclusions: Extracorporeal shockwave lithotripsy will stay the first choice therapy for pediatric urolithiasis in future because of high success-rate, low rate of complications and it’s non-invasiveness. Invasive procedures such as endoscopy are only indicated in case of big stone mass or accompanying anatomical anomalies.

Eur Urol Suppl 2007;6(2):215