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IN-SITU ESWL FOR URETERIC STONES – STILL UP TO DATE?
1085
1086
EFFICACY OF EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY FOR LOWER CALYCEAL STONES
IMPACT OF AIR BUBBLES IN THE COUPLING MEDIUM IN EFFICACY OF EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY
Sarica K.1, Alkan E.2, Karatas O.F.2 . 1 Memorial Hospital, Urology, Istanbul, Turkey, 2Memorial Hospital, Urology, Istabul, Turkey
Jain A., Shah T.
INTRODUCTION & OBJECTIVES: To evaluate the efficacy of extracorporeal shock wave lithotripsy (ESWL) in lower calyceal stones with respect to stone size, number and that of inverse body position to facilitate stone passage.
INTRODUCTION & OBJECTIVES: Replacement of water-bath by a watercushion in the newer lithotriptors introduces an acoustic interface between the water-cushion and the patient’s skin. An ideal coupling agent is, therefore, required to prevent energy loss at this interface. We aim to evaluate the effect of air bubbles in the coupling media in determining efficacy of extracorporeal shock wave lithotripsy (ESWL) using an in vitro stone model.
MATERIAL & METHODS: In a prospective study between January 2003 and September 2005, 300 renal units with inferior calyceal stone(s) were treated with ESWL The indications for treatment were pain in 184 patients (62%), infection in 48 patients (16%), pain and infection in 68 patients (22%). While treatments were carried out under sedo-analgesia in adults (n: 266, 88.6%), children were treated under general anaesthesia (n:34, 11.4%). While solitary stones were grouped with respect to their size (< 5 mm: 94 patients, 5-10 mm:155 patients and > 10mm: 33 patients); 18 patients had multiple stones (6%). All patients were instructed to drink adequate fluid intake along with the body shaking in inverse position regularly after ESWL. Patients demonstrating residual fragments after 3 months following a satisfactory fragmentation were considered as failures. These cases patients were managed successfully by percutaneous nephrolithotomy. RESULTS: Patient age ranged from 8 to 62 years with a mean value of 36.8 years. At 3 months while the overall stone free rate was 29.6%, these rates were 43.6%, 26.4% and 21.2% in sub-group patients with respect to the stone size. 5 out of 18 patients with multiple calculi were stone free (28%) after 3 months following the last SWL Following the first training session in SWL unit, majority of the patients becoming stone free after SWL did apply the instructed body shaking in a special inverse body position. CONCLUSIONS: ESWL is the initial treatment of choice in selected patients with inferior calyceal stones. The stone burden along with the number of stones was found are the most important factors affecting the final outcome of SWL. Patients applying body shaking in the inverse position after adequate fluid intake seemed to exhibit better stone clearance more effectively in shorter period.
Bradford Teaching Hospitals N.H.S. Trust, Bradford Royal Infirmary, Department of Urology, Bradford, United Kingdom
MATERIAL & METHODS: Using a standardised in vitro model 32 artificial stones were randomly treated using either conventional ultrasound gel (high bubble content) with and without displacing visible bubbles, a thin ultrasound gel (TherasonicTM) or silicon oil (both with negligible bubbles). Each stone was treated with 200 shock waves @ 60 shocks/minute and 90 MPa power on Storz Modulith SLK® lithotriptor. The diameters and depth of crater created in each stone was measured with Vernier callipers by two blinded observers. In-vivo efficacy of the two ultrasound gels was also compared by means of the pain scores and stone fragmentation rates in 10 patients undergoing ESWL with both gels on separate occasions. RESULTS: Volume of the craters (cones) was significantly greater (P=0.03) with the Therasonic ™ gel (93.8± 50.7mm³) or silicon oil (101.4± 9.9mm³) than the standard ultrasound gel (56.6± 37.9mm³). But, it was greatest (P<0.001) with ultrasound gel without bubbles (163.8± 28.9mm³). Compared to standard ultrasound gel, patients treated with TherasonicTM gel reported significantly higher pain scores (3.2± 1.4 vs. 7.9± 1.2; P<0.001) and higher stone fragmentation rate (6/10 vs. 8/10) at similar power settings. CONCLUSIONS: The efficacy of ESWL using different coupling media is related to air bubbles in the gel and can be improved significantly by meticulously eliminating the bubbles from the coupling medium.
1087 LONG-TERM FOLLOW-UP OF EFFECT OF EXTRACORPOREAL SHOCK WAVE
1088 IN-SITU ESWL FOR URETERIC STONES – STILL UP TO DATE? Chaussy C., Bergsdorf T., Thueroff S.
Eassa W., Shier K., Dawaba M., El-Kenawey M. Urology and Nephrology Centre, Urology, Mansoura, Egypt INTRODUCTION & OBJECTIVES: Since 1980, ESWL has revolutionized the management of renal stones. However, the long-term consequences of ESWL induced renal damage remain unclear. Significant renal morphological damage may be caused by ESWL, Also, in 1987, two independent studies reported an excess incidence of hypertension of 8% in patients following ESWL after a 1 year follow-up. Controversy about these changes and its effects on renal function and blood pressure after ESWL has continued ever since. The aim of our study is to clarify the long-term effects of ESWL on renal function and blood pressure. MATERIAL & METHODS: A total of 100 patients (65 males and 35 females) with single radio-opaque renal stone ≤ 2 cm in length were treated by ESWL monotherapy and were followed up for extended period of 18 to 57 months (mean 43.6 ± 13.8). Their age ranged from 23 to 66 years (mean 47.9 ± 9.1). Split renal function determinations by nuclear scintigraphy using Technetium-99m mercaptoacetyltriglycine as well as blood pressure measurements using a calibrated mercury sphygmomanometer all were recorded on admission and on the last follow-up visit. Blood pressure was considered high if systolic blood pressure is consistently≥ 140 mmHg, or diastolic blood pressure is consistently≥ 90 mmHg, or the patient is receiving antihypertensive drugs. RESULTS: Treated side mean split renal function before ESWL was 49.7 ± 7.31 and by the end of the follow-up period it was 49.96 ± 8.68 with no statistical significance (P= 0.577). On the other hand, the mean split renal function of the other side was 50.36 ± 7.31 before SWL and became 50.04 ± 8.7 by the end of the follow-up period, also with no statistical significance (P= 0.484). Regarding blood pressure, among the 100 patients included in the study, 18 patients (18%) were hypertensive before ESWL and at the end of the follow-up period there were 22 patients (22%) suffering from hypertension. The mean diastolic blood pressure before ESWL was 80.2±6.2 mmHg, and by the end of the follow-up period it was 80.6±7.8 mmHg with no statistical significance (P= 0.674). On the other hand the mean systolic blood pressure mean was 121.2±9 mmHg before ESWL and was 121.5±10.2 mmHg by the end of the study also with no statistical significance (P= 0.748). CONCLUSIONS: ESWL is a safe procedure and it has no significant effect on renal function and blood pressure on the long run.
Eur Urol Suppl 2006;5(2):294
Krankenhaus Muenchen Harlaching, Department of Urology, Munich, Germany INTRODUCTION & OBJECTIVES: Recently, modern endoscopic options enter into competition with ESWL for the management of ureteric stones. ESWLtreatments of the last 10 years have been analysed, to reconsider the value of this treatment option. MATERIAL & METHODS: More than 10.000 ESWL-treatments were performed in our department with an electromagnetic SW-system (SIEMENS Multiline) since 06/1994, including 5.000 ESWL-sessions on ureteric stones. ESWL was done preferably in-situ with on-demand analgesia, according our BOOSTER-strategy (early retreatment, if fragments are >=3 mm). All relevant data have been recorded for statistical evaluation. RESULTS: Average treatment time was 50 minutes; 73% of patients received i.v. analgesia with alfentanil (Ø1,7mg). 98% of stones fragmented within one ESWLsession. Retreatment rate was depending on stone size, strategy and SW-energy. Stones <=10 mm needed in 18% additional ESWL; stones >10 mm in 38%. The high retreatment-rate of 38% in stones >10 mm, induced by BOOSTER-strategy was balanced by high stone free-rate of 91% after one week (98% after 3 months) with a low rate of complications (12% colics). Only 13, 5% of patients required auxiliary procedures (7, 6% before, 5, and 9% after ESWL). CONCLUSIONS: In-situ ESWL is an attractive treatment option for ureteric stones, regarding the high stone free-rate, the low rate of complications and the feasibility of i.v. analgesia. ESWL-treatment of ureteric stones >10 mm is associated with a higher retreatment rate; the use of endoscopic measures should be taken into consideration.
1086
EFFICACY OF EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY FOR LOWER CALYCEAL STONES
IMPACT OF AIR BUBBLES IN THE COUPLING MEDIUM IN EFFICACY OF EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY
Sarica K.1, Alkan E.2, Karatas O.F.2 . 1 Memorial Hospital, Urology, Istanbul, Turkey, 2Memorial Hospital, Urology, Istabul, Turkey
Jain A., Shah T.
INTRODUCTION & OBJECTIVES: To evaluate the efficacy of extracorporeal shock wave lithotripsy (ESWL) in lower calyceal stones with respect to stone size, number and that of inverse body position to facilitate stone passage.
INTRODUCTION & OBJECTIVES: Replacement of water-bath by a watercushion in the newer lithotriptors introduces an acoustic interface between the water-cushion and the patient’s skin. An ideal coupling agent is, therefore, required to prevent energy loss at this interface. We aim to evaluate the effect of air bubbles in the coupling media in determining efficacy of extracorporeal shock wave lithotripsy (ESWL) using an in vitro stone model.
MATERIAL & METHODS: In a prospective study between January 2003 and September 2005, 300 renal units with inferior calyceal stone(s) were treated with ESWL The indications for treatment were pain in 184 patients (62%), infection in 48 patients (16%), pain and infection in 68 patients (22%). While treatments were carried out under sedo-analgesia in adults (n: 266, 88.6%), children were treated under general anaesthesia (n:34, 11.4%). While solitary stones were grouped with respect to their size (< 5 mm: 94 patients, 5-10 mm:155 patients and > 10mm: 33 patients); 18 patients had multiple stones (6%). All patients were instructed to drink adequate fluid intake along with the body shaking in inverse position regularly after ESWL. Patients demonstrating residual fragments after 3 months following a satisfactory fragmentation were considered as failures. These cases patients were managed successfully by percutaneous nephrolithotomy. RESULTS: Patient age ranged from 8 to 62 years with a mean value of 36.8 years. At 3 months while the overall stone free rate was 29.6%, these rates were 43.6%, 26.4% and 21.2% in sub-group patients with respect to the stone size. 5 out of 18 patients with multiple calculi were stone free (28%) after 3 months following the last SWL Following the first training session in SWL unit, majority of the patients becoming stone free after SWL did apply the instructed body shaking in a special inverse body position. CONCLUSIONS: ESWL is the initial treatment of choice in selected patients with inferior calyceal stones. The stone burden along with the number of stones was found are the most important factors affecting the final outcome of SWL. Patients applying body shaking in the inverse position after adequate fluid intake seemed to exhibit better stone clearance more effectively in shorter period.
Bradford Teaching Hospitals N.H.S. Trust, Bradford Royal Infirmary, Department of Urology, Bradford, United Kingdom
MATERIAL & METHODS: Using a standardised in vitro model 32 artificial stones were randomly treated using either conventional ultrasound gel (high bubble content) with and without displacing visible bubbles, a thin ultrasound gel (TherasonicTM) or silicon oil (both with negligible bubbles). Each stone was treated with 200 shock waves @ 60 shocks/minute and 90 MPa power on Storz Modulith SLK® lithotriptor. The diameters and depth of crater created in each stone was measured with Vernier callipers by two blinded observers. In-vivo efficacy of the two ultrasound gels was also compared by means of the pain scores and stone fragmentation rates in 10 patients undergoing ESWL with both gels on separate occasions. RESULTS: Volume of the craters (cones) was significantly greater (P=0.03) with the Therasonic ™ gel (93.8± 50.7mm³) or silicon oil (101.4± 9.9mm³) than the standard ultrasound gel (56.6± 37.9mm³). But, it was greatest (P<0.001) with ultrasound gel without bubbles (163.8± 28.9mm³). Compared to standard ultrasound gel, patients treated with TherasonicTM gel reported significantly higher pain scores (3.2± 1.4 vs. 7.9± 1.2; P<0.001) and higher stone fragmentation rate (6/10 vs. 8/10) at similar power settings. CONCLUSIONS: The efficacy of ESWL using different coupling media is related to air bubbles in the gel and can be improved significantly by meticulously eliminating the bubbles from the coupling medium.
1087 LONG-TERM FOLLOW-UP OF EFFECT OF EXTRACORPOREAL SHOCK WAVE
1088 IN-SITU ESWL FOR URETERIC STONES – STILL UP TO DATE? Chaussy C., Bergsdorf T., Thueroff S.
Eassa W., Shier K., Dawaba M., El-Kenawey M. Urology and Nephrology Centre, Urology, Mansoura, Egypt INTRODUCTION & OBJECTIVES: Since 1980, ESWL has revolutionized the management of renal stones. However, the long-term consequences of ESWL induced renal damage remain unclear. Significant renal morphological damage may be caused by ESWL, Also, in 1987, two independent studies reported an excess incidence of hypertension of 8% in patients following ESWL after a 1 year follow-up. Controversy about these changes and its effects on renal function and blood pressure after ESWL has continued ever since. The aim of our study is to clarify the long-term effects of ESWL on renal function and blood pressure. MATERIAL & METHODS: A total of 100 patients (65 males and 35 females) with single radio-opaque renal stone ≤ 2 cm in length were treated by ESWL monotherapy and were followed up for extended period of 18 to 57 months (mean 43.6 ± 13.8). Their age ranged from 23 to 66 years (mean 47.9 ± 9.1). Split renal function determinations by nuclear scintigraphy using Technetium-99m mercaptoacetyltriglycine as well as blood pressure measurements using a calibrated mercury sphygmomanometer all were recorded on admission and on the last follow-up visit. Blood pressure was considered high if systolic blood pressure is consistently≥ 140 mmHg, or diastolic blood pressure is consistently≥ 90 mmHg, or the patient is receiving antihypertensive drugs. RESULTS: Treated side mean split renal function before ESWL was 49.7 ± 7.31 and by the end of the follow-up period it was 49.96 ± 8.68 with no statistical significance (P= 0.577). On the other hand, the mean split renal function of the other side was 50.36 ± 7.31 before SWL and became 50.04 ± 8.7 by the end of the follow-up period, also with no statistical significance (P= 0.484). Regarding blood pressure, among the 100 patients included in the study, 18 patients (18%) were hypertensive before ESWL and at the end of the follow-up period there were 22 patients (22%) suffering from hypertension. The mean diastolic blood pressure before ESWL was 80.2±6.2 mmHg, and by the end of the follow-up period it was 80.6±7.8 mmHg with no statistical significance (P= 0.674). On the other hand the mean systolic blood pressure mean was 121.2±9 mmHg before ESWL and was 121.5±10.2 mmHg by the end of the study also with no statistical significance (P= 0.748). CONCLUSIONS: ESWL is a safe procedure and it has no significant effect on renal function and blood pressure on the long run.
Eur Urol Suppl 2006;5(2):294
Krankenhaus Muenchen Harlaching, Department of Urology, Munich, Germany INTRODUCTION & OBJECTIVES: Recently, modern endoscopic options enter into competition with ESWL for the management of ureteric stones. ESWLtreatments of the last 10 years have been analysed, to reconsider the value of this treatment option. MATERIAL & METHODS: More than 10.000 ESWL-treatments were performed in our department with an electromagnetic SW-system (SIEMENS Multiline) since 06/1994, including 5.000 ESWL-sessions on ureteric stones. ESWL was done preferably in-situ with on-demand analgesia, according our BOOSTER-strategy (early retreatment, if fragments are >=3 mm). All relevant data have been recorded for statistical evaluation. RESULTS: Average treatment time was 50 minutes; 73% of patients received i.v. analgesia with alfentanil (Ø1,7mg). 98% of stones fragmented within one ESWLsession. Retreatment rate was depending on stone size, strategy and SW-energy. Stones <=10 mm needed in 18% additional ESWL; stones >10 mm in 38%. The high retreatment-rate of 38% in stones >10 mm, induced by BOOSTER-strategy was balanced by high stone free-rate of 91% after one week (98% after 3 months) with a low rate of complications (12% colics). Only 13, 5% of patients required auxiliary procedures (7, 6% before, 5, and 9% after ESWL). CONCLUSIONS: In-situ ESWL is an attractive treatment option for ureteric stones, regarding the high stone free-rate, the low rate of complications and the feasibility of i.v. analgesia. ESWL-treatment of ureteric stones >10 mm is associated with a higher retreatment rate; the use of endoscopic measures should be taken into consideration.