1
|
Singh N, Agarwal S, Sarpal R. Prospective Evaluation of Extracorporeal Shockwave Lithotripsy in Renal and Upper Ureteric Stone Treatment: Clinical Assessment and Results. Cureus 2024; 16:e61102. [PMID: 38800778 PMCID: PMC11128184 DOI: 10.7759/cureus.61102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2024] [Indexed: 05/29/2024] Open
Abstract
INTRODUCTION Extracorporeal shockwave lithotripsy (ESWL) is a widely accepted non-invasive treatment for renal and upper ureteric stones smaller than 2 cm due to its safety and efficacy. Despite advancements in minimally invasive techniques, extracorporeal shockwave lithotripsy remains an important modality. AIMS AND OBJECTIVE This prospective observational study aimed to evaluate the outcomes of ESWL in managing renal and upper ureteric stones measuring less than 2 cm in terms of stone clearance. MATERIAL AND METHODS In a study conducted at a university-affiliated tertiary care hospital, 119 patients with renal and upper ureteric stones underwent extracorporeal shockwave lithotripsy over a 12-month period. Data on patient demographics, stone characteristics, treatment procedures, and complications were collected. Follow-up assessments were performed at two-week intervals for up to two months post-treatment. RESULTS The mean age of patients was 39.78 years, with a mean stone size of 1.2 cm. Right kidney stones were more prevalent (61.3% [n=76]). Complications included fever (19.3% [n=23]), gross haematuria (24.3% [n=29]), and steinstrasse (21.8% [n=26]). The success rate of extracorporeal shockwave lithotripsy was 81.5% (n=97), with 18.5% (n=22) of patients requiring surgical intervention due to incomplete fragmentation or residual fragments >4 mm. Stone size and density played significant roles in treatment success. CONCLUSION Despite advancements in minimally invasive techniques, ESWL retains its significance as a noninvasive and effective treatment option for renal and upper ureteric stones smaller than 2 cm. Its success depends on various factors, including the stone site, size, and composition. ESWL offers advantages such as minimal morbidity, shorter hospital stays, and better patient compliance. Complications such as steinstrasse are manageable with conservative measures or ancillary procedures. While ESWL may be losing ground in some cases, its noninvasive nature and favourable outcomes make it a valuable option in the armamentarium for stone management.
Collapse
Affiliation(s)
- Nimisha Singh
- General Surgery, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, IND
- Plastic and Reconstructive Surgery, Jawaharlal Nehru Medical College (JNMC) Aligarh Muslim University (AMU), Aligarh, IND
| | - Shikhar Agarwal
- Urology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, IND
| | - Rajeev Sarpal
- Urology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, IND
| |
Collapse
|
2
|
Patel R, Desai C, Acharya R, Raveshia D, Shah S, Panesar H, Patel N, Singh R. Five historical innovations that have shaped modern urological surgery. J Perioper Pract 2024; 34:154-163. [PMID: 38149615 DOI: 10.1177/17504589231214388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
Throughout history, many innovations have contributed to the development of modern urological surgery, improving patient outcomes and expanding the range of treatment options available to patients. This article explores five key historical innovations that have shaped modern urological surgery: External shockwave lithotripsy, transurethral resection of prostate, cystoscope, perioperative prostate-specific antigen and robotic surgery. The selection of innovations for inclusion in this article was meticulously determined through expert consensus and an extensive literature review. We will review the development, impact and significance of each innovation, highlighting their contributions to the field of urological surgery and their ongoing relevance in contemporary and perioperative practice.
Collapse
Affiliation(s)
- Ravi Patel
- Department of Trauma and Orthopaedics, Shrewsbury and Telford Trust, The Princess Royal Hospital, Apley Castle, Telford, UK
- Department of Trauma and Orthopaedics, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK
| | - Chaitya Desai
- Department of Urology, Walsall Manor Hospital, Walsall Healthcare NHS Trust, Walsall, UK
| | - Radhika Acharya
- Department of Intensive Care, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Dimit Raveshia
- Department of General Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Saumil Shah
- Department of Otolaryngology, The Princess Royal Hospital, Apley Castle, Telford, UK
| | - Harrypal Panesar
- Department of Otolaryngology, The Princess Royal Hospital, Apley Castle, Telford, UK
| | | | - Rohit Singh
- Department of Trauma and Orthopaedics, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK
| |
Collapse
|
3
|
Houlihan I, Kang B, De S, Krishna V. Photonic Lithotripsy: Near-Infrared Laser Activated Nanomaterials for Kidney Stone Comminution. NANO LETTERS 2023; 23:5981-5988. [PMID: 37358929 PMCID: PMC10348310 DOI: 10.1021/acs.nanolett.3c01166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/20/2023] [Indexed: 06/28/2023]
Abstract
Near-infrared activated nanomaterials have been reported for biomedical applications ranging from photothermal tumor destruction to biofilm eradication and energy-gated drug delivery. However, the focus so far has been on soft tissues, and little is known about energy delivery to hard tissues, which have thousand-fold higher mechanical strength. We present photonic lithotripsy with carbon and gold nanomaterials for fragmenting human kidney stones. The efficacy of stone comminution is dependent on the size and photonic properties of the nanomaterials. Surface restructuring and decomposition of calcium oxalate to calcium carbonate support the contribution of photothermal energy to stone failure. Photonic lithotripsy has several advantages over current laser lithotripsy, including low operating power, noncontact laser operation (distances of at least 10 mm), and ability to break all common stones. Our observations can inspire the development of rapid, minimally invasive techniques for kidney stone treatment and extrapolate to other hard tissues such as enamel and bone.
Collapse
Affiliation(s)
- Ian Houlihan
- Biomedical
Engineering, Lerner Research Institute,
Cleveland Clinic, Cleveland Ohio 44195, United States
| | - Benjamin Kang
- Biomedical
Engineering, Lerner Research Institute,
Cleveland Clinic, Cleveland Ohio 44195, United States
| | - Smita De
- Urology, Glickman
Urology and Kidney Institute, Cleveland Clinic, Cleveland Ohio 44195, United States
- Urology,
Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland Ohio 44106, United States
| | - Vijay Krishna
- Biomedical
Engineering, Lerner Research Institute,
Cleveland Clinic, Cleveland Ohio 44195, United States
- Biomedical
Engineering, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland Ohio 44106, United States
| |
Collapse
|
4
|
Sabhan AH, Alwan AAA. The feasibility of ultrasound-guided mini-percutaneous nephrolithotomy for ESWL-resistant lower calyx renal stones of up to two centimeters: a single center experience. J Med Life 2023; 16:520-525. [PMID: 37305831 PMCID: PMC10251387 DOI: 10.25122/jml-2023-0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 03/07/2023] [Indexed: 06/13/2023] Open
Abstract
Lower pole renal stones present a significant challenge in urologic practice due to difficulty in accessing the calyx and eliminating fragments. Management options for these stones include watchful waiting for asymptomatic stones, extracorporeal shock wave lithotripsy (ESWL), ureterorenoscopy (URS), and percutaneous nephrolithotomy (PCNL). Mini-PCNL is a newer modification of conventional PCNL. The study aimed to assess the feasibility of mini-PCNL in treating lower pole renal stones equal to or less than 20mm that were not responsive to ESWL therapy. We included 42 patients (24 male and 18 female) with a mean age of 40±2.3 who underwent mini-PCNL at a single urology center between June 2020 and July 2022 and assessed operative and postoperative outcomes. The mean total operative time was 47±3.11 minutes, ranging from 40 to 60 minutes. The stone-free rate was 90%, and the overall complication rate was 26%, which included minor bleeding (5%), hematuria (7%), pain (12%), and fever (2%). The mean hospital stay was 80±3.34 hours (3-4 days). Our findings suggest that mini-PCNL is an effective treatment option for lower pole renal stones that are not responsive to ESWL therapy. The immediate stone-free rate was high, with minimum non-serious complications.
Collapse
Affiliation(s)
- Ali Hadi Sabhan
- Department of Surgery, College of Medicine, University of Al-Qadisiyah, Al-Diwaneyah, Iraq
| | | |
Collapse
|
5
|
Wigley CH, Janssen TJ, Mosahebi A. Shock Wave Therapy in Plastic Surgery: A Review of the Current Indications. Aesthet Surg J 2023; 43:370-386. [PMID: 36226364 DOI: 10.1093/asj/sjac262] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/29/2022] [Accepted: 10/04/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Extracorporeal shock wave therapy (ESWT) represents a promising, non-invasive management strategy supporting the treatment of a variety of conditions related to plastic surgery. OBJECTIVES This literature review aimed to give a systematic overview of current applications, its mechanism of action, and its potential to provide tangible therapies in plastic surgery. METHODS The databases PubMed (National Institute of Health, Bethesda, MD), Embase (via Ovid [Elsevier, Amsterdam, the Netherlands]), and the Cochrane Library (Cochrane, London, UK) were searched for articles published up to June 1, 2021. Clinical studies of any design including ESWT in the context of plastic surgery were included. Two reviewers extracted data, and 46 articles were analyzed after application of the inclusion and exclusion criteria. RESULTS Forty-six included studies (n = 1496) were categorized into the following broad themes: cellulite/body contouring/skin rejuvenation, burns/scar treatment, diabetic foot ulcers/chronic wound, and future perspectives of ESWT. Overall, applications of ESWT were heterogenous, and the majority of studies reported effectiveness of ESWT as an alternative treatment technique. Flawed methodology and differences in technical standards limit the outcome and conclusion of this review. CONCLUSIONS There is yet insufficient evidence to support the effectiveness of any specific intervention included in this review; however, all included studies reported improvements in key outcomes. Where reported, ESWT displayed a good safety profile with no serious adverse events. Further research is needed to provide more evidence to delineate the indications of ESWT in plastic surgery.
Collapse
Affiliation(s)
- Catrin H Wigley
- Department of Plastic Surgery, Royal Free Hospital, University College London, London, UK
| | - Tim J Janssen
- Department of Plastic Surgery, Royal Free Hospital, University College London, London, UK
| | | |
Collapse
|
6
|
Duarsa GWK, Putra CN, Ivandi K, Wiryadana KA, Tirtayasa PMW, Pribadi F. Comparison of ultrasonography and fluoroscopy as guides for extracorporeal shock wave lithotripsy in nephrolithiasis patients: a systematic review. MEDICAL JOURNAL OF INDONESIA 2022. [DOI: 10.13181/mji.oa.226140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Extracorporeal shock wave lithotripsy (ESWL) is one of the first-line treatment options for patients with renal stones <2 cm. The large variability in ESWL results may be due to the stone visualization methods using ultrasonography (USG), fluoroscopy, or a combination of both. This study aimed to review the efficacy and safety of the stone visualization method on the stone-free rate (SFR) and postprocedural complications in nephrolithiasis patients.
METHODS We conducted a systematic review of USG and fluoroscopy on ESWL until July 2022, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We assessed and collected summaries of the screened papers. The main outcomes assessed were the SFR of renal stones and postprocedural complications between imaging modalities.
RESULTS A total of 7 studies were assessed, including 6 comparative assessments of USG versus fluoroscopy and 1 comparative assessment of USG and fluoroscopy versus fluoroscopy only. Although all studies showed that USG had a higher SFR than fluoroscopy, only 1 study showed a significant difference (p = 0.008). Additionally, superior results were obtained using a combination of USG and fluoroscopy compared with fluoroscopy only. Most studies agreed that USG was not inferior in post-ESWL complication results.
CONCLUSIONS Overall, the use of USG is comparable to fluoroscopy because it does not provide a significant difference in the SFR and complications. In most cases, USG is preferred because of the absence of radiation. The combination of fluoroscopy and USG also provides more promising results than a single modality.
Collapse
|
7
|
Somiya S, Koterazawa S, Ito K, Haitani T, Yamada H, Kanno T. Extremely slow, half-number shockwave lithotripsy for ureteral stones. Urolithiasis 2022; 50:635-641. [PMID: 35969268 DOI: 10.1007/s00240-022-01351-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/05/2022] [Indexed: 10/15/2022]
Abstract
To elucidate and compare the efficacy and safety of the reduced (30 shocks/min with 1200 shocks/session) and standard protocols (60 shocks/min with 2400 shocks/session) of extracorporeal shockwave lithotripsy (SWL) for ureteral stones treatment. This study was a retrospective review of 2410 SWL procedures with reduced or standard protocols (groups R and S) in 1106 patients for ureteral stones between March 2014 and March 2021. The primary outcome was treatment success, defined as the absence of residual fragments on ultrasonography and plain radiography within 30 and 90 days. A multivariate logistic regression and propensity score matching analysis evaluated the association between the reduced protocol and treatment success. This study included 311 and 544 patients in the reduced (R) and standard (S) protocol groups, respectively. The patient's characteristics were comparable, excluding the lithotripter machine. No significant difference was observed between groups R and S in treatment success rates within 30 (63.3 vs. 65.8%, p = 0.50) and 90 days (88.7 vs. 91.5%, p = 0.18). The multivariate analysis indicated no significant association between reduced protocol and treatment success within 30 and 90 days (p = 0.44 and p = 0.68, respectively). Propensity score matching showed no significant difference in the treatment success rates within 30 and 90 days. The Extremely slow, half number protocol outcomes are comparable to those of the standard protocol for treating ureteral stones.
Collapse
Affiliation(s)
- Shinya Somiya
- Department of Urology, Ijinkai Takeda General Hospital, 28-1 Ishida Moriminami-cho, Fushimi-ku, Kyoto, 601-1495, Japan
| | - Shigeki Koterazawa
- Department of Urology, Ijinkai Takeda General Hospital, 28-1 Ishida Moriminami-cho, Fushimi-ku, Kyoto, 601-1495, Japan
| | - Katsuhiro Ito
- Department of Urology, Ijinkai Takeda General Hospital, 28-1 Ishida Moriminami-cho, Fushimi-ku, Kyoto, 601-1495, Japan
| | - Takao Haitani
- Department of Urology, Ijinkai Takeda General Hospital, 28-1 Ishida Moriminami-cho, Fushimi-ku, Kyoto, 601-1495, Japan
| | - Hitoshi Yamada
- Department of Urology, Ijinkai Takeda General Hospital, 28-1 Ishida Moriminami-cho, Fushimi-ku, Kyoto, 601-1495, Japan
| | - Toru Kanno
- Department of Urology, Ijinkai Takeda General Hospital, 28-1 Ishida Moriminami-cho, Fushimi-ku, Kyoto, 601-1495, Japan.
| |
Collapse
|
8
|
Translational Applications of Extracorporeal Shock Waves in Dental Medicine: A Literature Review. Biomedicines 2022; 10:biomedicines10040902. [PMID: 35453651 PMCID: PMC9030023 DOI: 10.3390/biomedicines10040902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/04/2022] [Accepted: 04/12/2022] [Indexed: 12/04/2022] Open
Abstract
Extracorporeal shock wave therapy (ESWT) has been studied and applied extensively in medical practice for various applications including musculoskeletal, dermal, vascular, and cardiac indications. These indications have emerged from primary ESWT use in treating urolithiasis and cholelithiasis. Likewise, dental medicine has had its share of utilizing ESWT in various investigations. This review aimed to provide an up-to-date summary of ESWT use in preclinical and clinical dental medicine. There is growing interest in ESWT use stemming from its non-invasiveness, low cost, and safe qualities in addition to its proven regenerative biostimulating aspects. Targeted tissue and parameters of ESWT delivery continue to be an integral part of successful ESWT treatment to attain the clinical value of the anticipated dose’s effect.
Collapse
|
9
|
Colakerol A, Suzan S, Temiz MZ, Gonultas S, Aykan S, Ozsoy S, Kucuk SH, Yuruk E, Kandırali E, Semercioz A. Tissue neutrophil elastase contributes to extracorporeal shock wave lithotripsy-induced kidney damage and the neutrophil elastase inhibitor, sivelestat, attenuates kidney damage with gratifying immunohistopathological and biochemical findings: an experimental study. Urolithiasis 2022; 50:103-112. [PMID: 34778918 DOI: 10.1007/s00240-021-01287-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/20/2021] [Indexed: 02/07/2023]
Abstract
Although the efficacy of extracorporeal shock wave lithotripsy (ESWL) has been well established within the literature, debate continues on the safety of the procedure while focusing on cellular injury and its long-term consequences. Here, we describe the role of neutrophil elastase (NE) in ESWL-related rat kidney damage and investigate the protective effects of sivelestat, an inhibitor of NE, during the early and late phases. Four groups including control, ESWL alone, ESWL with sivelestat 50 mg/kg and ESWL with treatment of 100 mg/kg, each consisting of ten rats were created. Biochemical parameters of kidney function and damage and immunohistopathological findings were compared in the early (72 h after ESWL) and late (1 week after ESWL) periods between the groups. During the early period, serum and urine creatinine levels and urine kidney injury molecule-1 (KIM-1) levels and the KIM-1/creatinine ratio increased in rats treated with ESWL compared to the control group. Furthermore, increased tissue inflammation, ductal dilatation and hemorrhage, and glomerular, tubular, and interstitial damage with increased NE staining were also detected in the ESWL treatment group. During the late phase, although urine KIM-1 levels remained stable at high levels, other parameters showed significant improvements. On the other hand, the administration of sivelestat 50 mg/kg decreased serum creatinine and urine KIM-1 and KIM-1/creatinine levels significantly in rats treated with ESWL, during the early and late periods. Significant decreases in tissue inflammation, tubular, and interstitial tissue damage were also observed during the early period. In conclusion, ESWL-related kidney tissue damage occurs primarily during the early period, and NE is involved in this process. On the other hand, the NE inhibitor sivelestat attenuated this ESWL-induced kidney damage.
Collapse
Affiliation(s)
- Aykut Colakerol
- Department of Urology, Bagcilar Training and Research Hospital, Merkez Mah., Dr. Sadik Ahmet Cad., Bagcilar, Istanbul, Turkey
| | - Serhat Suzan
- Department of Urology, Bagcilar Training and Research Hospital, Merkez Mah., Dr. Sadik Ahmet Cad., Bagcilar, Istanbul, Turkey
| | - Mustafa Zafer Temiz
- Department of Urology, Bagcilar Training and Research Hospital, Merkez Mah., Dr. Sadik Ahmet Cad., Bagcilar, Istanbul, Turkey
| | - Serkan Gonultas
- Department of Urology, Bagcilar Training and Research Hospital, Merkez Mah., Dr. Sadik Ahmet Cad., Bagcilar, Istanbul, Turkey
| | - Serdar Aykan
- Department of Urology, Bagcilar Training and Research Hospital, Merkez Mah., Dr. Sadik Ahmet Cad., Bagcilar, Istanbul, Turkey
| | - Sule Ozsoy
- Department of Pathology, Bagcilar Training and Research Hospital, Bagcilar, Istanbul, Turkey
| | - Suat Hayri Kucuk
- Department of Biochemistry, Bagcilar Training and Research Hospital, Bagcilar, Istanbul, Turkey
| | - Emrah Yuruk
- Department of Urology, Bagcilar Training and Research Hospital, Merkez Mah., Dr. Sadik Ahmet Cad., Bagcilar, Istanbul, Turkey
| | - Engin Kandırali
- Department of Urology, Bagcilar Training and Research Hospital, Merkez Mah., Dr. Sadik Ahmet Cad., Bagcilar, Istanbul, Turkey
| | - Atilla Semercioz
- Department of Urology, Bagcilar Training and Research Hospital, Merkez Mah., Dr. Sadik Ahmet Cad., Bagcilar, Istanbul, Turkey.
| |
Collapse
|
10
|
Ignorance Led Fatal Complication of Shockwave Lithotripsy. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02677-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
11
|
Natal Alvarez F, Martín Martín S, Torrecilla García-Ripoll JR, Díaz Romero JM, Calleja Escudero J, Bedate Núñez M, Soto Rodríguez JL, Lara Pérez FM, Ruano Mayo A, Zamora Horcajada A, Cuéllar Martín LA, Muñoz Moreno MF, Cortiñas González JR. Endourological treatment for lumbar ureteral stones. What are the benefits of flexible ureterorenoscopy? Actas Urol Esp 2021; 45:569-575. [PMID: 34690104 DOI: 10.1016/j.acuroe.2021.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 06/27/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION AND OBJECTIVES Currently, there are no established criteria regarding treatment for lumbar ureteral stones. The objective of this work is to present our results in the endourological treatment of this pathology, analyzing the variables associated with the use of the flexible ureterorenoscope. MATERIAL AND METHODS Retrospective review of 103 patients who underwent retrograde URS with semi-rigid or flexible ureterorenoscope. Proximal location: L2-L3. Medial location: L4-L5. Semirigid URS was the initial treatment, with conversion to flexible URS when it was required to complete the procedure. Success was defined as absence of residual fragments (6 weeks). Demographic, surgical, immediate postoperative variables, and those related to the stone, were analyzed. Their correlation with the use of the flexible ureterorenoscope was evaluated. RESULTS Mean age: 57.2 years (SD 15.6); there were 73 men (70.9%). Stone size: 8 mm (range 4-30; IQR 4.5). Proximal location: 58 (56.3%). Previous JJ: 44.7%. Previous nephrostomy: 10.7%. Semirigid URS with conversion to flexible URS: 51 (49.5%). Impacted stones: 28.2%. Intraoperative complications: 2 (1.9%). Postoperative JJ: 84.5%. Immediate postoperative complications: 23 (22.3%) (Clavien-Dindo I-II: 91.3%). Postoperative ureteral stricture: 5.8%. Success: 88.4%. Residual fragments: 12 (11.7%). Spontaneous passage: 6 (50%). Greater performance of flexible URS in proximal ureteral stones (p = 0.001) of more than 11 mm (p = 0.02) in univariate analysis, and in proximal stones [OR 3.5; 1.5-8.1; p = 0.004] in multivariate analysis. CONCLUSIONS Endourological treatment obtained a high success rate in our sample. Size greater than 11 mm and proximal ureteral location in univariate and multivariate analysis, respectively, behaved as predictors of flexible URS.
Collapse
Affiliation(s)
- F Natal Alvarez
- Servicio de Urología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
| | - S Martín Martín
- Servicio de Urología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - J M Díaz Romero
- Servicio de Urología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - J Calleja Escudero
- Servicio de Urología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - M Bedate Núñez
- Servicio de Urología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - J L Soto Rodríguez
- Servicio de Urología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - F M Lara Pérez
- Servicio de Urología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - A Ruano Mayo
- Servicio de Urología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - A Zamora Horcajada
- Servicio de Urología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - L A Cuéllar Martín
- Servicio de Urología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - M F Muñoz Moreno
- Unidad de Apoyo a la Investigación, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - J R Cortiñas González
- Servicio de Urología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| |
Collapse
|
12
|
Natal Alvarez F, Martín Martín S, Torrecilla García-Ripoll JR, Díaz Romero JM, Calleja Escudero J, Bedate Núñez M, Soto Rodríguez JL, Lara Pérez FM, Ruano Mayo A, Zamora Horcajada A, Cuéllar Martín LA, Muñoz Moreno MF, Cortiñas González JR. Endourological treatment for lumbar ureteral stones. What are the benefits of flexible ureterorenoscopy? Actas Urol Esp 2021; 45:S0210-4806(21)00126-1. [PMID: 34344584 DOI: 10.1016/j.acuro.2021.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 05/19/2021] [Accepted: 06/27/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION AND OBJECTIVES Currently, there are no established criteria regarding treatment for lumbar ureteral stones. The objective of this work is to present our results in the endourological treatment of this pathology, analyzing the variables associated with the use of the flexible ureterorenoscope. MATERIAL AND METHODS Retrospective review of 103 patients who underwent retrograde URS with semi-rigid or flexible ureterorenoscope. Proximal location: L2-L3. Medial location: L4-L5. Semirigid URS was the initial treatment, with conversion to flexible URS when it was required to complete the procedure. Success was defined as absence of residual fragments (6 weeks). Demographic, surgical, immediate postoperative variables, and those related to the stone, were analyzed. Their correlation with the use of the flexible ureterorenoscope was evaluated. RESULTS Mean age: 57.2 years (SD 15.6); there were 73 men (70.9%). Stone size: 8mm (range 4-30; IQR 4.5). Proximal location: 58 (56.3%). Previous JJ: 44.7%. Previous nephrostomy: 10.7%. Semirigid URS with conversion to flexible URS: 51 (49.5%). Impacted stones: 28.2%. Intraoperative complications: 2 (1.9%). Postoperative JJ: 84.5%. Immediate postoperative complications: 23 (22.3%) (Clavien-Dindo I-II: 91.3%). Postoperative ureteral stricture: 5.8%. Success: 88.4%. Residual fragments: 12 (11.7%). Spontaneous passage: 6 (50%). Greater performance of flexible URS in proximal ureteral stones (P=0.001) of more than 11mm (P=0.02) in univariate analysis, and in proximal stones [OR 3.5; 1.5-8.1; P=0.004] in multivariate analysis. CONCLUSIONS Endourological treatment obtained a high success rate in our sample. Size greater than 11mm and proximal ureteral location in univariate and multivariate analysis, respectively, behaved as predictors of flexible URS.
Collapse
Affiliation(s)
- F Natal Alvarez
- Servicio de Urología, Hospital Clínico Universitario de Valladolid, Valladolid, España.
| | - S Martín Martín
- Servicio de Urología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | | | - J M Díaz Romero
- Servicio de Urología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - J Calleja Escudero
- Servicio de Urología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - M Bedate Núñez
- Servicio de Urología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - J L Soto Rodríguez
- Servicio de Urología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - F M Lara Pérez
- Servicio de Urología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - A Ruano Mayo
- Servicio de Urología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - A Zamora Horcajada
- Servicio de Urología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - L A Cuéllar Martín
- Servicio de Urología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - M F Muñoz Moreno
- Unidad de Apoyo a la Investigación, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - J R Cortiñas González
- Servicio de Urología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| |
Collapse
|
13
|
Chen Z, Zeng DD, Seltzer RGN, Hamilton BD. Automated Generation of Personalized Shock Wave Lithotripsy Protocols: Treatment Planning Using Deep Learning. JMIR Med Inform 2021; 9:e24721. [PMID: 33973862 PMCID: PMC8150413 DOI: 10.2196/24721] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/31/2020] [Accepted: 04/11/2021] [Indexed: 12/23/2022] Open
Abstract
Background Though shock wave lithotripsy (SWL) has developed to be one of the most common treatment approaches for nephrolithiasis in recent decades, its treatment planning is often a trial-and-error process based on physicians’ subjective judgement. Physicians’ inexperience with this modality can lead to low-quality treatment and unnecessary risks to patients. Objective To improve the quality and consistency of shock wave lithotripsy treatment, we aimed to develop a deep learning model for generating the next treatment step by previous steps and preoperative patient characteristics and to produce personalized SWL treatment plans in a step-by-step protocol based on the deep learning model. Methods We developed a deep learning model to generate the optimal power level, shock rate, and number of shocks in the next step, given previous treatment steps encoded by long short-term memory neural networks and preoperative patient characteristics. We constructed a next-step data set (N=8583) from top practices of renal SWL treatments recorded in the International Stone Registry. Then, we trained the deep learning model and baseline models (linear regression, logistic regression, random forest, and support vector machine) with 90% of the samples and validated them with the remaining samples. Results The deep learning models for generating the next treatment steps outperformed the baseline models (accuracy = 98.8%, F1 = 98.0% for power levels; accuracy = 98.1%, F1 = 96.0% for shock rates; root mean squared error = 207, mean absolute error = 121 for numbers of shocks). The hypothesis testing showed no significant difference between steps generated by our model and the top practices (P=.480 for power levels; P=.782 for shock rates; P=.727 for numbers of shocks). Conclusions The high performance of our deep learning approach shows its treatment planning capability on par with top physicians. To the best of our knowledge, our framework is the first effort to implement automated planning of SWL treatment via deep learning. It is a promising technique in assisting treatment planning and physician training at low cost.
Collapse
Affiliation(s)
- Zhipeng Chen
- Shenzhen Artificial Intelligence and Data Science Institute (Longhua), Longhua, Shenzhen, China
| | - Daniel D Zeng
- The State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Ryan G N Seltzer
- Translational Analytics and Statistics, Tucson, AZ, United States
| | - Blake D Hamilton
- School of Medicine, University of Utah, Salt Lake City, UT, United States
| |
Collapse
|
14
|
Fawzy AM, Abdelkafy AA, Elahawy MM, Abdelgawad AH, Hasanein MGS, Abdelgawad AT, Magdi Ali M, Fathelbab TK, Galal EM. Contralateral Coupling During Extracorporeal Shockwave Lithotripsy for Stones in Ectopic Kidney: Is It Feasible? J Endourol 2021; 35:1090-1096. [PMID: 33544033 DOI: 10.1089/end.2020.1064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Extracorporeal shockwave lithotripsy (SWL) results in a lower stone-free rate (SFR) for ectopic kidneys when using the standard technique, directing the shock wave from the same side of the stone; however, this may not be the optimal approach when the ectopic kidney is located more medial and anterior than the normally positioned kidney. Thus, contralateral coupling where waves come from the opposite direction may result in a better outcome. We tested the feasibility and outcome of contralateral coupling during SWL for stone in ectopic kidney. Materials and Methods: We prospectively recruited 20 patients with simple renal ectopia, who presented with renal stones that were amenable for SWL in the period between 2014 and 2018 at outpatient clinic of urology department, Minia University. Patients received SWL in Private Nile SWL Center were included to benefit from the ability of the electromagnetic SWL lithotripter. We did SWL in a supine position, and then contralateral coupling was performed from the opposite side of the affected kidney, rather than using the standard ipsilateral coupling approach. The SFR and various pre-, intra-, and postprocedural SWL variables were assessed, including stone characteristics, body habitus, shock wave numbers, and auxiliary measures. Count and percentages were calculated. Results: The mean stone radius was 14.7 mm with a mean S.T.O.N.E. (size, topography, obstructions, number of stones, and evaluation of HUs) of 9.6 points. Effective SWL was achieved in 80% of cases, 65% of them were stone free with effective single SWL session in 56% of cases. Hematuria, infection, and obstruction occurred in 50%, 20%, and 15% cases, respectively. One case required ureteral stent insertion. Conclusions: SWL applied through contralateral coupling is feasible, with comparable safety profile to the standard ipsilateral approach. Better SFR was achieved with the contralateral approach, in fewer sessions. However, the recruitment of more cases is necessary.
Collapse
Affiliation(s)
- Ahmed M Fawzy
- Faculty of Medicine, Minia Urology and Nephrology University Hospital, Minia University, Minia, Egypt.,Nile SWL Center, Minia, Egypt
| | - Amr Abdelhameed Abdelkafy
- Faculty of Medicine, Minia Urology and Nephrology University Hospital, Minia University, Minia, Egypt
| | - Mamdouh Mohamed Elahawy
- Faculty of Medicine, Minia Urology and Nephrology University Hospital, Minia University, Minia, Egypt
| | - Ahmed Hakeem Abdelgawad
- Faculty of Medicine, Minia Urology and Nephrology University Hospital, Minia University, Minia, Egypt
| | - Mohammed G S Hasanein
- Faculty of Medicine, Minia Urology and Nephrology University Hospital, Minia University, Minia, Egypt.,Nile SWL Center, Minia, Egypt
| | - Asmaa Taha Abdelgawad
- Faculty of Medicine, Minia Urology and Nephrology University Hospital, Minia University, Minia, Egypt
| | - Mostafa Magdi Ali
- Department of Urology, School of Medicine, Minia University, Minia, Egypt
| | - Tarek Khalaf Fathelbab
- Faculty of Medicine, Minia Urology and Nephrology University Hospital, Minia University, Minia, Egypt.,Nile SWL Center, Minia, Egypt
| | - Ehab Mohamed Galal
- Faculty of Medicine, Minia Urology and Nephrology University Hospital, Minia University, Minia, Egypt
| |
Collapse
|
15
|
ÇAKMAK V, TÜRKÇÜER İ, ÖZEN M. EXTRACORPOREAL SHOCK-WAVE LITHOTRIPSY'S UNUSUAL COMPLICATION: RETROPERITONEAL GAS. JOURNAL OF EMERGENCY MEDICINE CASE REPORTS 2020. [DOI: 10.33706/jemcr.818755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
16
|
Abstract
Chronic kidney disease is a global health care burden, yet clinically-proven treatments are limited. Low-intensity shockwave, which utilizes ≈10% of the energy levels used in clinically indicated shockwave lithotripsy, is a promising technique to ameliorate ischemia and regenerate tissues. It has been demonstrated to improve healing in tissues such as bone, muscle, myocardium, and kidney via several mechanisms, particularly through promoting neovascularization. Low-intensity shockwave stimulates mechanoreceptors located primarily in endothelial and proximal tubular cells and subsequently upregulates vascular endothelial growth factors. This, in turn, promotes angiogenesis and ameliorates renal hypoxia, inflammation, and fibrosis, and ultimately preserves renal function. Furthermore, low-intensity shockwave can stimulate release of homing factors to attract endothelial progenitor or stem cells into injured kidneys for tissue repair. These effects may be beneficial in several kidney disease models, including renal artery stenosis, diabetic kidney disease, and various chronic kidney diseases, although most studies reported to date have been performed in animal models. Because of its low energy intensity, the procedure is relatively tolerable and safe, yet, more clinical studies are needed to establish its efficacy beyond currently existing strategies. Therefore, low-intensity shockwave therapy emerges as an alternative therapeutic approach that may offer a promising noninvasive intervention for treating renal diseases. Registration- URL: https://www.clinicaltrials.gov; Unique identifier: NCT02515461; NCT03602807; and NCT03445247.
Collapse
Affiliation(s)
- Nattawat Klomjit
- From the Division of Nephrology and Hypertension (N.K., L.O.L.), Mayo Clinic, Rochester, MN
| | - Amir Lerman
- Department of Cardiovascular Disease (A.L.), Mayo Clinic, Rochester, MN
| | - Lilach O Lerman
- From the Division of Nephrology and Hypertension (N.K., L.O.L.), Mayo Clinic, Rochester, MN
| |
Collapse
|
17
|
Gadelkareem RA, Abdelsalam YM, Ibraheim MA, Reda A, Sayed MAB, El-Azab AS. Is Percutaneous Nephrolithotomy the Modality of Choice Versus Extracorporeal Shockwave Lithotripsy for a 20 to 30 mm Single Renal Pelvic Stone with ≤1000 Hounsfield Unit in Adults? A Prospective Randomized Comparative Study. J Endourol 2020; 34:1141-1148. [PMID: 32668990 DOI: 10.1089/end.2020.0288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Objectives: To compare the efficacy, complications, and costs of percutaneous nephrolithotomy (PNL) and extracorporeal shock wave lithotripsy (SWL) in the treatment of a 20 to 30 mm single renal pelvic stone with a density ≤1000 HU. Patients and Methods: Eighty patients were prospectively randomized to receive either PNL or SWL during May 2017 to April 2019. The relevant demographic and clinical characteristics were compared. Results: The mean age in the PNL and SWL groups was 43.25 ± 15.16 and 44.18 ± 12.08 years, respectively. The mean stone sizes were 25.2 ± 3.9 and 24.6 ± 2.3 mm, respectively. The stone-free rate (SFR) was significantly different after the primary procedures (92.5% vs 37.5%, respectively; p < 0.04), but it was comparable after 3 months (97.5% vs 90%, respectively; p = 0.723), with a higher rate of auxiliary procedures after SWL (p = 0.017). On multivariate analysis, stone density was the only significant variable for the SFR in the SWL group (p = 0.004). Complications occurred in 27.5% and 22.5% of cases, respectively (p = 0.796). The mean costs of SWL (650.23 ± 424.74 United States Dollars [US$]) were significantly lower than those of PNL (1137.65 ± 224.43 US$; p < 0.0001). Conclusions: The SFRs for PNL and SWL were not significantly different after 3 months in the treatment of a 20 to 30 mm single renal pelvic stone with ≤1000 HU, although PNL provided a significantly higher rate after its primary procedure. SWL was significantly less costly, but it mandated a significantly higher number of auxiliary procedures than PNL.
Collapse
Affiliation(s)
- Rabea Ahmed Gadelkareem
- Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt
| | | | | | - Ahmed Reda
- Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt
| | | | - Ahmed Shehata El-Azab
- Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt
| |
Collapse
|
18
|
Saunders R. Laparotomy for duodenal obstruction, caused by a renal haematoma after extracorporeal shockwave lithotripsy. JOURNAL OF CLINICAL UROLOGY 2020. [DOI: 10.1177/2051415820958958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Extracorporeal shockwave lithotripsy is a widely used, acceptable and common first line treatment for non-conservatively managed renal and ureteric stone disease. Although considered a relatively safe non invasive treatment for renal and ureteric stones, can carry with it significant associated morbiditiy especially in high risk patients, such as those who are anticoagulated. Renal haematomas are not an uncommon finding after extracorporeal shockwave lithotripsy, however, fewer than 1% of patients presenting with a symptomatic renal haematoma require intervention in the form of urgent embolisation under interventional radiology, or emergency nephrectomy. Rare cases of splenic and hepatic haematomas have been reported and rarer still cases of gastro-intestinal perforation following extracorporeal shockwave lithotripsy. We report a case with a significant renal haematoma needing emergency embolisation of the renal artery, and subsequent development of duodenal obstruction from direct haematoma compression requiring a laparotomy and intended duodenal jejunal bypass. Level of evidence: 5
Collapse
|
19
|
|