Optimal Shock Wave Rate for Shock Wave Lithotripsy in Urolithiasis Treatment: A Prospective Randomized Study

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Abstract

Purpose

We aimed to compare the effects of a fast shock wave rate (120 shocks per minute) and a slow shock wave rate (60 shocks per minute) on the shock wave lithotripsy (SWL) success rate, patient's pain tolerance, and complications.

Materials and Methods

A total of 165 patients with radiopaque renal pelvis or upper ureter stones were included in the study. Patients were classified by use of a random numbers table. Group I (81 patients) received 60 shock waves per minute and group II (84 patients) received 120 shock waves per minute. For each session, the success rate, pain measurement, and complication rate were recorded.

Results

No statistically significant differences were observed in the patients according to age, sex, body mass index, stone size, side, location, total energy level, or number of shocks. The success rate of the first session was greater in group I than in group II (p=0.002). The visual analogue pain scale was lower in group I than in group II (p=0.001). The total number of sessions to success and the complication rate were significantly lower in group I than in group II (p=0.001).

Conclusions

The success rate of SWL is dependent on the interval between the shock waves. If the time between the shock waves is short, the rate of lithotripsy success decreases, and the pain measurement score and complications increase. We conclude slow SWL is the optimal shock wave rate.

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Most cited references 15

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Extracorporeal shock wave lithotripsy 25 years later: complications and their prevention.

Andreas Skolarikos, Jean de La Coussaye, Gerasimos Alivizatos (2006)

We review the pathophysiology and possible prevention measures of complications after extracorporeal shock wave lithotripsy (ESWL). A literature search was performed with the Medline database on ESWL between 1980 and 2004. ESWL application has been intuitively connected to complications. These are related mostly to residual stone fragments, infections, and effects on tissues such as urinary, gastrointestinal, cardiovascular, genital, and reproductive systems. Recognition of ESWL limitations, use of alternative therapies, correction of pre-existing renal or systemic disease, treatment of urinary tract infection, use of prophylactic antibiotics, and improvement of ESWL efficacy are the most important measures of prevention. Decrease of shock wave number, rate and energy, use of two shock-wave tubes simultaneously, and delivery of two shock waves at carefully timed close intervals improve ESWL efficacy and safety. ESWL is a safe method to treat stones when proper indications are followed. The need for well-designed prospective randomised trials on aetiology and prevention of its complications arises through the literature review.

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Report of the United States cooperative study of extracorporeal shock wave lithotripsy.

G W Drach, S Dretler, W Fair … (1986)

Extracorporeal shock wave lithotripsy effectively fragments urinary calculi in the upper urinary tract and upper ureter. These fragments pass completely by 3 months in 77.4 per cent of the patients with single stones. Risk of obstruction, increased postoperative pain, need for additional urological operations and retained fragments are low for stones less than 1 cm. in size. As the number of stones treated or single stone size increases above 1 cm. the risk for these factors increases. Adjunctive urological surgical management is required in 9 per cent of the patients preoperatively and 8 per cent postoperatively. Only 0.6 per cent of the patients require some type of open operation to resolve the stone problems after extracorporeal shock wave lithotripsy. Hemorrhage, obstruction by fragments, severe pain and urinary infection all constitute known complications and require careful urological management of all patients. Hospitalization averages 2 days after treatment and patients usually return to work within a few days after they are discharged from the hospital.

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Stone fragmentation during shock wave lithotripsy is improved by slowing the shock wave rate: studies with a new animal model.

Ryan F. Paterson, David Lifshitz, James Lingeman … (2002)

The current trend toward ungated shock wave lithotripsy means that more patients are being treated with shock waves delivered at a rapid rate (120 shock waves per minute or greater). However, no benefit of an increased shock wave rate has been shown and in vitro studies indicate that slowing the shock wave rate actually improves stone fragmentation. We tested the effect of the shock wave rate on stone comminution in a new animal model. Gypsum model stones were inserted via upper pole percutaneous access into the lower pole calix of the kidneys of female pigs weighing approximately 100 pounds. Shock wave lithotripsy was performed (400 shock waves uninterrupted at 20 kV. and 30 or 120 shock waves per minute) 2 hours later using an unmodified HM3 lithotriptor (Dornier Medical Systems, Marietta, Georgia). After en bloc excision of the urinary tract stone fragments were collected and sieved through 2 mm. mesh. The particles were weighed and surface area was determined. Stones treated at 30 shock waves per minute broke more completely than stones treated at 120 shock waves per minute. The percent of fragments greater than 2 mm. was significantly higher for stones treated at the fast rate of 120 versus the slow rate of 30 shock waves per minute (mean +/- SEM 81% +/- 14% versus 45% +/- 12%, p <0.005). When stone fragmentation was expressed as the percent increase in fragment surface area, significantly greater fragmentation occurred at the slower than at the more rapid rate (327% +/- 63% versus 135% +/- 136%, p <0.02). Slowing the rate of shock wave administration during shock wave lithotripsy significantly improves the efficiency of stone fragmentation in vivo.

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Author and article information

Journal

Journal ID (nlm-ta): Korean J Urol

Journal ID (iso-abbrev): Korean J Urol

Journal ID (publisher-id): KJU

Title: Korean Journal of Urology

Publisher: The Korean Urological Association

ISSN (Print): 2005-6737

ISSN (Electronic): 2005-6745

Publication date (Print): November 2012

Publication date (Electronic): 14 November 2012

Volume: 53

Issue: 11

Pages: 790-794

Affiliations

Department of Urology, Bundang Jesaeng General Hospital, Seongnam, Korea.

Author notes

Corresponding Author: Seok Heun Jang. Department of Urology, Bundang Jesaeng General Hospital, 20 Seohyeon-ro 180beon-gil, Bundang-gu, Seongnam 463-774, Korea. TEL: +82-31-779-0165, FAX: +82-31-779-0169, shjang@ 123456dmc.or.kr

Article

DOI: 10.4111/kju.2012.53.11.790

PMC ID: 3502739

PubMed ID: 23185672

SO-VID: 61fb47aa-4e1f-408d-afb6-b2ff56b405b8

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Optimal Shock Wave Rate for Shock Wave Lithotripsy in Urolithiasis Treatment: A Prospective Randomized Study

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Abstract

Purpose

Materials and Methods

Results

Conclusions

Related collections

Gravitational Waves

Most cited references 15

Extracorporeal shock wave lithotripsy 25 years later: complications and their prevention.

Report of the United States cooperative study of extracorporeal shock wave lithotripsy.

Stone fragmentation during shock wave lithotripsy is improved by slowing the shock wave rate: studies with a new animal model.

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