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      Comparison between two shock wave regimens using frequencies of 60 and 90 impulses per minute for urinary stones

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          Abstract

          PURPOSE:

          Two different regimens of SWL delivery for treating urinary stones were compared.

          METHODS:

          Patients with urinary stones were randomly divided into two groups, one of which received 3000 shocks at a rate of 60 impulses per minute and the other of which received 4000 shocks at 90 impulses per minute. Success was defined as stone‐free status or the detection of residual fragments of less than or equal to 3 mm three months after treatment. Partial fragmentation was considered to have occurred if a significant reduction in the stone burden was observed but residual fragments of 3mm or greater remained.

          RESULTS:

          A total of 143 procedures were performed with 3000 impulses at a rate of 60 impulses per minute, and 156 procedures were performed with 4000 impulses at 90 impulses per minute. The stone‐free rate was 53.1% for patients treated with the first regimen and 54.8% for those treated with the second one (p =  0.603). The stone‐free rate for stones smaller than 10 mm was 60% for patients treated with 60 impulses per minute and 58.6% for those treated with 90 impulses per minute. For stones bigger than 10 mm, stone‐free rates were 34.2% and 45.7%, respectively (p = 0.483). Complications occurred in 2.3% of patients treated with 60 impulses per minute and 3.3% of patients treated with 90 impulses per minute.

          CONCLUSION:

          No significant differences in the stone‐free and complication rates were observed by reducing the total number of impulses from 4000 to 3000 and the frequency from 90 to 60 impulses per minute.

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          Most cited references81

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          Lower pole I: a prospective randomized trial of extracorporeal shock wave lithotripsy and percutaneous nephrostolithotomy for lower pole nephrolithiasis-initial results.

          The efficacy of shock wave lithotripsy and percutaneous stone removal for the treatment of symptomatic lower pole renal calculi was determined. A prospective randomized, multicenter clinical trial was performed comparing shock wave lithotripsy and percutaneous stone removal for symptomatic lower pole only renal calculi 30 mm. or less. Of 128 patients enrolled in the study 60 with a mean stone size of 14.43 mm. were randomized to percutaneous stone removal (58 treated, 2 awaiting treatment) and 68 with a mean stone size of 14.03 mm. were randomized to shock wave lithotripsy (64 treated, 4 awaiting treatment). Followup at 3 months was available for 88% of treated patients. The 3-month postoperative stone-free rates overall were 95% for percutaneous removal versus 37% lithotripsy (p <0.001). Shock wave lithotripsy results varied inversely with stone burden while percutaneous stone-free rates were independent of stone burden. Stone clearance from the lower pole following shock wave lithotripsy was particularly problematic for calculi greater than 10 mm. in diameter with only 7 of 33 (21%) patients becoming stone-free. Re-treatment was necessary in 10 (16%) lithotripsy and 5 (9%) percutaneous cases. There were 9 treatment failures in the lithotripsy group and none in the percutaneous group. Ancillary treatment was necessary in 13% of lithotripsy and 2% percutaneous cases. Morbidity was low overall and did not differ significantly between the groups (percutaneous stone removal 22%, shock wave lithotripsy 11%, p =0.087). In the shock wave lithotripsy group there was no difference in lower pole anatomical measurements between kidneys in which complete stone clearance did or did not occur. Stone clearance from the lower pole following shock wave lithotripsy is poor, especially for stones greater than 10 mm. in diameter. Calculi greater than 10 mm. in diameter are better managed initially with percutaneous removal due to its high degree of efficacy and acceptably low morbidity.
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            Extracorporeal shock wave lithotripsy 25 years later: complications and their prevention.

            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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              Hounsfield units on computerized tomography predict stone-free rates after extracorporeal shock wave lithotripsy.

              Studies suggest that HU values on non-contrast computerized tomography may predict the ability to fragment urinary calculi. We determined whether the HUs of in vivo urinary stones could be used to predict the stone-free rates after extracorporeal shock wave lithotripsy. We evaluated 50 patients who underwent extracorporeal shock wave lithotripsy for 5 to 10 mm. upper urinary tract stones. Chemical analyses and HU calculations were performed for each stone and posttreatment radiographic assessment categorized patients into a stone-free or a residual stone group. Statistical analysis was performed using the Student t test to compare mean HU values in the 2 groups. Of the patients 32 (64%) were stone-free and 18 (36%) had residual stones. Mean values +/- SEM for the stone-free and residual stone groups were significantly different (551.20 +/- 46.66 versus 926.20 +/- 51.42 HU, p <0.0001). A total of 30 calculi (60%) were located in the ureter, including 21 in the stone-free group and 9 in the residual stone group with a mean value of 505.10 +/- 46.66 and 888.70 +/- 102.00 HU, respectively, which was significantly different (p = 0.0005). A total of 20 calculi (40%) were located in the kidney, including 11 in the stone-free group and 9 in the residual stone group with a mean value of 558.40 +/- 62.38 and 905.10 +/- 61.49 HU, respectively, which was significantly different (p = 0.001). These findings suggest that HU measurement of urinary calculi on pretreatment non-contrast computerized tomography may predict the stone-free rate. This information may be beneficial for selecting the preferred treatment option for patients with urinary calculi.
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                Author and article information

                Journal
                Clinics (Sao Paulo)
                Clinics
                Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
                1807-5932
                1980-5322
                October 2010
                : 65
                : 10
                : 961-965
                Affiliations
                Division of Urology, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
                Author notes
                E-mail: mazuchi@ 123456terra.com.br Tel.: 55 11 3069‐8080
                Article
                cln_65p961
                10.1590/S1807-59322010001000006
                2972613
                21120294
                c5fca17f-72d5-49d1-9354-39d85f244f70
                Copyright © 2010 Hospital das Clínicas da FMUSP

                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.

                History
                : 23 May 2010
                : 11 June 2010
                : 9 July 2010
                Page count
                Pages: 5
                Categories
                Clinical Science

                Medicine
                kidney calculi,extracorporeal shockwave lithotripsy,urologic surgical procedures,urolithiasis

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