Abstract

Abstract

The treatment of ureteral lithiasis by extracorporeal shock wave lithotripsy (ESWL) is progressively being abandoned owing to advances in endoscopic lithotripsy. The purpose of this paper is to analyze the causes as to why ESWL is less effective-with a measurable parameter: focal applied energy quotient (FAEQ) that allows us to apply an improvement project in ESWL results for ureteral lithiasis. A prospective observational cohort study with 3-year follow-up and enrollment period was done with three groups of cases. In Group A, 83 cases of ureteral lithiasis were treated by endoscopic lithotripsy using Holmiun:YAG laser. In Group B, 81 cases of ureteral lithiasis were treated by ESWL using Doli-S device (EMSE 220F-XXP). In Group C, 65 cases of ureteral lithiasis were treated by ESWL using Doli-S device (EMSE 220F-XXP) (FAEQ >10). Statistical study and calculation of RR, NNT, Chi-square test, Fisher's exact test, and Student's t test were done. Efficiency quotient (EQ) and focal applied energy quotient [FAEQ = (radioscopy seconds/number of shock waves) × ESWL session J] were analyzed. From the results, the success rate of the treatment using Holmium:YAG laser lithotripsy and ESWL is found to be 94 and 48%, respectively, with a statistically significant difference (p 10, we do not observe absolute benefit choosing one or the other. In conclusion, the application of ESWL with FAEQ >10, that is, improving radiologic focalization of the calculus and increasing the number of Joules/SW, makes possible a treatment as safe and equally efficient as Holmium:YAG laser lithotripsy in ureteral lithiasis less than 13 mm.

Urol Res. 2012 Aug;40(4):377-81. doi: 10.1007/s00240-011-0430-6. Epub  2011 Oct 15

PMID:22002726[PubMed - as supplied by publisher]

Comment

Comment

GOOD NEWS!

The authors initiated an “Improvement project, FAEQ>10” for the ESWL outcome in the treatment of ureteral calculi. They compared the results of URS and laser lithotripsy (1 session success: 94%)  to a classical ESWL therapy (1 session success: 61,7%)  and the improved ESWL protocol (1 session success: 93,84%).

That is exceptionally good news for the ESWL treatment. The FAEQ in the classical Group was 8.12% and in the improved group it was 10.64%.

Unfortunately the authors fail to give details on the practical application of their protocol.

Ureteroscopy was performed under analgesia and sedation in ambulatory settings. That might explain a difference in the three treatment arms: The male/female proportion was 39/44 in the URS group and 58/23 and 55/10 resp. in the two ESWL groups.

Peter Alken