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Choi HJ et al, 2012: Usefulness of early extracorporeal shock wave lithotripsy in colic patients with ureteral stones

Choi HJ, Jung JH, Bae J, Cho MC, Lee HW, Lee KS
Department of Urology, Dongguk University Ilsan Hospital, Goyang, Korea


Abstract

PURPOSE: To compare efficacy and safety between early extracorporeal shock wave lithotripsy (eESWL) and deferred ESWL (dESWL) in colic patients with ureteral stones and to investigate whether eESWL can play a critical role in improving treatment outcomes.

MATERIALS AND METHODS: A total of 279 patients who underwent ESWL for single radio-opaque ureteral stones of 5 to 20 mm in size were included in this retrospective study. The patients were categorized into two groups according to the time between the onset of colic and ESWL: eESWL (

RESULTS: For all patients, the success rate in the eESWL group was significantly higher than that in the dESWL group. The eESWL group required significantly fewer ESWL sessions and less time to achieve stone-free status than did the dESWL group. For 241 patients with stones <10 mm, all treatment outcomes in the former group were superior to those in the latter group, but not for 38 patients with stones sized 10 to 20 mm. The superiority of eESWL over dESWL in the treatment outcomes was more pronounced for proximal ureteral stones than for mid-to-distal ureteral stones. Post-ESWL complication rates were comparable between the two groups. In the multivariate analysis, smaller stone size and a time to ESWL of <48 hours were independent predictors of success.

CONCLUSIONS: Our data suggest that eESWL in colic patients with ureteral stones is an effective and safe treatment with accelerated stone clearance.

Korean J Urol. 2012 Dec;53(12):853-9. doi: 10.4111/kju.2012.53.12.853. Epub 2012 Dec 20
PMID:23301130 [PubMed] PMCID:PMC3531639

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Comments 1

Hans-Göran Tiselius on Monday, 03 June 2013 08:47

Early elimination of ureteral stones is beneficial from several points of view. Preservation of renal function and reduced patient suffering are the main goals. The advantage of early SWL has previously been discussed in several publications and it has been concluded that early treatment is easier to carry out and results in a better outcome. This retrospective study lends further support to the advantage of an early active procedure. The number of SWL sessions and number of shock waves were significantly lower in patients treated early. The need of URS following early and delayed SWL was 9.8% and 26.2%, respectively.

The conclusion is that whenever possible, SWL should be carried out as early as possible for stones in the ureter and the local organization of SWL service should take that aspect into account.

Hans-Göran Tiselius

Early elimination of ureteral stones is beneficial from several points of view. Preservation of renal function and reduced patient suffering are the main goals. The advantage of early SWL has previously been discussed in several publications and it has been concluded that early treatment is easier to carry out and results in a better outcome. This retrospective study lends further support to the advantage of an early active procedure. The number of SWL sessions and number of shock waves were significantly lower in patients treated early. The need of URS following early and delayed SWL was 9.8% and 26.2%, respectively. The conclusion is that whenever possible, SWL should be carried out as early as possible for stones in the ureter and the local organization of SWL service should take that aspect into account. Hans-Göran Tiselius
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