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Pirola GM et al, 2016: Evaluation of long-term side effects after shock-wave lithotripsy for renal calculi using a third generation electromagnetic lithotripter.

Pirola GM, Micali S, Sighinolfi MC, Martorana E, Territo A, Puliatti S, Bianchi G.
Department of Urology, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy.

Abstract

To assess the incidence of long-term side effects after shock-wave lithotripsy treatment performed with an electromagnetic Dornier Lithotripter S device. A specific follow-up was undertaken on a cohort of 100 selected patients that underwent SWL for a single renal stone in our center from 2002 to 2004. Previous and current data were compared using the Student t test. Factors associated with the incidence of hypertension and diabetes mellitus were determined. Ten years after treatment, mean serum creatinine level and glomerular filtration rate remained similar to previous values (serum creatinine level: 0.96 ± 0.22 vs. 0.92 ± 0.19 mg/dL; glomerular filtration rate: 92.8 ± 17.8 vs. 88.1 ± 21.7 mL/min). There were marked increases in blood cholesterol, blood pressure, and blood glucose levels, while smoking decreased. Age, glomerular filtration rate, body mass index, blood glucose and blood pressure at the time of treatment were significantly  associated with the presence of hypertension and diabetes mellitus at follow-up; blood cholesterol was associated with diabetes mellitus  development. After 10 years, overall renal function appeared to have been unaffected by shock-wave lithotripsy treatment. The increased rate of hypertension and diabetes mellitus were consistent with the incidence in the global population. This is the first report on the long-term safety of a third generation electromagnetic lithotripter, and indicates that there are no long-term sequelae.

Urolithiasis. 2016 Mar 11. [Epub ahead of print]

 

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Comments 1

Hans-Göran Tiselius on Tuesday, 17 May 2016 07:18

Long-term side effects of SWL are an important aspect of this treatment modality and have been subject to a large number of reports and considerations over the years. The most interesting questions have been if hypertension or diabetes mellitus are consequences of SWL. The authors found it necessary to look at this problem which, according to their opinion, had not previously been analysed for the “third generation of electromagnetic lithotripters”. Their conclusion was that neither hypertension nor diabetes mellitus developed as a result of SWL during a follow-up period of 10 years.

Similar conclusions have been drawn from meta-analyses in adults [1,2] with follow-up periods of 20 to 25 years and also from follow-up studies of children [3] treated with SWL and with a mean follow-up of more than 5 years. This problem thus appears to have been both extensively and sufficiently examined.

The reviewer’s concluding reflection is that unless there will be a future dramatic change in lithotripter technology, there seems to be little reason to worry about the risk of developing hypertension or diabetes mellitus as a result of SWL. There are also weak indications for the need to further extensively explore this problem. On the other hand it appears highly relevant to worry about the long-term effects of the increasingly common metabolic syndrome (frequently associated with stone formation), the consequences of which are both hypertension and diabetes mellitus [2].

References
1. Yu C, Longfei L, Long W, Feng Z, Jiping N, Mao L, Lin Q, Hequn C.
A systematic review and meta-analysis of new onset hypertension after extracorporeal shock wave lithotripsy.
Int Urol Nephrol. 2014 Apr;46(4):719-25. doi: 10.1007/s11255-013-0588-7. Epub 2013 Oct 27. Review.
2. Chew BH, Zavaglia B, Sutton C, Masson RK, Chan SH, Hamidizadeh R, Lee JK, Arsovska O, Rowley VA, Zwirewich C, Afshar K, Paterson RF Twenty-year prevalence of diabetes mellitus and hypertension in patients receiving shock-wave lithotripsy for urolithiasis. BJU Int. 2012 Feb;109(3):444-9. doi: 10.1111/j.1464-410X.2011.10291.x. Epub 2011 Jun 2.
3. El-Nahas AR, Awad BA, El-Assmy AM, Abou El-Ghar ME, Eraky I, El-Kenawy MR, Sheir KZ.
Are there long-term effects of extracorporeal shockwave lithotripsy in paediatric patients?
BJU Int. 2013 Apr;111(4):666-71. doi: 10.1111/j.1464-410X.2012.11420.x. Epub 2012 Aug 23.

Long-term side effects of SWL are an important aspect of this treatment modality and have been subject to a large number of reports and considerations over the years. The most interesting questions have been if hypertension or diabetes mellitus are consequences of SWL. The authors found it necessary to look at this problem which, according to their opinion, had not previously been analysed for the “third generation of electromagnetic lithotripters”. Their conclusion was that neither hypertension nor diabetes mellitus developed as a result of SWL during a follow-up period of 10 years. Similar conclusions have been drawn from meta-analyses in adults [1,2] with follow-up periods of 20 to 25 years and also from follow-up studies of children [3] treated with SWL and with a mean follow-up of more than 5 years. This problem thus appears to have been both extensively and sufficiently examined. The reviewer’s concluding reflection is that unless there will be a future dramatic change in lithotripter technology, there seems to be little reason to worry about the risk of developing hypertension or diabetes mellitus as a result of SWL. There are also weak indications for the need to further extensively explore this problem. On the other hand it appears highly relevant to worry about the long-term effects of the increasingly common metabolic syndrome (frequently associated with stone formation), the consequences of which are both hypertension and diabetes mellitus [2]. References 1. Yu C, Longfei L, Long W, Feng Z, Jiping N, Mao L, Lin Q, Hequn C. A systematic review and meta-analysis of new onset hypertension after extracorporeal shock wave lithotripsy. Int Urol Nephrol. 2014 Apr;46(4):719-25. doi: 10.1007/s11255-013-0588-7. Epub 2013 Oct 27. Review. 2. Chew BH, Zavaglia B, Sutton C, Masson RK, Chan SH, Hamidizadeh R, Lee JK, Arsovska O, Rowley VA, Zwirewich C, Afshar K, Paterson RF Twenty-year prevalence of diabetes mellitus and hypertension in patients receiving shock-wave lithotripsy for urolithiasis. BJU Int. 2012 Feb;109(3):444-9. doi: 10.1111/j.1464-410X.2011.10291.x. Epub 2011 Jun 2. 3. El-Nahas AR, Awad BA, El-Assmy AM, Abou El-Ghar ME, Eraky I, El-Kenawy MR, Sheir KZ. Are there long-term effects of extracorporeal shockwave lithotripsy in paediatric patients? BJU Int. 2013 Apr;111(4):666-71. doi: 10.1111/j.1464-410X.2012.11420.x. Epub 2012 Aug 23.
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