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Sallami S et al, 2015: Extracorporeal lithotripsy in patients with hemophilia: systematic review.

Sallami S, Baccouche H, Mahjoub S, Ben Romdhane N.

Abstract

BACKGROUND: The management of urolithiasis in patients with haemophilia poses a real challenge to the urologist.AIM: We conducted a systematic literature review to assess the safety and efficacy of extracorporeal shock wave lithotripsy (ESWL) in the treatment of urolithiasis in hemophiliacs.
METHODS: A systematic review was conducted by using the National Library of Medicine (PubMed) search engine between January 1985 and June 2013. We've used these key words: "haemophilia" and "extracorporeal shock wave lithotripsy". All articles dealing with the treatment of nephrolithiasis by ESWL in patients with hemophilia were included. Two independent reviewers extracted the data from each article. The data was included into a systematic review and analyzed.
RESULTS: A total of 12 medical articles were selected with a total of 25 patients. The stone size varies from 6 to 21 mm. The substitution of the deficient clotting factor started the day before the ESWL. ESWL was effective in all patients except one after 1-6 sessions / patient. An ultrasound was performed after the procedure to look for potential bleeding complications. The judgment of the substitution therapy depends on the patient's condition, the presence of hematuria and the absence of signs of bleeding. Major bleeding complications were observed in 4 patients.
CONCLUSIONS: With effective substitution of deficient clotting factors, ESWL is a safe and low morbidity method in the treatment of urinary calculi in hemophiliacs.

Tunis Med. 2015 Jan;93(1):1-4. 

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Comments 1

Hans-Göran Tiselius on Thursday, 24 September 2015 08:44

In this review article the authors have summarized literature data (together with one case treated by themselves) on SWL in patients with haemophilia types A and B. The general conclusion is that SWL was safe and efficient in these patients provided adequate substitution therapy was instituted before stone disintegration and during follow-up. In this review no recommendations are given how the treatment most safely should be carried out and only occasionally is such information found in the original publications referred to.

Hemorrhagic complications were recorded in 4 out of the 25 treated patients, but a closer analysis of the reason for bleeding complications in these patients cannot be made.

That SWL successfully can be carried out in patients with haemophilia after close collaboration with experts in haematology is in accordance with the reviewer's own experience using Modulith SLX lithotripters. A look into the original publications disclosed that both electrohydrulic and electromagnetic lithotripters had been used (Table)

http://storzmedical.com/images/blog/Sallami_S_.jpg

Most surprisingly is the report that SWL successfully was completed in one patient who refused substitution therapy. I would not recommend SWL in such a situation.

It seems reasonable to always apply a very careful and gentle SWL strategy when treating patients with haemophilic disorders and keep both the number of shockwaves and the energy level as low as possible.

In this review article the authors have summarized literature data (together with one case treated by themselves) on SWL in patients with haemophilia types A and B. The general conclusion is that SWL was safe and efficient in these patients provided adequate substitution therapy was instituted before stone disintegration and during follow-up. In this review no recommendations are given how the treatment most safely should be carried out and only occasionally is such information found in the original publications referred to. Hemorrhagic complications were recorded in 4 out of the 25 treated patients, but a closer analysis of the reason for bleeding complications in these patients cannot be made. That SWL successfully can be carried out in patients with haemophilia after close collaboration with experts in haematology is in accordance with the reviewer's own experience using Modulith SLX lithotripters. A look into the original publications disclosed that both electrohydrulic and electromagnetic lithotripters had been used (Table) [img]http://storzmedical.com/images/blog/Sallami_S_.jpg[/img] Most surprisingly is the report that SWL successfully was completed in one patient who refused substitution therapy. I would not recommend SWL in such a situation. It seems reasonable to always apply a very careful and gentle SWL strategy when treating patients with haemophilic disorders and keep both the number of shockwaves and the energy level as low as possible.
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