Al-Naemi RSM. et al., 2019: By-products of lithotripsy: Are they related to abdominal fat and wave characteristics?
Al-Naemi RSM, Aldosky HYY, Shukri BSA.
College of Medicine, University of Duhok, Kurdistan Region, Iraq.
Department of Physics, College of Science, University of Duhok, Iraq.
Objectives: This study aimed to evaluate the correlations between by-products of extracorporeal shock wave lithotripsy (ESWL) and some physical parameters such as abdominal fat, energy levels, and shock wave pulses. Methods: A total of 40 patients (20 men and 20 women), aged 37.18 ± 10.64 years, with renal or ureteral stones were recruited. All patients were treated with ESWL, and their abdominal fat was measured using an Omron body fat monitor and the body mass index (BMI). Parameters such as the levels of malondialdehyde (MDA), ketones, and protein in urine were measured before and after ESWL using a Bio Doctor Analyzer. The wave characteristics of the lithotripsy procedure and the wave pulses were determined. Results: The mean levels of urinary MDA and ketones showed statistically significant increases in post-ESWL compared with pre-ESWL values. The results showed significant elevations in MDA and ketones in both male and female patients. In addition, there was a significant correlation between MDA/ketones and energy levels and between ketones and BMI in female patients. The analysis also revealed that the shock wave pulse had an insignificant impact on the by-product parameters. Conclusion: An energy level of ≤4 J is recommended for overweight and obese patients undergoing ESWL. In addition, measurement of the post-ESWL MDA urinary level should be performed as a routine test, especially in obese male patients.
J Taibah Univ Med Sci. 2019 Feb 5;14(2):156-162. doi: 10.1016/j.jtumed.2019.01.003. eCollection 2019 Apr. FREE ARTICLE
The authors measured the effects of SWL on the production of free radicals and oxidative stress in terms of urinary excretion of malondialdehyde (MDA) and ketones. Both variables were significantly increased after SWL and positively correlated with administerd energy levels and BMI. It is of note, however, that increased levels of ketones might have been the effect of the fasting period before treatment that the authors considered necessary.
The effects of SWL were most pronounced in overweight and obese patients. Cut off values for energy levels above 4J and BMI above 27. It is obvious that SWL causes oxidative stress in the abdominal fat but it is not quite clear to the reviewer how this information should be used. It is not shown how long lasting the effects are and the clinical relevance for these observations remains to be shown.