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Bandac AC. et al., 2024: Efficacy and Safety of Extracorporeal Shock Wave Lithotripsy (ESWL) in Patients With Infected Ureterohydronephrosis Due to Ureteral Stones Following

Bandac AC, Ristescu AI, Costache CR, Bobeica RL, Pantilimonescu TF, Onofrei P Sr, Radu VD.
Urology, C.I. Parhon University Hospital, Iasi, ROU.
Anaesthesiology and Intensive Care, Grigore T. Popa University of Medicine and Pharmacy, Iasi, ROU.
Urology, Grigore T. Popa University of Medicine and Pharmacy, Iasi, ROU.
Morphofunctional Sciences II, Grigore T. Popa University of Medicine and Pharmacy, Iasi, ROU.
Urology, Elytis Hope Hospital, Iasi, ROU.

Abstract

Introduction: Double-J ureteral catheters in patients with ureteral lithiasis undergoing extracorporeal shockwave lithotripsy (ESWL) procedures reduce the efficacy of the procedure or have no effect on the stone-free rate. However, the effect of double-J catheters on the patients in whom they were inserted for infected hydronephrosis is not known. The aim of our study was to evaluate the efficacy and safety of the ESWL procedure in patients with ureteral lithiasis and double-J catheters previously inserted for infected hydronephrosis.

Method: We conducted a comparative case-control, match-paired study in a group of patients with ureteral lithiasis treated by ESWL from January 1, 2018, to March 1, 2023, who were divided into two groups according to the presence of the double-J catheter. For each patient with the double-J catheter from the study group, we selected one patient for the control group without the double-J catheter and matched them in terms of size, location of stones, and body mass index (BMI). We analyzed the stone-free rate and complications that occurred in the two groups.

Results: Forty patients with ureteral lithiasis and a double-J catheter inserted for infected hydronephrosis were enrolled in the study group. The control group included 40 patients with ureteral stones without double-J catheters. The patients in the two groups were predominantly men with stones located in the lumbar region and on the right side and with a BMI between 25 and 30 kg/m2. The stones had an average size of 0.9+/-0.12mm and 0.89+/-0.15mm, respectively (p=0.624). There was no statistically significant difference in stone-free rate between the two groups after the first session of ESWL (47.5% vs. 52.5%, p=0.502), the second (70% vs. 75%, p = 0.616), and the third session (85% vs. 87.5%, p=0.761). The rate of complications was similar in both groups (7.5% vs. 5%, p=0.761).

Conclusions: The presence of double-J catheters inserted in patients with ureteral stones who underwent ESWL for infected hydronephrosis does not affect the stone-free rate of the procedure or the complication rate. The procedure of ESWL in patients with ureteral lithiasis and double-J catheters inserted for infected hydronephrosis is a safe and efficient method that can be recommended as an initial treatment alongside retrograde ureteroscopy.

Cureus. 2024 Jan 6;16(1):e51742. doi: 10.7759/cureus.51742. eCollection 2024 Jan. PMID: 38318541 FREE PMC ARTICLE

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Comments 1

Hans-Göran Tiselius on Monday, 10 June 2024 11:00

In this poorly proof-read article, the authors present their experience with SWL in patients with an internal stent that had been inserted because of stones associated with infection. Comparison was made with a stent-free control group.
The patients had stones measuring 5-10 mm, although it is stated both in the Abstract and in the Results section (Table 1) that the mean stone-sizes were 0.90 and 0.89 mm, respectively!?
It is of interest that the stone-free rates were 85% and 90% in the stented and stent-free controls, respectively. BUT that was the result only after three sessions. This means that the stone-free rate was lower than expected. It is my assumption that this result reflects the lack of pain-treatment: “no anesthetic method” and with a maximum shock wave determined by the occurrence of pain (patients’ tolerance). It is increasingly common today that SWL is carried out without adequate pain treatment. In the reviewer’s experience this means that the treatment is carried out with insufficient SWL energy and accordingly with need of repeated treatment sessions. This methodological trend is one reason why SWL guidelines continuously need to be modified, not because of technical limitations or shortcomings but because of how the technique is used!!
Although it is mentioned in the report that the stents were inserted because of infection, it is not mentioned how or if antibiotics were given during the 3-week pre-treatment period, only that a single dose of cefuroxime was given at the time of treatment.
The small, size of the samples, the small stone sizes and the way in which SWL was carried out make conclusions difficult. The reviewer’s experience is that in patients with stone and stent, it might be of value to remove the stent at the time of SWL treatment.
I assume that with a better method for pain treatment the stone-free rate had been better and the need of repeated SWL lower. The authors are recommended to look at the importance of these factors and also to include larger stones.

Hans-Göran Tiselius

In this poorly proof-read article, the authors present their experience with SWL in patients with an internal stent that had been inserted because of stones associated with infection. Comparison was made with a stent-free control group. The patients had stones measuring 5-10 mm, although it is stated both in the Abstract and in the Results section (Table 1) that the mean stone-sizes were 0.90 and 0.89 mm, respectively!? It is of interest that the stone-free rates were 85% and 90% in the stented and stent-free controls, respectively. BUT that was the result only after three sessions. This means that the stone-free rate was lower than expected. It is my assumption that this result reflects the lack of pain-treatment: “no anesthetic method” and with a maximum shock wave determined by the occurrence of pain (patients’ tolerance). It is increasingly common today that SWL is carried out without adequate pain treatment. In the reviewer’s experience this means that the treatment is carried out with insufficient SWL energy and accordingly with need of repeated treatment sessions. This methodological trend is one reason why SWL guidelines continuously need to be modified, not because of technical limitations or shortcomings but because of how the technique is used!! Although it is mentioned in the report that the stents were inserted because of infection, it is not mentioned how or if antibiotics were given during the 3-week pre-treatment period, only that a single dose of cefuroxime was given at the time of treatment. The small, size of the samples, the small stone sizes and the way in which SWL was carried out make conclusions difficult. The reviewer’s experience is that in patients with stone and stent, it might be of value to remove the stent at the time of SWL treatment. I assume that with a better method for pain treatment the stone-free rate had been better and the need of repeated SWL lower. The authors are recommended to look at the importance of these factors and also to include larger stones. Hans-Göran Tiselius
Saturday, 13 July 2024