Chen X. et al., 2022: Is there a place for extracorporeal shockwave lithotripsy (ESWL) in the endoscopic era?
Chen X, Chen J, Zhou X, Long Q, He H, Li X.
Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, 710061, Shaanxi Province, China.
Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, 710061, Shaanxi Province, China.
Abstract
This retrospective study aimed to evaluate whether there was still a place for ESWL therapy in the endourological era. From 1988 to 2018, ESWL therapy was performed with 3 successive types of lithotripters in our hospital. From 1988 to 1998, the electrohydraulic lithotripter NS-15 was used, and the electromagnetic lithotripter HK-V was put to use in 1999. Since 2010, the electromagnetic lithotripter HK-Vm has been used. Over the 30-year period, 16,969 urolithiasis patients underwent ESWL therapy, including 124 paediatric cases and 178 special cases. The stone clearance rate (SCR) and postoperative complications in the 3 lithotripter groups were recorded and analysed. The SCR was estimated by ultrasonography or plain X-ray, while the complications were recorded by the modified Clavien grading system. The primary stone clearance rate (pSCR) of ureteral and renal stones was significantly improved in the HK-Vm group compared with the NS-15 and HK-V groups. The final stone clearance rate (fSCR) of lower calyx stones was considerably higher in the HK-Vm group (55.9%) than in the NS-15 (41.1%) and HK-V (44.1%) groups. Most complications were grade I and II, while the incidence of grade III and above complications was less than 3%. Additionally, the fSCR in paediatric and special cases ranged from 66.5% to 83.5%, with no record of severe complications. As our data showed, ESWL was effective and safe for most urolithiasis patients, including paediatric patients and special cases. Therefore, ESWL is still the major treatment option in the current endourological era.
Urolithiasis. 2022 Jun;50(3):369-374. doi: 10.1007/s00240-022-01307-4. Epub 2022 Feb 4.
Comments 1
In contrast to most recent articles on stone removal, the authors of this report present a positive experience of SWL. The results in the article are based on SWL-treatments carried out during 30 years with three different Chinese lithotripters: NS-15, HK-V and HK-Vm. The total number of treated patients was almost 17 000: an impressive number. The total number of patients treated for urinary tract stones was approximately 22 000. This means that roughly 77% of the stone problems were managed with SWL.
The approximate data shown below are extracted from the article and are those obtained following treatment with the HK-Vm device.
The authors’ conclusion is that because SWL is more convenient and less expensive than endoscopic procedures and moreover possible to carry out in an outpatient setting without anaesthesia, SWL was the preferred method in most patients.
One point that is emphasized is that SWL is “particularly effective in treating ureteral stones” for which fSCR was 80-90%. I fully agree with this view, it is also my own experience. It is indeed surprising that in many centres and in several recommendations, SWL is NOT an option for distal ureteral stones.
In view of the inferior stone clearance rates for lower calyx stones it had been of great interest to know what inversion/vibration therapy would have added.
Hans-Göran Tiselius