Eterović D et al, 2014: Are we estimating the adverse effects of shock-wave lithotripsy on a faulty scale?
Eterović D, Situm M, Marković V, Kuna K, Punda A
Department of Nuclear Medicine, University Hospital Split and Department of Medical Physics, University of Split School of Medicine, Croatia
Department of Urology, University Hospital Split and University of Split School of Medicine, Croatia
Department of Nuclear Medicine, University Hospital Split and University of Split School of Medicine, Croatia
Department of Gynecology and Obstetrics, University Hospital Sisters of Charity, Zagreb, Croatia
Abstract
The adverse effect of shock-wave lithotripsy (SWL) for renal stones on blood pressure is currently defined as its post-treatment increase. On the contrary, we hypothesize that even mild, unilateral renal obstruction initiates an increase in blood pressure. Then, in absence of treatment-induced injury, the stone removal should decrease the blood pressure. We derived the formula to assess the expected change in the mean arterial pressure following relief of renal obstruction without affecting the kidney functions. The predictions were well replicated in the cohort of patients with renal stone treated with parenchyma-saving open surgery, with 6.4mmHg decrease at 3months. On the contrary, in SWL cohort, instead of the expected 4.7mmHg decrease, the blood pressure was unchanged. In conclusion, the absence of decrease in blood pressure is a very common adverse effect of SWL, leading to an epidemiologically significant increase in the risk of arterial vascular events.
Med Hypotheses. 2014 Mar 13. pii: S0306-9877(14)00107-8. doi: 10.1016/j.mehy.2014.03.005. [Epub ahead of print]
PMID:24674349[PubMed - as supplied by publisher]
Comments 1
Most patients with urine flow obstruction present with stones in the ureter and they are accordingly treated with shockwaves that most commonly do not hit the renal tissue. The authors of this study have studied a subset of patients with obstructing stones that either was treated with open surgery or with SWL for stones located in the kidney. Exactly how the patients were selected for each treatment is not stated. In the study referred to by the authors (1) and in which both staghorn stones and small/medium sized stones were treated, the type of stone and the duration of the obstruction might have been of importance for how well the release of obstruction would result in lowering of the blood pressure.
Reference 1. Eterovic D et al. A decrease in blood pressure following pyelolithotomy but not extracorporeal lithotripsy. Urol Res 2005; 33: 93-98
Hans-Göran Tiselius