Reesink DJ et al., 2018: Extracorporeal shock wave lithotripsy under intravenous sedation for treatment of urolithiasis
Reesink DJ, Scheltema JMW, Barendrecht MM, Boeken Kruger AE, Jansonius A, Wiltink J, van der Windt F.
a Urology Department , Tergooi Hospital Hilversum/Blaricum , Blaricum , The Netherlands.
Abstract
BACKGROUND: In contrast to treatment with oral or intramuscular analgesics, extracorporeal shock wave lithotripsy (E.S.W.L.) can be performed with patients under sedation too. Besides the advantage of increased shock energy, patients tend to have more constant breathing excursions and are more idle during treatment, potentially increasing the stone-free ratio (S.F.R.) after treatment. METHODS: This study presents the results of 310 patients who underwent 400 E.S.W.L. procedures under sedation, with a stationary lithotripter. RESULTS: After one procedure, the S.F.R. was 54.8% (170/310). A second treatment was successful in 42.1% (32/76), a third treatment in 21.4% (3/14). Therefore, 66.1% (205/310) of patients eventually became stone-free. Kidney stones were successfully treated in 65.4% (161/246), ureteral stones in 68.8% (44/64) of cases. Patients with stones ≤15 mm were successfullytreated in 67.4% (194/288), patients with stones >15 mm in 50% (11/22) of cases. Considering each procedure individually, 45.3% (181/400) of procedures were successful after 3 weeks. Extending follow-up to 3 months is important, since 26.7% of stones (24/90) eventually still disappeared, increasing S.F.R. to 51.3% after one procedure. Complications occurred after 5.5% E.S.W.L.-procedures. CONCLUSIONS: E.S.W.L. is a well-tolerated, non-invasive procedure that produces reasonable stone clearance of both upper and lower urinary tract calculi. Performing the procedure whilst patients are intravenously sedated results in an acceptable S.F.R. Strong selection based on unfavourable factors could increase the chance on successful treatment and spare patients a pointless procedure. However, considering E.S.W.L.'s elegant nature, sometimes a more tolerant approach seems justifiable.
Scand J Urol. 2018 Nov 18:1-6. doi: 10.1080/21681805.2018.1524398. [Epub ahead of print]
Comments 1
We have reviewed more than 1000 publication on EWSL and I have read a lot of other publications on different urological topics. The present paper is exceptional. It presents a traditional attitude towards patient selection, treatment and follow-up and exposes the results achieved in a critical position to results published in the literature. In an era without patience the authors suggest to take the time of 3 months post ESWL to wait for the natural improvement of SFR by an additional 26.7% spontaneous fragment passage rate.
The sentence I really love most is in the section about limitations of the study: “Conclusions are, therefore, unreliable” It is so much more candid than the usual nonsense “Further studies have to confirm these results” which accompanies so many other publications.