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Literature Databases

Ibrahim RM. et al., 2024: Shock wave lithotripsy in the era of COVID-19.

Ibrahim RM, Elzawy F, Ragheb AM, Elmarakbi AA, Sayed O, Lotfy AM, Youssef A, Badwy HF, Mohamed AG.
Department of Urology, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt.

Abstract

Objective: The objective of the study y was to evaluate factors which can improve shock wave lithotripsy (SWL) results to keep up with COVID-19 pandemic.

Methods: Between June 2020 and June 2021, patients with radio-opaque or faint radio-opaque upper urinary tract stones, stone attenuation value ≤1200 HU, and stones size <2.5 cm were treated by electrohydraulic SWL. Patients with respiratory tract symptoms elevated temperature, contact with COVID-19 patients, or positive COVID-19 swab 2 weeks preoperatively, skin-to-stone distance >11 cm, and body mass index >30 kg/m2 were excluded from the study. Patients were prospectively enrolled in SWL done at a rate of 40-50 SWs/min under combined ultrasound and fluoroscopy-guided, ramped into high power in the 1st 300 shocks. Success rate and complications were recorded.

Results: Five hundred and ninety patients completed the study. The success rate after 1st session was 408/590 patients (69.15%) which was augmented by 2nd session to reach 527/590 patients 89.3%. The success rate was 96.2% at 3 months postoperatively. Most complications were mild (Grade 1 or 2).

Conclusions: SWL results improved using slow rate high power from the start of the session under combined fluoroscopy and ultrasound guidance. SWL may be a preferred option during a pandemic.

Urol Ann. 2024 Jan-Mar;16(1):104-107. doi: 10.4103/ua.ua_42_22. Epub 2024 Jan 25.
PMID: 38415230 FREE PMC ARTICLE

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Comments 1

Peter Alken on Wednesday, 05 June 2024 11:00

I do not really see that the title of the paper reflects the message. Covid-19 did not have a direct influence on the results presented.
The paper presents further development of a treatment technique described in an earlier work from the department (1) on slow shock-wave frequency SWL. In order to spare treatment time, the formerly applied technique was changed in three aspect: Power ramping was rapidly done in one treatment phase,” we waived the safety pause and ramped to reach the maximum power in the 1st 300 SWs” in addition “Tapering the tip of electrodes and readjusting the distance between them after each session were done.” In addition, “continuous ultrasound targeting of the stone decreased the number of shocks to 2053.7 ± 243 SWs compared to 3900 SWs in Al-Dessoukey et al. 2020 (1).” No details of how the latter was achieved are given. The results are impressive with a 2nd, 3rd, and 4th session in only 20%, 6,9% and 1% respectively, a duration of session of 45.26±20 (min)” and “no complicated gross perinephric or subcapsular hematomas, perinephric collections, and parenchymal lesions during the follow‑up.”
1 Al-Dessoukey AA, Abdallah M, Moussa AS, Sayed O, Abdelbary AM, Abdallah R, Massoud AM, Abdelhamid MH, Elmarakbi AA, Ragheb AM, ElSheemy MS, Ghoneima W. Ultraslow full-power shock wave lithotripsy versus slow power-ramping shock wave lithotripsy in stones with high attenuation value: A randomized comparative study. Int J Urol. 2020 Feb;27(2):165-170. doi: 10.1111/iju.14158. Epub 2019 Dec 2. PMID: 31793084

Peter Alken

I do not really see that the title of the paper reflects the message. Covid-19 did not have a direct influence on the results presented. The paper presents further development of a treatment technique described in an earlier work from the department (1) on slow shock-wave frequency SWL. In order to spare treatment time, the formerly applied technique was changed in three aspect: Power ramping was rapidly done in one treatment phase,” we waived the safety pause and ramped to reach the maximum power in the 1st 300 SWs” in addition “Tapering the tip of electrodes and readjusting the distance between them after each session were done.” In addition, “continuous ultrasound targeting of the stone decreased the number of shocks to 2053.7 ± 243 SWs compared to 3900 SWs in Al-Dessoukey et al. 2020 (1).” No details of how the latter was achieved are given. The results are impressive with a 2nd, 3rd, and 4th session in only 20%, 6,9% and 1% respectively, a duration of session of 45.26±20 (min)” and “no complicated gross perinephric or subcapsular hematomas, perinephric collections, and parenchymal lesions during the follow‑up.” 1 Al-Dessoukey AA, Abdallah M, Moussa AS, Sayed O, Abdelbary AM, Abdallah R, Massoud AM, Abdelhamid MH, Elmarakbi AA, Ragheb AM, ElSheemy MS, Ghoneima W. Ultraslow full-power shock wave lithotripsy versus slow power-ramping shock wave lithotripsy in stones with high attenuation value: A randomized comparative study. Int J Urol. 2020 Feb;27(2):165-170. doi: 10.1111/iju.14158. Epub 2019 Dec 2. PMID: 31793084 Peter Alken
Friday, 12 July 2024