STORZ MEDICAL – Literature Databases
STORZ MEDICAL – Literature Databases
Literature Databases
Literature Databases

Iqbal N. et al., 2022: Percutaneous nephrolithotomy in new versus those patients with previous history of Extracorporeal Shock Wave Lithotripsy on ipsilateral side.

Iqbal N, Iqbal S, Zareen N, Blair KAA.
Nadeem Iqbal, Shifa International Hospital, Islamabad, Pakistan.
Sajid Iqbal, Department of Rehabilitation, Pakistan Navy PNS Hospital, Karachi, Pakistan.
Nasir Zareen, SKBZ/CMH Rawlakot.
Keron Akintola Ayodele Blair, American International School of Medicine, Georgetown Guyana.

Abstract

Objectives: To appraise the effects of previous history of ineffectual extracorporeal shockwave lithotripsy (SWL) treatment on the execution and end result of percutaneous nephrolithotomy (PCNL).

Methods: The study was performed from January 2012 till November 2019 at the urology department at our hospital, a tertiary healthcare center. In total, four hundred and twenty two patients were enrolled in the study. We arranged the study participants into two groups. Group-I comprised of 66 subjects who had undergone failed SWL 12 months prior to PCNL procedure, while Group-II included patients who had no history of previous SWL. Information related to study variables was registered in designated proformas and then processed in SPSS version 16 for the statistical computations.

Results: On the whole, the mean age of patients was 45.25± 14.38 years. While the mean calculus size was 494.80±128.83 mm2. The complexity of stones formulated on the basis of Guy's stone score was identical among the two groups. American Society of Anesthesiologists (ASA) class categories were almost similar among the two groups. Stone free rates of 80.30% and 81.74% (p value=0.73) were observed in Group-I and II respectively. Time to create PCNL tract and mean drop in hemoglobin were noted to be significantly higher in Group-I. Complication rates and grades were not being dissimilar among the two groups.

Conclusion: Patients having prior history of unsuccessful SWL history before undertaking the PCNL procedure manifested similar stone free rates and complications rates as those observed in SWL naive cases of PCNL.
Pak J Med Sci. 2022 Mar-Apr;38(4Part-II):833-837. doi: 10.12669/pjms.38.4.5116. PMID: 35634635. FREE ARTICLE

0
 

Comments 1

Peter Alken on Saturday, 03 December 2022 09:30

The patients of the post-ESWL group had a mean stone size of 469.77±72.51 mm2. Assuming the stones had a spherical shape, then the mean diameter would have been 2,17 cm which is only slightly above the recommended size ≤ 2 cm for shock wave lithotripsy of renal stones. This could explain why they did not find similar negative effects of a previous ESWL as shown in one of the references (1). Zhong et al. (1) saw stone fragments embedded beneath the pelvi-calyceal mucosa in 72.6 % of the post-ESWL patients. In these patients, the stone size was 3.8 ± 0.7 cm, which would be equivalent to 1134 mm2 and well above a reasonable stone size for ESWL.
ESWL application to stones in vitro or under constant ultrasound visualization in vivo only shows the stone moving while braking but never shows “high-velocity” fragments. Larger stones do not behave different. I assume that the finding of submucosal stone fragments was a misinterpretation of fibrin-covered fragments something I have often seen during secondary PNL.

1 Zhong W, et al. Percutaneous nephrolithotomy for renal stones following failed extracorporeal shockwave lithotripsy: different performances and morbidities. Urolithiasis. 2013 Apr;41(2):165-8. doi: 10.1007/s00240-013-0545-z

See also: Li H, Hu XF, Deng L, Zhang L, Li H. Does prior failed shock-wave lithotripsy impact outcomes of ureterorenoscopy? A systematic review and meta-analysis. Eur Rev Med Pharmacol Sci. 2022 Apr;26(7):2501-2510. doi: 10.26355/eurrev_202204_28486.PMID: 35442465

Peter Alken

The patients of the post-ESWL group had a mean stone size of 469.77±72.51 mm2. Assuming the stones had a spherical shape, then the mean diameter would have been 2,17 cm which is only slightly above the recommended size ≤ 2 cm for shock wave lithotripsy of renal stones. This could explain why they did not find similar negative effects of a previous ESWL as shown in one of the references (1). Zhong et al. (1) saw stone fragments embedded beneath the pelvi-calyceal mucosa in 72.6 % of the post-ESWL patients. In these patients, the stone size was 3.8 ± 0.7 cm, which would be equivalent to 1134 mm2 and well above a reasonable stone size for ESWL. ESWL application to stones in vitro or under constant ultrasound visualization in vivo only shows the stone moving while braking but never shows “high-velocity” fragments. Larger stones do not behave different. I assume that the finding of submucosal stone fragments was a misinterpretation of fibrin-covered fragments something I have often seen during secondary PNL. 1 Zhong W, et al. Percutaneous nephrolithotomy for renal stones following failed extracorporeal shockwave lithotripsy: different performances and morbidities. Urolithiasis. 2013 Apr;41(2):165-8. doi: 10.1007/s00240-013-0545-z See also: Li H, Hu XF, Deng L, Zhang L, Li H. Does prior failed shock-wave lithotripsy impact outcomes of ureterorenoscopy? A systematic review and meta-analysis. Eur Rev Med Pharmacol Sci. 2022 Apr;26(7):2501-2510. doi: 10.26355/eurrev_202204_28486.PMID: 35442465 Peter Alken
Saturday, 18 May 2024