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Kurkar A. et al., 2022: Predictors of successful emergency shock wave lithotripsy for acute renal colic.

Kurkar A, Elderwy AA, Osman MM, Abdelkawi IF, Shalaby MM, Abdelhafez MF.
Department of Urology, Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt.
Department of Urology, Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt.

Abstract

The role of emergency shockwave lithotripsy (SWL) in persistent pain control in patients with ureteral stones is not well established. The aim of this study is to evaluate efficacy as well as the predicting variables for successful early SWL patients with symptomatic ureteral stones. Eighty-six patients with a persistent renal colic secondary to single ureteral stone (6-12 mm) were prospectively enrolled in this study. SWL was performed within 24 h of the onset of flank pain. Pain control and stone-free rate after emergency SWL session were 58.1% and 44.2%, respectively. Seven patients required post-SWL ureteroscopy and ureteral stent placement for uncontrolled pain. The overall 3-month stone-free rate after SWL monotherapy was 83.7%. On multivariate analysis, predictors for pain relief after emergency SWL were lower Hounsfield (HU) stone density, mild hydronephrosis (HN) at presentation and presentation during the first colic episode. Lower HU stone density was the single predictor of successful stone clearance after single emergency SWL session on multivariate analysis. In conclusion, early SWL is feasible and effective in management of ureteral stones presented by renal colic with low HU.
Urolithiasis. 2022 Jun 3. doi: 10.1007/s00240-022-01332-3. Online ahead of print. PMID: 35657411. FREE ARTICLE

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Comments 1

Hans-Göran Tiselius on Wednesday, 05 October 2022 10:45

It has been emphasized repeatedly that early SWL of ureteral stones is advantageous. Accordingly, patients with acute renal colic caused by ureteral stones would benefit from early intervention both in terms of reduced pain and stone disintegration. That is also my own experience.

The percentage of pain-free patients in this series of treatment was only 58% and the stone-free rate not more than 44%, which is lower than I expected following early intervention.

The lessons learnt from this review of 86 patients were that low stone density (low HU) was the most important predictor. Moreover, mild hydronephrosis is of value and, perhaps most important, SWL should be carried out in direct relation to the FIRST colic episode.

Even though the results in this study were less successful than expected they are good enough to support early emergency SWL.

Hans-Göran Tiselius

It has been emphasized repeatedly that early SWL of ureteral stones is advantageous. Accordingly, patients with acute renal colic caused by ureteral stones would benefit from early intervention both in terms of reduced pain and stone disintegration. That is also my own experience. The percentage of pain-free patients in this series of treatment was only 58% and the stone-free rate not more than 44%, which is lower than I expected following early intervention. The lessons learnt from this review of 86 patients were that low stone density (low HU) was the most important predictor. Moreover, mild hydronephrosis is of value and, perhaps most important, SWL should be carried out in direct relation to the FIRST colic episode. Even though the results in this study were less successful than expected they are good enough to support early emergency SWL. Hans-Göran Tiselius
Thursday, 23 May 2024