Lu YM et al, 2016: Is Extracorporeal Shock Wave Lithotripsy Really Safe in Long-Term Follow-Up? A Nationwide Retrospective 6-Year Age-Matched Non-Randomized Study.

Thursday, 08 June 2017

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Lu YM, Chien TM, Chou YH, Wu WJ, Huang CN.
Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.

Abstract

INTRODUCTION: Shock wave lithotripsy (SWL) is widely used. However, several studies have reported increased blood pressure immediately after SWL. Until now, the association between SWL and new-onset hypertension has been a topic of discussion. This study is aimed at determining whether SWL leads to new-onset hypertension.
METHODS: Data were sourced from the Longitudinal Health Insurance Database 2000 of Taiwan, Republic of China, which was compiled from 1996 to 2010 using National Health Insurance data. Patients who had undergone SWL were compared with controls that were matched for age, sex, obesity, diabetes mellitus, and hyperlipidemia.
RESULTS: Patients who had undergone SWL had a higher incidence of new-onset hypertension compared to the control groups. Furthermore, new hypertension developed faster in the SWL group.
CONCLUSIONS: The results of this study demonstrated that an association exists between nephrolithiasis patients who were treated with SWL and subsequent hypertension diagnosis. Patients who undergo SWL may need regular follow-up of blood pressure.

Urol Int. 2016 Oct 13. [Epub ahead of print]

Comments 2

Peter Alken on Thursday, 08 June 2017 11:52

I do not believe any more in ESWL induced hypertension if described in studies which are based on reviews of statistics without seeing and examining the patients. Stone patients as such have a higher risk of hypertension.
In Krambeck’s “landmark” paper which is quoted and quoted again also in the present paper (Krambeck AE, et al. Diabetes mellitus and hypertension associated with shock wave lithotripsy of renal and proximal ureteral stones at 19 years of follow-up. J Urol. 2006;175:1742–1747) the conclusion was:
” At 19 years of followup SWL for renal and proximal ureteral stones was associated with the development of hypertension and diabetes mellitus.” This was based on questionnaires sent to 578 patients with a response rate of only 58.9%. Only 18,6 % of the patients were actually seen during the follow up without an information when they were seen. The control group consisted of a weird group of stone patients:
“Controls were selected from patients diagnosed and followed at our institution in whom urolithiasis was managed nonsurgically.”
Stone patients who do not need a therapy during 19 years of follow up must have a disease very different from those patients who were treated. So they are no real controls.
“Medical records of the control group were retrospectively reviewed in the same manner as those of the cases.” The manner is not properly described.
The conclusion was not justified and has never been directly but only indirectly revoked.

Now to the present paper: The result is: “Patients who had undergone SWL had a higher incidence of new-onset hypertension compared to the control groups” and the conclusion is “an association exists between nephrolithiasis patients who were treated with SWL and subsequent hypertension diagnosis.”
The same authors have published 2016 a paper: Tsu-Ming Chien , Yen-Man Lu, Yii-Her Chou, Wen-Jeng Wu, Chun-Nung Huang: Shock wave lithotripsy for renal stones is not associated with development of hypertension in Taiwan's Chinese population. Urological Science (http://dx.doi.org/10.1016/j.urols.2016.05.088)
The conclusion is based on the same patient material. The text of the two publications is partially identical.
The authors do not reference their publications.
I think that this is a good example of fooling and misleading readers of scientific journals. I would call it fraud.

Now to the present paper: The result is: “Patients who had undergone SWL had a higher incidence of new-onset hypertension compared to the control groups” and the conclusion is “an association exists between nephrolithiasis patients who were treated with SWL and subsequent hypertension diagnosis.”
The same authors have published 2016 a paper:  Tsu-Ming Chien , Yen-Man Lu, Yii-Her Chou, Wen-Jeng Wu, Chun-Nung Huang: Shock wave lithotripsy for renal stones is not associated with development of hypertension in Taiwan's Chinese population.  Urological Science (http://dx.doi.org/10.1016/j.urols.2016.05.088) 
The conclusion is based on the same patient material. The text of the two publications is partially identical.
The authors do not reference their publications. 
I think that this is a good example of fooling and misleading readers of scientific journals. I would call it fraud.

I do not believe any more in ESWL induced hypertension if described in studies which are based on reviews of statistics without seeing and examining the patients. Stone patients as such have a higher risk of hypertension. In Krambeck’s “landmark” paper which is quoted and quoted again also in the present paper (Krambeck AE, et al. Diabetes mellitus and hypertension associated with shock wave lithotripsy of renal and proximal ureteral stones at 19 years of follow-up. J Urol. 2006;175:1742–1747) the conclusion was: ” At 19 years of followup SWL for renal and proximal ureteral stones was associated with the development of hypertension and diabetes mellitus.” This was based on questionnaires sent to 578 patients with a response rate of only 58.9%. Only 18,6 % of the patients were actually seen during the follow up without an information when they were seen. The control group consisted of a weird group of stone patients: “Controls were selected from patients diagnosed and followed at our institution in whom urolithiasis was managed nonsurgically.” Stone patients who do not need a therapy during 19 years of follow up must have a disease very different from those patients who were treated. So they are no real controls. “Medical records of the control group were retrospectively reviewed in the same manner as those of the cases.” The manner is not properly described. The conclusion was not justified and has never been directly but only indirectly revoked. Now to the present paper: The result is: “Patients who had undergone SWL had a higher incidence of new-onset hypertension compared to the control groups” and the conclusion is “an association exists between nephrolithiasis patients who were treated with SWL and subsequent hypertension diagnosis.” The same authors have published 2016 a paper: Tsu-Ming Chien , Yen-Man Lu, Yii-Her Chou, Wen-Jeng Wu, Chun-Nung Huang: Shock wave lithotripsy for renal stones is not associated with development of hypertension in Taiwan's Chinese population. Urological Science (http://dx.doi.org/10.1016/j.urols.2016.05.088) The conclusion is based on the same patient material. The text of the two publications is partially identical. The authors do not reference their publications. I think that this is a good example of fooling and misleading readers of scientific journals. I would call it fraud.

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Hans-Göran Tiselius on Thursday, 08 June 2017 10:21

The two articles referred to (by the same group of authors) represent an amazing scientific story. In the two articles, based on data from the same National database in Taiwan and submitted for publication within only three months, the authors present two opposite conclusions regarding the risk of developing hypertension as a consequence of SWL. In the first article there was no significant difference but in the other one there was. The authors do neither state why the second data extraction was made nor why they found it necessary to repeat the analysis. Surprisingly, there is absolutely no reference to their first report.

I have tried to find an explanation for this kind of contradictory “double publication”. In the article that was submitted first (March 2016) the authors found 940 patients treated with SWL. In the second article (submitted June 2016) they found 1500 SWL-treated patients (from the same National registry!). The control-groups of patients in the two studies, with the same criteria, were 2820 and 7500. Obviously the authors did not believe in their results in study 1 (that did not show hypertension) and therefore made a new obviously adapted search that better would correspond to their hypothesis of increased incidence of hypertension? Inasmuch as no information is available on when and how the blood pleasure was measured it also seems impossible to draw any conclusion on the time of onset of hypertension.

These two articles is a scary example of how the information from registries can be used to demonstrate anything that supports a specific hypothesis or idea.

Although “double publications” not infrequently are observed, it is exceptional that two publications on the same subject and submitted not more than three months apart present completely opposite conclusions. The first article published in August and the second one in October 2016.

Reading these two articles was indeed a useful lesson. They give rise to two major concerns. It obviously seems possible to find support for any kind of outcome, just by appropriately selecting the subjects from large registries. Can we really trust authors and published information?

I have tried to find an explanation for this kind of contradictory “double publication”. In the article that was submitted first (March 2016) the authors found 940 patients treated with SWL. In the second article (submitted June 2016) they found 1500 SWL-treated patients (from the same National registry!). The control-groups of patients in the two studies, with the same criteria, were 2820 and 7500. Obviously the authors did not believe in their results in study 1 (that did not show hypertension) and therefore made a new obviously adapted search that better would correspond to their hypothesis of increased incidence of hypertension? Inasmuch as no information is available on when and how the blood pleasure was measured it also seems impossible to draw any conclusion on the time of onset of hypertension.

These two articles is a scary example of how the information from registries can be used to demonstrate anything that supports a specific hypothesis or idea.

Although “double publications” not infrequently are observed, it is exceptional that two publications on the same subject and submitted not more than three months apart present completely opposite conclusions. The first article published in August and the second one in October 2016.

Reading these two articles was indeed a useful lesson. They give rise to two major concerns. It obviously seems possible to find support for any kind of outcome, just by appropriately selecting the subjects from large registries. Can we really trust authors and published information?

The two articles referred to (by the same group of authors) represent an amazing scientific story. In the two articles, based on data from the same National database in Taiwan and submitted for publication within only three months, the authors present two opposite conclusions regarding the risk of developing hypertension as a consequence of SWL. In the first article there was no significant difference but in the other one there was. The authors do neither state why the second data extraction was made nor why they found it necessary to repeat the analysis. Surprisingly, there is absolutely no reference to their first report. I have tried to find an explanation for this kind of contradictory “double publication”. In the article that was submitted first (March 2016) the authors found 940 patients treated with SWL. In the second article (submitted June 2016) they found 1500 SWL-treated patients (from the same National registry!). The control-groups of patients in the two studies, with the same criteria, were 2820 and 7500. Obviously the authors did not believe in their results in study 1 (that did not show hypertension) and therefore made a new obviously adapted search that better would correspond to their hypothesis of increased incidence of hypertension? Inasmuch as no information is available on when and how the blood pleasure was measured it also seems impossible to draw any conclusion on the time of onset of hypertension. These two articles is a scary example of how the information from registries can be used to demonstrate anything that supports a specific hypothesis or idea. Although “double publications” not infrequently are observed, it is exceptional that two publications on the same subject and submitted not more than three months apart present completely opposite conclusions. The first article published in August and the second one in October 2016. Reading these two articles was indeed a useful lesson. They give rise to two major concerns. It obviously seems possible to find support for any kind of outcome, just by appropriately selecting the subjects from large registries. Can we really trust authors and published information?

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