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Minguez Ojeda C. et al., 2023: Is extracorporeal lithotripsy a first-line treatment for urinary stones today?

Minguez Ojeda C, Laso García I, López Curtis D, Duque Ruiz G, Mata Alcaraz M, Santiago González M, Artiles Medina A, Hevia Palacios M, Arias Fúnez F, Burgos Revilla FJ.
Servicio de Urología, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid. Spain.
Servicio de Urología, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid. Spain.

Abstract

Objective: To evaluate the efficacy and complications of extracorporeal lithotripsy (SWL) as a first-line treatment for renal and ureteral stones METHODS: Retrospective and observational study of all the patients treated with lithotripsy in a third level center between January 2014 and January 2021; characteristics of the patients, the stones, complications and results of SWL is recollected. Multivariate logistic regression of the factors associated with stone size reduction was performed. A statistical analysis of the factors associated with additional treatment after SWL and factors associated with complications is also executed.

Results: 1727 patients are included. Stone mean size was 9,5mm. 1540 (89.4%) patients presented reduction in stone size. In multivariate analysis, stone size (OR=1.13; p=0.00), ureteral location of the lithiasis (OR=1.15; p=0.052) and number of waves (p=0.002; OR=1.00) used in SWL are the factors associated with reduction of stone size. Additional treatment after lithotripsy was needed in 665 patients (38.5%). The factors associated with the need for retreatment were stone size (OR=1.131; p=0.000), number of waves (OR=1.000; p=0.000), energy (OR=1.005; p=0.000). 153 patients (8.8%) suffered complications after SWL. A statistically significant association was found between the size of the lithiasis (p=0.024, OR=1.054) and the previous urinary diversion (P=0.004, OR=0.571).

Conclusion: Lithotripsy remains an effective treatment as the first line of therapy for reno-ureteral lithiasis with a low percentage of complications.

Actas Urol Esp (Engl Ed). 2023 Aug 30:S2173-5786(23)00104-X. doi: 10.1016/j.acuroe.2023.08.006. Online ahead of print. PMID: 37657709 English, Spanish. FREE ARTICLE

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Comments 1

Peter Alken on Tuesday, 28 May 2024 11:00

“Additional treatment after lithotripsy was needed in 665 patients (38.5%). Up to 486 patients (28.1%) received at least another lithotripsy session, 98 patients (5.7%) required ureteroscopy and 65 (3.8%) required RIRS after lithotripsy.” The term “reduction in stone size” is no defined. The result of ESWL was determined after 4---6 weeks with abdominal X-ray, ultrasound or CT scan.

“Stone-free rate (SFR), was defined as the presence of residual fragments below 5 mm.” This was achieved in 1188 patients (68.8%). The complication rate was low.
If these data are accepted as indicators to answer the question of the title, the conclusion is right: “We can therefore conclude that lithotripsy is still an effective treatment as the first line therapy for the majority of reno-ureteral lithiasis.”

Peter Alken

“Additional treatment after lithotripsy was needed in 665 patients (38.5%). Up to 486 patients (28.1%) received at least another lithotripsy session, 98 patients (5.7%) required ureteroscopy and 65 (3.8%) required RIRS after lithotripsy.” The term “reduction in stone size” is no defined. The result of ESWL was determined after 4---6 weeks with abdominal X-ray, ultrasound or CT scan. “Stone-free rate (SFR), was defined as the presence of residual fragments below 5 mm.” This was achieved in 1188 patients (68.8%). The complication rate was low. If these data are accepted as indicators to answer the question of the title, the conclusion is right: “We can therefore conclude that lithotripsy is still an effective treatment as the first line therapy for the majority of reno-ureteral lithiasis.” Peter Alken
Friday, 12 July 2024