Nimisha Singh et al., 2024: Prospective Evaluation of Extracorporeal Shockwave Lithotripsy in Renal and Upper Ureteric Stone Treatment: Clinical Assessment and Results

Nimisha Singh 1 2 , Shikhar Agarwal 3 , Rajeev Sarpal 3
1General Surgery, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, IND.
2Plastic and Reconstructive Surgery, Jawaharlal Nehru Medical College (JNMC) Aligarh Muslim University (AMU), Aligarh, IND.
3Urology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, IND.

Abstract

Introduction: Extracorporeal shockwave lithotripsy (ESWL) is a widely accepted non-invasive treatment for renal and upper ureteric stones smaller than 2 cm due to its safety and efficacy. Despite advancements in minimally invasive techniques, extracorporeal shockwave lithotripsy remains an important modality.

Aims and objective: This prospective observational study aimed to evaluate the outcomes of ESWL in managing renal and upper ureteric stones measuring less than 2 cm in terms of stone clearance.

Material and methods: In a study conducted at a university-affiliated tertiary care hospital, 119 patients with renal and upper ureteric stones underwent extracorporeal shockwave lithotripsy over a 12-month period. Data on patient demographics, stone characteristics, treatment procedures, and complications were collected. Follow-up assessments were performed at two-week intervals for up to two months post-treatment.

Results: The mean age of patients was 39.78 years, with a mean stone size of 1.2 cm. Right kidney stones were more prevalent (61.3% [n=76]). Complications included fever (19.3% [n=23]), gross haematuria (24.3% [n=29]), and steinstrasse (21.8% [n=26]). The success rate of extracorporeal shockwave lithotripsy was 81.5% (n=97), with 18.5% (n=22) of patients requiring surgical intervention due to incomplete fragmentation or residual fragments >4 mm. Stone size and density played significant roles in treatment success.

Conclusion: Despite advancements in minimally invasive techniques, ESWL retains its significance as a noninvasive and effective treatment option for renal and upper ureteric stones smaller than 2 cm. Its success depends on various factors, including the stone site, size, and composition. ESWL offers advantages such as minimal morbidity, shorter hospital stays, and better patient compliance. Complications such as steinstrasse are manageable with conservative measures or ancillary procedures. While ESWL may be losing ground in some cases, its noninvasive nature and favourable outcomes make it a valuable option in the armamentarium for stone management.

Cureus. 2024 May 26;16(5):e61102. doi: 10.7759/cureus.61102. eCollection 2024 May.
PMID: 38800778 PMCID: PMC11128184 DOI: 10.7759/cureus.61102