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Noureldin YA. et al., 2023: The effect of piezo-lithotripsy with 2-and 8-mm focus sizes on stone disintegration and renal injury.

Department of Urology, Faculty of Medicine, Benha University, Benha, Egypt.
Division of Clinical Sciences, Northern Ontario School of Medicine, Thunder Bay, ON, Canada.
Department of Clinical and Chemical Pathology, Faculty of Medicine, Benha University, Benha, Egypt.
Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.

Abstract

Objectives: To compare the efficacy and safety of shock-wave lithotripsy (SWL) using a narrow-focus and wide-focus for renal stones.

Methods: A double-blind randomized trial included adult patients with solitary radio-opaque renal pelvic stone 1-2 cm. Patients were randomized into two groups; narrow-focus (2 mm) SWL and wide-focus (8mm) SWL. The stone-free rate (SFR) and presence of complications such as hematuria, fever, pain, and peri-renal hematoma were evaluated. Preoperative and postoperative urinary markers (NGAL and KIM-1) levels were compared to assess the renal injury.

Results: A total of 135 patients were recruited for this study. The SFR after the first SWL session was 79.2% and 69.1% in narrow- and wide-focus groups, respectively. There was a comparable rise in the median (IQR) 2-hour NGAL level in both groups (p= 0.62). However, the rise in the median (IQR) 2-hour KIM-1 level was significantly higher in the narrow-focus 4.9 (4.6, 5.8) ng/mL compared with the wide-focus group 4.4 (3.2, 5.7) ng/mL; (p=0.02). Nevertheless, 3-day urinary markers were significantly improved in NGAL and in KIM-1 (p= 0.263 and 0.963), respectively. The overall SFR after three sessions was 86.6% and 86.8% in narrow- and wide-focus groups, respectively (p=0.77). Both groups were comparable in complications, apart from the median (IQR) pain score and the percentage of high-grade hematuria which were significantly higher in the narrow-focus group (p<0.001and p=0.03), respectively.

Conclusion: Narrow-focus and wide-focus SWL were associated with comparable outcomes and re-treatment rates. However, narrow-focus lithotripsy was associated with significantly higher morbidity in terms of pain and hematuria.

BJU Int. 2023 May 22. doi: 10.1111/bju.16083. Online ahead of print.PMID: 37216189

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Comments 1

Peter Alken on Friday, 15 September 2023 08:45

Patients were equally satisfied in both groups: 77.6 % and 77.9 %. If it is recommended to apply the different focus in different conditions, I wonder why the basic data of both groups examined were not different. Seems to make no sense as the differing indications could not be evaluated.

Peter Alken

Patients were equally satisfied in both groups: 77.6 % and 77.9 %. If it is recommended to apply the different focus in different conditions, I wonder why the basic data of both groups examined were not different. Seems to make no sense as the differing indications could not be evaluated. Peter Alken
Monday, 20 May 2024