Sheir KZ et al, 2014: Evaluation of Acute Post-Shock Wave Lithotripsy Renal Changes by Dynamic Magnetic Resonance Imaging: A Prospective Clinical Study.
Sheir KZ, El-Ghar MA, El Shal A, Elsaadany MM, Taha DE, El-Nahas AR
Departments of Urology and Radiology (MAEG), Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
PURPOSE: We studied acute renal morphological and hemodynamic changes after shock wave lithotripsy of renal stones. MATERIALS AND METHODS: A total of 60 adult patients with a single renal stone 25 mm or less in a radiologically normal urinary tract were eligible for shock wave lithotripsy and included in analysis. Study exclusion criteria were hypertension, diabetes mellitus, previous recent stone
management and other contraindications to shock wave lithotripsy. Renal perfusion and morphological changes were evaluated by dynamic magnetic resonance imaging before, and 2 to 4 hours and 1 week after lithotripsy. RESULTS: In all cases there was a
statistically significant decrease in renal perfusion 1 week after shock wave lithotripsy compared to before and 2 to 4 hours after lithotripsy (aortic blood flow 66% vs 71% and 72%, respectively, p <0.05). At 1-week followup 39 unobstructed renal units (65%) showed no significant difference in renal perfusion at any time while 21 (35%) obstructed renal units showed a significant decrease in renal perfusion compared to before and 2 to 4 hours after lithotripsy (63% vs 76% and 75%, p = 0.003 and 0.005, respectively). Hematomas were observed in 7 cases (12%) 2 to 4 hours after lithotripsy, of which 5 were subcapsular and 2 were intrarenal. Three subcapsular hematomas resolved after 1 week. Localized loss of corticomedullary differentiation was observed in 2 patients (3.3%) with intrarenal hematoma 2 to 4 hours after treatment. Generalized loss of corticomedullary differentiation was observed 1 week after lithotripsy in 5 cases (8.3%). CONCLUSIONS: Shock wave lithotripsy alone induces minimal, reversible acute renal morphological changes and does not induce significant changes in renal perfusion. Posttreatment obstruction has a major effect on renal perfusion on the treated side and must be managed urgently.
J Urol. 2014 Jun 27. pii: S0022-5347(14)03912-3. doi: 10.1016/j.juro.2014.06.074. [Epub ahead of print]
The message is: These MRI studies do not show post-ESWL findings that are different from what we already know: they are minimal and transient. A post-ESWL obstruction caused a reduction of the renal perfusion estimated as renal-to-aortic blood flow ratio. But there were no follow-up studies of these patients; it is not known how and with what effect they were treated. Hence I do not think that the conclusion “Posttreatment obstruction has a major effect on renal perfusion on the treated side and must be managed urgently” is justified by the data.