Thiel DD et al, 2011: Evaluation of pancreatic damage after extracorporeal shock wave lithotripsy, percutaneous stone surgery, and ureteroscopy
Thiel DD, Brisson TE, Heckman MG, Arnold M, Haley W, Khambhati J, Wehle MJ, Igel TC, Parker AS.
Department of Urology, Mayo Clinic Jacksonville, Jacksonville, Florida.
OBJECTIVES: To complete a prospective evaluation of serum amylase and lipase levels before and after shock wave lithotripsy (SWL) for renal stones. We also compared these serum levels to those of patients undergoing percutaneous and ureteroscopic stone surgery. SWL injury to the pancreas should be noted by an increase in serum amylase and lipase.
METHODS: A prospective evaluation of 38 patients (16 who underwent SWL, 15 who underwent percutaneous nephrostolithotomy, and 7 who underwent ureteroscopic stone manipulation) who underwent treatment of renal calculi at our institution was completed. The control group was the combined group of patients who had undergone percutaneous nephrostolithotomy or ureteroscopic stone manipulation. The serum amylase and lipase levels were measured before the procedure, immediately after the procedure (2 hours), and ≥30 days after the procedure.
RESULTS: No statistically significant difference was found in the change from before to immediately after the procedure between the SWL group and the controls in amylase (median decrease 6 U/L vs 11 U/L, P = .45) or lipase (median decrease 4 U/L vs 9 U/L, P = .31). Also, no statistically significant evidence was seen in the change from before to >30 days after the procedure between the SWL group and controls in the amylase level (median increase 0 U/L vs 2 U/L, P = 1.00) or lipase (median change 2 U/L increase vs 1 U/L decrease, P = .96).
CONCLUSIONS: SWL does not appear to noticeably increase the serum amylase and lipase level directly postoperatively or >30 days after the procedure compared with baseline or compared with the controls.
Copyright © 2011 Elsevier Inc. All rights reserved.
Urology. 2011 Jun;77(6):1288-91. doi: 10.1016/j.urology.2010.08.066. Epub 2011 Jan 7
PMID: 21215433 [PubMed - in process]
In 2006 Krambeck et al reported that ESWL was associated with an increased long term risk of diabetes mellitus. This is another publication that prospectively shows no acute reaction of pancreatic enzymes within 30 days after ESWL. Cases of PNL and URS served as control. In the comment section the authors correctly remark that “It is not known whether the findings of the study by Krambeck et al. were secondary to the uniqueness of the shock path and focal area of the HM-3 lithotripter.”