Hüsnü Tokgöz, Özlem Tokgöz
lithotripsy (SWL). Urologia. 2025 Sep 11:3915603251377595. doi: 10.1177/03915603251377595
Abstract
no abstract available
Comment Peter Alken
Based on 4 own referenced studies of which I add two below (1,2), their critical argument on the paper of Zareian Baghdadabad et al (3) is: “Increasing the number of treatment sessions is typically associated with reduced patient tolerance, with the first session generally reported as the least painful. Based on these findings, it may be more appropriate to transition to minimally invasive treatment modalities if stone fragmentation is not achieved after the first or second session, rather than prolonging SWL therapy. In elderly female patients, however, our recent study demonstrated a lower perception of pain. For this subgroup, and considering the increased anesthesia-related risks associated with advanced age, scheduling a third or even fourth SWL session may represent a reasonable therapeutic strategy.”
If repeat EWSL as such is not the problem, I do not see a reason to turn to a “minimally invasive treatment modality” which has to be done under general anesthesia.
1. Tokgöz H, Yalçınkaya S, İslamoğlu E, et al. Lunar cycle may have an effect on shock wave lithotripsy related pain outcome. Ghana Med J 2017; 51(4): 181–186.
2. Islamoglu E, Tas S, Karamik K, et al. Does extracorporeal shock wave lithotripsy-related pain get affected by menstrual cycle and menopause? Urolithiasis 2019; 47(6): 575–581.
3 Zareian Baghdadabad L, Mohammadi A, Menbari Oskouie I, Alaeddini F, Farajidavar H, Oliveira Reis L, Aghamir SMK. Evaluation of the analgesic effect of a combination of oral acetaminophen and oxycodone after extracorporeal shock wave lithotripsy (SWL). Urologia. 2025 Aug;92(3):439-445. doi: 10.1177/03915603251317046. Epub 2025 Feb 14. PMID: 39950358.
Peter Alken
Based on 4 own referenced studies of which I add two below (1,2), their critical argument on the paper of Zareian Baghdadabad et al (3) is: “Increasing the number of treatment sessions is typically associated with reduced patient tolerance, with the first session generally reported as the least painful. Based on these findings, it may be more appropriate to transition to minimally invasive treatment modalities if stone fragmentation is not achieved after the first or second session, rather than prolonging SWL therapy. In elderly female patients, however, our recent study demonstrated a lower perception of pain. For this subgroup, and considering the increased anesthesia-related risks associated with advanced age, scheduling a third or even fourth SWL session may represent a reasonable therapeutic strategy.”
If repeat EWSL as such is not the problem, I do not see a reason to turn to a “minimally invasive treatment modality” which has to be done under general anesthesia.
1. Tokgöz H, Yalçınkaya S, İslamoğlu E, et al. Lunar cycle may have an effect on shock wave lithotripsy related pain outcome. Ghana Med J 2017; 51(4): 181–186.
2. Islamoglu E, Tas S, Karamik K, et al. Does extracorporeal shock wave lithotripsy-related pain get affected by menstrual cycle and menopause? Urolithiasis 2019; 47(6): 575–581.
3 Zareian Baghdadabad L, Mohammadi A, Menbari Oskouie I, Alaeddini F, Farajidavar H, Oliveira Reis L, Aghamir SMK. Evaluation of the analgesic effect of a combination of oral acetaminophen and oxycodone after extracorporeal shock wave lithotripsy (SWL). Urologia. 2025 Aug;92(3):439-445. doi: 10.1177/03915603251317046. Epub 2025 Feb 14. PMID: 39950358.
Peter Alken