Türk H et al, 2017: Effects of previous unsuccessful extracorporeal shockwave lithotripsy treatment on the performance and outcome of percutaneous nephrolithotomy.
Türk H, Yoldaş M, Süelözgen T, İşoğlu CS, Karabıçak M, Ergani B, Ün S.
Dumlupınar University, Evliya Celebi Training and Research Hospital, Department of Urology, Kutahya, Turkey.
Tepecik Training and Research Hospital, Department of Urology, Izmir, Turkey.
Ataturk Training and Research Hospital, Department of Urology, Izmir, Turkey.
OBJECTIVE: To evaluate the effects of previous unsuccessful extracorporeal shockwave lithotripsy (ESWL) treatment on the performance and outcome of percutaneous nephrolithotomy (PCNL).
PATIENTS AND METHODS: Of 1625 PCNL procedures performed in our clinic, 393 renal units with similar stone burden and number of accesses was included in the present study. We categorised the study patients into two groups according to whether they underwent ESWL within 1 year prior to PCNL or not. Accordingly, Group 1 comprised 143 (36.3%) ESWL-treated patients and Group 2 comprised 250 (63.7%) non-ESWL-treated patients.
RESULTS: Residual stones were detected in 36 (25.1%) of the ESWL-treated patients (Group 1) and in 60 (24%) of non-ESWL-treated patients (Group 2). There were no statistically significant differences between the groups for length of hospital stay (LOS), nephrostomy tube removal time, and the presence of residual stones. When we evaluated the groups for both the preoperative and postoperative haemoglobin (Hb) drop and blood transfusion rate, manifest Hb declines and more transfusions were required in the ESWL-treated patients (both P = 0.01).
CONCLUSIONS: In our study, previous ESWL treatment had no influence on the PCNL stone-free rate, operation time, incidence of postoperative complications, and LOS, in patients with similar stone burdens. However, bleeding during PCNL was more prevalent in the ESWL-treated patients, so close attention should be paid to bleeding in patients who have been pretreated with ESWL.
Arab J Urol. 2017 Apr 7;15(2):94-99. doi: 10.1016/j.aju.2017.01.009. eCollection 2017 Jun. FREE ARTICLE
It is difficult to draw reasonable conclusions from this retrospective analysis of the outcome of PCNL with or without previous SWL. Although details are given for the PCNL procedure no information is provided on how SWL was carried out in terms of shockwave number, energy or duration of the treatment. No information is presented on stone composition in any of the two groups.
The bottom-line is that the SFR was almost identical in the two groups and that the only observed difference was increased bleeding in patients who had been treated with SWL.
Although it was concluded that partial disintegration of stones before PCNL prolonged the procedure this might be an effect of treating relatively small stones with SWL. In a recent article it was shown that SWL before PCNL of large stones might be successfully applied .
1. He XZ, Ou TW, Cui X, Li J, Wang SH. Analysis of the safety and efficacy of combined extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy for the treatment of complex renal calculus. Eur Rev Med Pharmacol Sci. 2017 21(11): 2567-2571.