Reviewer's Choice

Wu W et al, 2017: How to accelerate the upper urinary stone discharge after extracorporeal shockwave lithotripsy (ESWL) for bole (EPVL).

Friday, 23 March 2018

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Wu W, Yang Z, Tang F, Xu C, Wang Y, Gu X, Chen X, Wang R, Yan J, Wang X, Gao W, Hou C, Guo J, Zhang J, Gurioli A, Ye Z, Zeng G.
Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Urology, Guangzhou, 510230, China.
Department of Urology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Department of Urology, The Chinese Medicine Hospital of Jiangsu Province, Nanjing, China.
Department of Urology, The People's Hospital of Huzhou, Huzhou, China.
Department of Urology, The Tongji Hospital of Huazhong Science and Technology University, Wuhan, China.
Department of Urology, The Chinese Medicine Hospital of Hubei Province, Wuhan, China.
Department of Urology, The Zhongshan Hospital of Fudan University, Shanghai, China.
Department of Urology, Turin University of Studies, Turin, Italy.
Department of Urology, The Tongji Hospital of Huazhong Science and Technology University, Wuhan, China.

Abstract

OBJECTIVE: To asset the efficacy and safety of EPVL plus ESWL compared with ESWL alone for the treatment of simple upper urinary stones (< 15 mm).
MATERIALS AND METHODS: All patients with upper urinary stones (< 15 mm) were prospectively randomized into two groups. In treatment group, patients were assigned to immediate EPVL after ESWL, while in control group, ESWL alone was offered. All patients were reexamined at 1, 2, and 4 weeks after ESWL. Stone size, stone location, stone-free rate (SFR), and complication rate were compared. RESULTS: 56 males and 20 females in treatment group were compared to 52 male and 25 females in control group (p = 0.404). Median ages were 42.9 ± 1.5 years in treatment group and 42.7 ± 1.3 years in control group (p = 0.943). Median stone size was 10.0 ± 0.4 mm (3-15 mm) in treatment group and 10.4 ± 0.4 mm (4-15 mm) in control group (p = 0.622). The stone clearance rate in treatment and control group at 1 week after ESWL was 51.3% (39/76) and 45.4% (35/77) (p > 0.05), at 2 weeks was 81.6% (62/76) and 64.9% (50/77) (p < 0.05), and at 4 weeks was 90.8% (69/76) and 75.3% (58/77) (p < 0.05), respectively.
CONCLUSIONS: EPVL is a noninvasive, effective, and safe adjunctive treatment which increases and accelerates upper urinary stones discharge after ESWL treatment.

World J Urol. 2017 Dec 1. doi: 10.1007/s00345-017-2123-4. [Epub ahead of print]

Comments 1

Hans-Göran Tiselius on Friday, 23 March 2018 14:52

Different ideas have emerged with the aim of improving the end result of SWL and make this method attractive in comparison with endoscopic procedures. It is well recognized that the latter techniques currently is enthusiastically embraced by urologists. One explanation for that is that SWL by too many urologists is considered “boring” and generally associated with less efficient stone clearance.

With more than 30 years of experience with SWL using different lithotripters, various shortcomings have been addressed in terms of shockwave power, strategies of treatment and safety procedures.

Attempts to improve stone disintegration have been suggested as one way to achieve higher stone-free rates. My personal opinion is, however, that stone disintegration usually is satisfactory even though repeated sessions might be necessary to get sufficiently small fragments. But the absolutely most important shortcoming of SWL is the presence of residual fragments mainly in the lower calyces (LC). This is a consequence of the anatomy of the collecting system and usually not an effect of insufficient stone disintegration.

The new invention EPVL described in this report represents a highly interesting way to address the problem of LC residual fragments. EPVL is a device that enables improved non-invasive fragment removal. Previous methods using inversion and vibration have usually been carried out with equipments not ideally suited for this purpose. EPVL takes this form of treatment to a higher level.

It is of interest that fragment clearance in the authors’ experience was significantly better after 2 and 4 weeks with repeated sessions of EVPL. Unfortunately, the outcome is obscured by the large number of patients with ureteral stones. The number of patients with residuals in LC was numerically smaller with SWL+EPVL than with only SWL.

This device means a technical improvement and ´shows a highly interesting way to maintain a non-invasive treatment strategy while reducing the number of residual LC fragments. We thus should look forward to further studies with this device.

With more than 30 years of experience with SWL using different lithotripters, various shortcomings have been addressed in terms of shockwave power, strategies of treatment and safety procedures.

Attempts to improve stone disintegration have been suggested as one way to achieve higher stone-free rates. My personal opinion is, however, that stone disintegration usually is satisfactory even though repeated sessions might be necessary to get sufficiently small fragments. But the absolutely most important shortcoming of SWL is the presence of residual fragments mainly in the lower calyces (LC). This is a consequence of the anatomy of the collecting system and usually not an effect of insufficient stone disintegration.

The new invention EPVL described in this report represents a highly interesting way to address the problem of LC residual fragments. EPVL is a device that enables improved non-invasive fragment removal. Previous methods using inversion and vibration have usually been carried out with equipments not ideally suited for this purpose. EPVL takes this form of treatment to a higher level.

It is of interest that fragment clearance in the authors’ experience was significantly better after 2 and 4 weeks with repeated sessions of EVPL. Unfortunately, the outcome is obscured by the large number of patients with ureteral stones. The number of patients with residuals in LC was numerically smaller with SWL+EPVL than with only SWL.

This device means a technical improvement and ´shows a highly interesting way to maintain a non-invasive treatment strategy while reducing the number of residual LC fragments. We thus should look forward to further studies with this device.

Different ideas have emerged with the aim of improving the end result of SWL and make this method attractive in comparison with endoscopic procedures. It is well recognized that the latter techniques currently is enthusiastically embraced by urologists. One explanation for that is that SWL by too many urologists is considered “boring” and generally associated with less efficient stone clearance. With more than 30 years of experience with SWL using different lithotripters, various shortcomings have been addressed in terms of shockwave power, strategies of treatment and safety procedures. Attempts to improve stone disintegration have been suggested as one way to achieve higher stone-free rates. My personal opinion is, however, that stone disintegration usually is satisfactory even though repeated sessions might be necessary to get sufficiently small fragments. But the absolutely most important shortcoming of SWL is the presence of residual fragments mainly in the lower calyces (LC). This is a consequence of the anatomy of the collecting system and usually not an effect of insufficient stone disintegration. The new invention EPVL described in this report represents a highly interesting way to address the problem of LC residual fragments. EPVL is a device that enables improved non-invasive fragment removal. Previous methods using inversion and vibration have usually been carried out with equipments not ideally suited for this purpose. EPVL takes this form of treatment to a higher level. It is of interest that fragment clearance in the authors’ experience was significantly better after 2 and 4 weeks with repeated sessions of EVPL. Unfortunately, the outcome is obscured by the large number of patients with ureteral stones. The number of patients with residuals in LC was numerically smaller with SWL+EPVL than with only SWL. This device means a technical improvement and ´shows a highly interesting way to maintain a non-invasive treatment strategy while reducing the number of residual LC fragments. We thus should look forward to further studies with this device.

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