Tiwari AK, Sarkar D, Pal DK.
Urologia. 2022 Dec 14:3915603221140444. doi: 10.1177/03915603221140444
Abstract
Objectives: Evaluation of safety, efficacy, and feasibility of emergency extracorporeal shockwave lithotripsy (eESWL) in combating obstructing stones with colic on emergency basis.
Materials and methods: From November 2019 to November 2021, 102 subjects underwent emergency ESWL for obstructing ureteric and renal stones with colic within 24 h of presentation.
Results: Patients in this study belonged to age group of 18-67 years with mean being 39 years consisting of 85 males and 22 females (M:F = 85:22). Mean stone dimensions were 8.26 mm in length and 7.65 mm in width. A total of 42 patients had their stone in kidney or upper ureter while 24 patients had stone in mid ureter and remaining patients (n = 36) had stone in lower ureter. About 65 patients had their stone completely cleared after single ESWL session while 20 patients required multiple sessions to achieve complete clearance. Of these 17 patients (16.67%) were not rendered stone free even after three sessions and had to undergo ureteroscopic lithotripsy (URSL). Overall Stone Free Rate (SFR) was 83.33%. For stone attenuation of ⩽900 HU, SFR was 97.18% while for >900 HU it was only 51.61%.
Conclusion: eESWL is safe, feasible, and efficacious noninvasive alternative for definitive management of obstructing ureteral and renal stones with colic as far as stone clearance and rapid and definitive pain relief are concerned and that too with very minimal morbidity without the need for admission and hence can reduce the prolonged waiting period for endoscopic stone surgery in any high-volume tertiary care hospital. Length, width, and attenuation of stone were found to be the main factors dictating the success of eESWL.
Comment Hans-Göran Tiselius
This article provides valuable reading for all colleagues involved in the care of patients with urolithiasis. I completely agree with the authors that that emergency treatment with SWL in case of stone colic is insufficiently applied.
The authors report their experience in 102 patients in whom an overall stone-free rate of 83% was achieved. Interestingly, as many as 65 patients only required ONE SWL-session!
Early treatment of ureteral stones is considered important at a point of time when pronounced edema and impaction has not been fully established. It is of note that all treatments were carried out without anesthesia. Only when it was required, was injection of Diclofenac given. It is thus likely that the results had been even better with advanced analgetic/sedation regimen.
Emergency SWL treatment of patients with renal colic caused by stones (most of which are in the ureter) is a field that definitely should be given full attention at a time when URS worldwide is replacing SWL as first line stone removing tool.
Importantly, all treatments were carried out within 24h whereby the waiting time for planned URS could be avoided. The major advantage is rapid solution of severe pain, no patient preparation, outpatient treatment and very few side effects. Skin bruising and hematuria, mentioned in the report, in the reviewer’s opinion are not complications.
What is needed is an internal organization that allows emergency treatments. This step might require some important change in routines, but the benefits are obvious.
Read this article and take the necessary steps to accomplish rapid and efficient care of patients who very often are tremendously plagued by severe colic pain!
Hans-Göran Tiselius