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Desoky EA et al, 2016: Immediate versus delayed shockwave lithotripsy for inaccessible stones after uncomplicated percutaneous nephrolithotomy.

Desoky EA, Fawzi AM, Sakr A, Eliwa A, El Sayed ER, El Sayed D, Shahin AM, Salem EA, Kamel HM, Shabana W, Kamel M.
Department of Urology, Faculty of Medicine, Zagazig University Hospital, Zagazig University, Zagazig, Egypt.

Abstract

OBJECTIVE: To evaluate the efficacy and safety of immediate versus delayed shockwave lithotripsy (SWL) for inaccessible stones after uncomplicated percutaneous nephrolithotomy (PCNL).
PATIENTS AND METHODS: Between December 2011 and June 2014, patients with residual inaccessible stones after uncomplicated PCNL were prospectively randomised into two treatment groups; Group I, immediate SWL and Group II, delayed SWL at 1 week after PCNL. Patients with residual stones of ⩾1.5 cm, a stone density of >1000 Hounsfield units and body mass index of >40 kg/m2 were excluded from the study. The following data were reported: patients' demographics, stone characteristics after PCNL, hospital stay, perioperative complications, stent duration, and stone-free rate (SFR).
RESULTS: In all, 84 patients (51 males and 33 females) with mean (SD) age of 39 (8.5) years were included in the study. Group I included 44 patients, whilst Group II included 40 patients. There was no statistically significant difference amongst the groups for patients' demographics, stone characteristics, and perioperative complications. The hospital stay was significantly shorter in Group I, at a mean (SD) of 34 (3.7) vs 45 (2.9) h (P < 0.001). The duration of ureteric stenting was significantly lower in Group I as compared to Group II, at a mean (SD) of 12 (4.2) vs 25 (3.5) days (P < 0.001). The SFR was 93.2% and 95% in Groups I and II, respectively (P = 0.9).
CONCLUSIONS: Immediate SWL after PCNL is as effective and safe as delayed SWL with a lesser hospital stay and duration of ureteric stenting.

Arab J Urol. 2016 Dec 28;15(1):30-35. doi: 10.1016/j.aju.2016.11.002.

 

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Комментарии 1

Peter Alken в 21.06.2017 07:15

Too good to simply replicate.
The most dangerous complication after PNL is SIRS or Sepsis which is most frequent in patients with urinary tract infection or after the treatment of infectious stones respectively.
No information is given about the possibility that these conditions were present in this patient material and no information is given if patients with these conditions were excluded from the study. Antibiotic therapy is not mentioned. I would not like to shock a kidney that may within hours after PNL become the focus of SIRS or even sepsis.
“A subfebrile body temperature developed in five patients (11.4%) in Group I and five patients (12.5%) in Group II (P = 0.84). No sepsis was detected in our present study“.
The percentage with fever is relatively low. May be the risks mentioned were not existing in the present study or patients were excluded without specifying it in the publication.

Too good to simply replicate. The most dangerous complication after PNL is SIRS or Sepsis which is most frequent in patients with urinary tract infection or after the treatment of infectious stones respectively. No information is given about the possibility that these conditions were present in this patient material and no information is given if patients with these conditions were excluded from the study. Antibiotic therapy is not mentioned. I would not like to shock a kidney that may within hours after PNL become the focus of SIRS or even sepsis. “A subfebrile body temperature developed in five patients (11.4%) in Group I and five patients (12.5%) in Group II (P = 0.84). No sepsis was detected in our present study“. The percentage with fever is relatively low. May be the risks mentioned were not existing in the present study or patients were excluded without specifying it in the publication.
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