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Reviewer's Choice 

López-Acón JD et al, 2017: Analysis of the Efficacy and Safety of Increasing the Energy Dose Applied Per Session by Increasing the Number of Shock Waves in Extracorporeal Lithotripsy: A Prospective and Comparative Study.

López-Acón JD, Budía Alba A, Bahílo-Mateu P, Trassierra-Villa M, de Los Ángeles Conca-Baenas M, de Guzmán Ordaz-Jurado D, Boronat FT.
Endourology and Lithotripsy Department, La Fe University and Polythecnic Hospital, Valencia, Spain.

Abstract

PURPOSE: To evaluate the efficacy and safety of increasing the energy dose in treating urinary lithiasis with extracorporeal lithotripsy through an expanded number of Shock Waves Per Session (SWPS). MATERIALS AND METHODS: a randomized, prospective, and comparative study was performed with patients with renal or ureteral lithiasis from 2011 to 2014. Two groups were studied: Group A (n = 136), treated with 3500 SWPS, and Group B (n = 171), subjected to an expanded treatment with 7000 SWPS. Patients were considered stone free when there was no lithiasis or it were less or equal to 4 mm after treatment. Variables related to the patient, stones, treatment, and complications were collected.
RESULTS: The global SFR was 75.0% and 87.7% in Groups A and B, respectively (p = 0.004). In renal location, the SFR was higher in Group B (74.1% vs 90.7%, p = 0.003) regardless of the size. In the ureteral location, there were differences in the pelvic only (73.7% vs 95.2%). There were no differences in either the complication rate (27.2% vs 25.7%, p = 0.77), or the severity between the two groups. The variable "number of SWPS" was seen to be an independent predictor of the resolution of lithiasis, having the probability of resolving lithiasis 2.62 (CI 95% = 1.40-4.89) times greater when applying 7000 SWPS.
CONCLUSION: In our study, increasing the energy dose applied through an expanded number of SWPS has been shown to be more effective than standard regimens with a similar safety profile. However, more clinical studies on different types of lithotripters are required to confirm these results.

J Endourol. 2017 Dec;31(12):1289-1294. doi: 10.1089/end.2017.0261. Epub 2017 Nov 15.

 

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Comments 1

Peter Alken on Monday, 16 April 2018 10:48

No ramping, 120 Hz, up to 7000 shots per session with good results and no difference in the complication rate in a prospective RCT!
“Traditionally, the number of waves administered per session has been established generically by the recommendations of each manufacturer, despite having no scientific studies that support these recommendations.” It is difficult to tell what the driving force for this study was. The authors must already have had some experience because the “sample size calculation was performed, assuming a
stone-free rate (SFR) with Group A of 70% and an expected rate of nearly 90% with Group B.” If the drop-out rates of 67 in group A and 32 in group B would be included as failures the results of group B would even have been better.
The relatively low and non-statistically different success rate after the first session in the two groups is difficult to understand.
Table modified from López-Acón JD et al. (López-Acón JD et al. Analysis of the Efficacy and Safety of Increasing the Energy Dose Applied Per Session by Increasing the Number of Shock Waves in Extracorporeal Lithotripsy: A Prospective and Comparative Study. J Endourol. 2017 Dec;31(12):1289-1294)
http://storzmedical.com/images/blog/Lopez-Acon_JD.JPG
The authors suggest more studies on their technique: “The parameter that should be used is the total energy dose applied per session and not the total number of shock waves applied, allowing for comparisons to be made between different lithotripters with the same energy source.”

No ramping, 120 Hz, up to 7000 shots per session with good results and no difference in the complication rate in a prospective RCT! “Traditionally, the number of waves administered per session has been established generically by the recommendations of each manufacturer, despite having no scientific studies that support these recommendations.” It is difficult to tell what the driving force for this study was. The authors must already have had some experience because the “sample size calculation was performed, assuming a stone-free rate (SFR) with Group A of 70% and an expected rate of nearly 90% with Group B.” If the drop-out rates of 67 in group A and 32 in group B would be included as failures the results of group B would even have been better. The relatively low and non-statistically different success rate after the first session in the two groups is difficult to understand. Table modified from López-Acón JD et al. (López-Acón JD et al. Analysis of the Efficacy and Safety of Increasing the Energy Dose Applied Per Session by Increasing the Number of Shock Waves in Extracorporeal Lithotripsy: A Prospective and Comparative Study. J Endourol. 2017 Dec;31(12):1289-1294) [img]http://storzmedical.com/images/blog/Lopez-Acon_JD.JPG[/img] The authors suggest more studies on their technique: “The parameter that should be used is the total energy dose applied per session and not the total number of shock waves applied, allowing for comparisons to be made between different lithotripters with the same energy source.”
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