Treatment of Moderate-sized Kidney Stone with Third-generation Electromagnetic Shock Wave Lithotripter

Authors

  • Ivica Stojanoski Department of Urology, General Hospital “8th September”, Skopje, Republic of Macedonia
  • Toni Krstev Department of Urology, General Hospital “8th September”, Skopje, Republic of Macedonia
  • Lazar Iievski Department of Urology, General Hospital “8th September”, Skopje, Republic of Macedonia
  • Nerhim Tufekgioski Department of Urology, General Hospital “8th September”, Skopje, Republic of Macedonia
  • Sotir Stavridis University Clinic of Urology, Skopje, Republic of Macedonia

DOI:

https://doi.org/10.3889/oamjms.2020.5258

Keywords:

ESWL, nephrolithiasis, renal stones, moderate sized renal stone, electromagnetic shock wave lithotripter

Abstract

BACKGROUND: The extracorporeal shock wave lithotripsy (ESWL) is a non-invasive method in the treatment of urinary tract stones and its discovery has led to a complete change in the therapeutic strategy for urolithiasis. Due to the low morbidity and excellent fragmentation of the stones, ESWL has proven to be an effective and non-invasive method in the treatment of renal stones.

AIM: The aim of this retrospective study is to evaluate the efficacy and safety of the ESWL as a monotherapy in the treatment of moderate size kidney stones with stone area (SA) of 100–300 mm².

MATERIALS AND METHODS: We made a retrospective study of 98 patients with moderate size kidney stones with SA of 100–300 mm², divided into two subgroups, into a group with a SA of 100–200 mm² and with 200–300 mm², treated with ESWL in the period of November 2018–December 2019. The patients were treated with a third-generation electromagnetic lithotripter (Lithoskop®, Siemens Medical Systems, Erlangen, Germany), with a source of electromagnetic shocks (Pulso™) and dual ultrasonographic/fluoroscopic system for detection of the stones. The stone location, size, maximum energy used, localization technique, number of shock waves, sessions, re-treatment rate, and additional procedures were reviewed. All the patients before the intervention had a complete laboratory and radiological examinations. Postoperatively, patients were monitored on the 1st, 30th, and 90th post-operative days.

RESULTS: Ninety-eight patients with solitary kidney stone with a SA of 100–300 mm² were treated with ESWL. The study included 58 men (59.18%) and 44 women (40.81%). The average length and width of the stone were 15.47 ± 2.68 mm and 12.99 ± 2.83 mm, respectively. The average surface area of the stones in our series was 203.78 ± 72.85 mm². The mean number of treatments for the entire series of patients was 1.82 ± 0.91. The mean number of shock waves for the total series of patients was 3899.11 ± 40. The mean energy used for the overall patient series was 110106.17 ± 21489.61 mJ. The total re-treatment rate was 47.95%. The entire rate of additional procedures was 19.38%. The overall success rate (SR) in our study was 77.55%. The efficiency quotient for the upper-middle and lower calyx was 55.57, 57.15, and 30.81, respectively.

CONCLUSION: ESWL is a safe and effective method in the treatment of renal stones, and we recommend as the first method in the treatment of moderate size kidney stone with a surface area of 100–300 mm². The treatment of each patient should be individualized and take into account all favored and non-favored factors that influence the decision to choose extracorporeal lithotripsy as a method of treatment of medium-sized stones.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

Stamatelou KK, Francis ME, Jones CA, Nyberg LM, Curhan GC. Time trends in reported prevalence of kidney stones in the United States: 1976-1994. Kidney Int. 2003;63(5):1817-23. https://doi.org/10.1046/j.1523-1755.2003.00917.x PMid:12675858

Chaussy C, Brendel W, Schmiedt E. Extracorporeally induced destruction of kidney stones by shock waves. Lancet. 1980;2(8207):1265-8. https://doi.org/10.1016/ s0140-6736(80)92335-1 PMid:6108446

Chaussy C, Schmiedt E, Jocham D, Brendel W, Forssmann B, Walther V. First clinical experience with extracorporeally induced destruction of kidney stones by shock waves. J Urol. 1982;127(3):417-20. https://doi.org/10.1016/j.juro.2016.10.104 PMid:6977650

Gerber R, Studer UE, Danuser H. Is newer always better? A comparative study of 3 lithotriptor generations. J Urol. 2005;173(6):2013-6. https://doi.org/10.1097/01. ju.0000158042.41319.c4 PMid:15879807

Türk C, Knoll T, Petrik A, Sarica K, Skolarikos A, Straub M, et al. Guidelines on Urolithiasis. Arnhem, Netherlands: European Association of Urology; 2013. https://doi.org/10.1016/j. eururo.2015.07.041

Motola JA, Smith AD. Therapeutic options for the management of upper tract calculi. Urol Clin North Am. 1990;17(1):191-206. PMid:1968301

Fuchs GJ, Patel A. Treatment of renal calculi. In: Smith AD, Badlani GH, Bagley DH, editors. Smith’s Textbook of Endourology. St Louis: Quality Medical Publishing; 1996. p. 590-621.

Rassweiler J, Tailly G, Chaussy C. Progress in lithotripter technology. EAU Update Series. 2005;3(1):17. https://doi. org/10.1016/j.euus.2004.11.003

Leistner R, Wendt-Nordahl G, Grobholz R, Michel MS, Marlinghaus E, Köhrmann KU, et al. A new electromagnetic shock-wave generator “SLX-F2” with user-selectable dual focus size: Ex vivo evaluation of renal injury. Urol Res. 2007;35(4):165. https://doi.org/10.1007/s00240-007-0097-1 PMid:17483935

Neisius A, Wöllner J, Thomas C, Roos FC, Brenner W, Hampel C, at al. Treatment efficacy and outcomes using a third generation shockwave lithotripter. BJU Int. 2013;112(7):972-81. https://doi.org/10.1111/bju.12159 PMid:24118958

Saxby MF, Sorahan T Slaney P, Coppinger SW. A case-control study of percutaneous nephrolithotomy versus extracorporeal shock wave lithotripsy. Br J Urol. 1997;79(3):317-23. https://doi. org/10.1046/j.1464-410x.1997.00362.x PMid:9117207

Cecen K, Karadag MA, Demir A, Bagcioglu M, Kocaaslan R, Sofikerim M. Flexible ureterorenoscopy versus extracorporeal shock wave lithotripsy for the treatment of upper/middle calyx kidney stones of 10-20 mm: A retrospective analysis of 174 patients. Springerplus. 2014;3(1):557. https://doi. org/10.1186/2193-1801-3-557 PMid:25332859

El-Damanhoury H, Scharfe T, Ruth J, Roos S, Hohenfellner R. Extracorporeal shock wave lithotripsy of urinary calculi: Experience in treatment of 3,278 patients using the Siemens Lithostar and Lithostar plus. J Urol. 1991;145(3):484. https://doi. org/10.1016/s0022-5347(17)38375-1

Graff J, Diederichs W, Schulze H. Long-term followup in 1,003 extracorporeal shock wave lithotripsy patients. J Urol. 1988;140(3):479. https://doi.org/10.1016/ s0022-5347(17)41696-x PMid:3411655

Öbek C, Onal B, Kantay K, Kalkan M, Yalçin V, Oner A, et al. The efficacy of extracorporeal shock wave lithotripsy for isolated lower pole calculi compared with isolated middle and upper caliceal calculi. J Urol. 2001;166(6):2081. https://doi. org/10.1016/s0022-5347(05)65509-7 PMid:11696710

Sahinkanat T, Ekerbicer H, Onal B, Tansu N, Resim S, Citgez S, et al. Evaluation of the effects of relationships between main spatial lower pole calyceal anatomic factors on the success of shock-wave lithotripsy in patients with lower pole kidney stones. Urology. 2008;71(5):801-5. https://doi.org/10.1016/j. urology.2007.11.052 PMid:18279941

Lingeman JE, Siegel YI, Steele B, Nyhuis AW, Woods JR. Management of lower pole nephrolithiasis: A critical analysis. J Urol. 1994;151(3):663-7. https://doi.org/10.1016/ s0022-5347(17)35042-5 PMid:8308977

Netto NR Jr., Claro JF, Lemos GC, Cortado PL. Renal calculi in lower pole calices: What is the best method of treatment? J Urol. 1991;146(3):721. https://doi.org/10.1016/ s0022-5347(17)37905-3 PMid:1875480

Rao PP, Desai RM, Sabnis RB, Patel HS, Desai MR. The relative cost-effectiveness of PCNL and ESWI, for medium sized (<2cm), renal calculi in a tertiary care urological referral center. Indian J Urol. 2001;17(2):121-3.

You YD, Kim JM, Kim ME. Comparison of the cost and effectiveness of different medical options fortreating lower calyceal stones less than 2 cm: Extracorporeal shock wave lithotripsy versus percutaneou nephrolithotomy. Korean J Urol. 2006;47(7):703-7. https://doi.org/10.4111/kju.2006.47.7.703

Kumar A, Kumar N, Vasudeva P, Jha SK, Kumar R, Singh H. A prospective, randomized comparison of shock wave lithotripsy, retrograde intrarenal surgery and miniperc for treatment of 1 to 2 cm radiolucent lower calyceal renal calculi: A single center experience. J Urol. 2015;193(1):160-4. https://doi.org/10.1016/j. juro.2014.07.088 PMid:25066869

Bierkens AF, Hendrikx AJ, de Kort VJ, de Reyke T, Bruynen CA, Bouve ER, et al. Efficacy of second generation lithotriptors: A multicenter comparative study of 2,206 extracorporeal shock wave lithotripsy treatments with the Siemens Lithostar, Dornier HM4, wolf piezolith 2300, direx tripter X-1 and breakstone lithotriptors. J Urol. 1992;148(3):1052. https://doi. org/10.1016/s0022-5347(17)36814-3

Evan AP, Willis LR, Connors B, Reed G, McAteer JA, Lingeman JE. Shock wave lithotripsy-induced renal injury. Am J Kidney Dis. 1991;17(4):445. https://doi.org/10.1016/s0272-6386(12)80639-1 PMid:2008914

Bas O, Bakirtas H, Sener NC, Ozturk U, Tuygun C, Goktug HN, et al. Comparisn of shock wave lithotripsy, flexible ureterorenoscopy and percutaneous nephrolithotripsy onmoderate size renal pelvis stones. Urolithiasis. 2014;42(2):115120. https://doi.org/10.1007/s00240-013-0615-2 PMid:24162954

Turna B, Ekren F, Nazli O, Akbay K, Altay B, Ozyurt C, et al. Comparative results of shockwave lithotripsy for renal calculi in upper, middle, and lower calices. J Endourol. 2007;21(9):951-6. https://doi.org/10.1089/end.2006.0275 PMid:17941767

Downloads

Published

2020-08-30

How to Cite

1.
Stojanoski I, Krstev T, Iievski L, Tufekgioski N, Stavridis S. Treatment of Moderate-sized Kidney Stone with Third-generation Electromagnetic Shock Wave Lithotripter. Open Access Maced J Med Sci [Internet]. 2020 Aug. 30 [cited 2024 Mar. 29];8(B):851-7. Available from: https://oamjms.eu/index.php/mjms/article/view/5258

Most read articles by the same author(s)