SWL literature
SWL Literature

Soliman MG. et al., 2020: Extracorporeal shock wave lithotripsy for distal ureteric stones: which is the ideal approach?

Soliman MG, Gameel T, El-Tatawy H, El-Abd AS.
Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.

Abstract

Objective: To compare the safety and efficacy of different approaches using ESWL for management of distal ureteric stone in an attempt to select the ideal one.

Patients and methods: This is a prospective randomized single-center study conducted on patients with lower third single radiopaque ureteric stone with size less than 15 mm. Patients were randomized into three groups, group A: Supine transgluteal, group B: Modified prone and group C: Prone position (80 patients each). The success of the procedure was assessed by NCCT and is defined as complete stone removal or had only clinically insignificant fragments (< 3 mm) for a maximum of three sessions. The success rate, rate of complications, pain intensity by visual pain scale and patients' satisfaction rate were compared among the three study groups.

Results: Data of 240 patients were analyzed (80 in each group). Overall, no significant difference has been observed among all groups regarding demographic data, stone and treatment characteristics. The overall success rates for treatment after the last session were 86.3%, 65% and 62.5% in the three study groups, respectively, with a statistically significant difference for group A. Regarding pain perception and complication rate, all groups were comparable. Patient satisfaction is significantly better in group A versus the other two groups.

Conclusion: Our study has confirmed better efficacy profile and patients' satisfaction rate of ESWL in the supine position (transgluteal approach) than other different known approaches for the treatment of distal ureteral stones.
Int Urol Nephrol. 2020 Dec;52(12):2269-2274. doi: 10.1007/s11255-020-02572-1. Epub 2020 Jul 18. PMID: 32683658.

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Commentaires 1

Hans-Göran Tiselius le jeudi 28 janvier 2021 08:30

SWL of distal ureteral stones is usually successful and in my own experience the stone-free rate was 97.8% with an average number of sessions of 1.22. There is a window in the pelvic skeleton that allows passage of the shockwave to the stone without significant interference with skeletal structures. My personal preference has been to treat patients in supine position whenever possible, but it is extremely important to adjust patient position so that the shock wave passes at distance from the skeleton.

There are, however, some situations in which prone position is a superior alternative and that is the case when it is difficult or impossible to avoid hitting bone structures. This is particularly the case for stones located within ~ 2 cm below the sacroiliac joint. SWL in prone position requires passage of the shockwave without interference with intestinal gas and if gas is in the shockwave path the treatment will fail. When patients with distal ureteral stones were treated with Storz Modulith SLX F2 lithotripter only 9% were managed in prone position [1]. My personal experience thus is in agreement with what is reported in the article.

Reference.
Tiselius HG. How efficient is extracorporeal shockwave lithotripsy with modern lithotripters for removal of ureteral stones? J Endourology 2008; 22; 249-255

Hans-Göran Tiselius

SWL of distal ureteral stones is usually successful and in my own experience the stone-free rate was 97.8% with an average number of sessions of 1.22. There is a window in the pelvic skeleton that allows passage of the shockwave to the stone without significant interference with skeletal structures. My personal preference has been to treat patients in supine position whenever possible, but it is extremely important to adjust patient position so that the shock wave passes at distance from the skeleton. There are, however, some situations in which prone position is a superior alternative and that is the case when it is difficult or impossible to avoid hitting bone structures. This is particularly the case for stones located within ~ 2 cm below the sacroiliac joint. SWL in prone position requires passage of the shockwave without interference with intestinal gas and if gas is in the shockwave path the treatment will fail. When patients with distal ureteral stones were treated with Storz Modulith SLX F2 lithotripter only 9% were managed in prone position [1]. My personal experience thus is in agreement with what is reported in the article. Reference. Tiselius HG. How efficient is extracorporeal shockwave lithotripsy with modern lithotripters for removal of ureteral stones? J Endourology 2008; 22; 249-255 Hans-Göran Tiselius
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lundi 27 septembre 2021

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