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BMC Urology
Published in: BMC Urology 1/2020

01-12-2020 | Ultrasound | Research article

Comparison of ultrasound-assisted and pure fluoroscopy-guided extracorporeal shockwave lithotripsy for renal stones

Authors: Tsung-Hsin Chang, Wun-Rong Lin, Wei-Kung Tsai, Pai-Kai Chiang, Marcelo Chen, Jen-Shu Tseng, Allen W. Chiu

Published in: BMC Urology | Issue 1/2020

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Abstract

Background

In this study, we aimed to compare the efficacy and clinical outcomes of shock wave lithotripsy (SWL) for patients with renal stones using pure fluoroscopy (FS) or ultrasound-assisted (USa) localization with two lithotripters.

Methods

We retrospectively identified 425 patients with renal calculi who underwent SWL with either a LiteMed LM-9200 ELMA lithotripter (209 cases), which combined ultrasound and fluoroscopic stone targeting or a Medispec EM-1000 lithotripter machine (216 cases), which used fluoroscopy for stone localization and tracking. The patient demographic data, stone-free rates, stone disintegration rates, retreatment rates and complication rates were analyzed.

Results

The USa group had a significantly higher overall stone-free rate (43.6 vs. 28.2%, p < 0.001) and stone disintegration rate (85.6 vs. 64.3%, p < 0.001), as well as a significantly lower retreatment rate (14.8 vs. 35.6%, p < 0.001) and complication rate (1.9 vs. 5.5%, p = 0.031) compared with the FS group. This superiority remained significant in the stone size < 1 cm stratified group. In the stone size > 1 cm group, the stone-free rate (32.4 vs. 17.8%, p = 0.028), disintegration rate (89.2 vs. 54.8%, p = 0.031) and retreatment rate (21.6 vs. 53.4%, p < 0.001) were still significantly better in the USa group, however there was no significant difference in the complication rate. The most common complication was post-SWL-related flank pain.

Conclusion

SWL is a safe and non-invasive way of treating renal stones. This study compared two electromagnetic shock wave machines with different stone tracking systems. LiteMed LM-9200 ELMA lithotripter, which combined ultrasound and fluoroscopic stone targeting outperformed Medispec EM-1000 lithotripter, which used fluoroscopy for stone localization and tracking, with better stone-free rates and disintegration rates, as well as lower retreatment rates and complications with possible reduced radiation exposure.
Literature
1.
Chaussy C, Brendel W, Schmiedt E. Extracorporeally induced destruction of kidney stones by shock waves. Lancet (London, England). 1980;2(8207):1265–8. CrossRef
2.
Fialkov JM, Hedican SP, Fallon B. Reassessing the efficacy of the Dornier MFL-5000 lithotriptor. J Urol. 2000;164(3 Pt 1):640–3. PubMedCrossRef
3.
Nafie S, Dyer JE, Minhas JS, Mills JA, Khan MA. Efficacy of a mobile lithotripsy service: a one-year review of 222 patients. Scand J Urol. 2014;48(3):324–7. PubMedCrossRef
4.
Chung VY, Turney BW. The success of shock wave lithotripsy (SWL) in treating moderate-sized (10–20 mm) renal stones. Urolithiasis. 2016;44(5):441–4. PubMedCrossRef
5.
Nielsen TK, Jensen JB. Efficacy of commercialised extracorporeal shock wave lithotripsy service: a review of 589 renal stones. BMC Urol. 2017;17(1):59. PubMedPubMedCentralCrossRef
6.
Abdel-Khalek M, Sheir KZ, Mokhtar AA, Eraky I, Kenawy M, Bazeed M. Prediction of success rate after extracorporeal shock-wave lithotripsy of renal stones–a multivariate analysis model. Scand J Urol Nephrol. 2004;38(2):161–7. PubMedCrossRef
7.
Lee CC, Lin WR, Hsu JM, Chow YC, Tsai WK, Chiang PK, Chen M, Chiu AW. Comparison of electrohydraulic and electromagnetic extracorporeal shock wave lithotriptors for upper urinary tract stones in a single center. World J Urol. 2019;37(5):931–5. PubMedCrossRef
8.
El-Nahas AR, El-Assmy AM, Mansour O, Sheir KZ. A prospective multivariate analysis of factors predicting stone disintegration by extracorporeal shock wave lithotripsy: the value of high-resolution noncontrast computed tomography. Eur Urol. 2007;51(6):1688–93 (discussion 1693–1684). PubMedCrossRef
9.
Nakasato T, Morita J, Ogawa Y. Evaluation of Hounsfield Units as a predictive factor for the outcome of extracorporeal shock wave lithotripsy and stone composition. Urolithiasis. 2015;43(1):69–75. PubMedCrossRef
10.
Cui HW, Devlies W, Ravenscroft S, Heers H, Freidin AJ, Cleveland RO, Ganeshan B, Turney BW. CT Texture analysis of ex vivo renal stones predicts ease of fragmentation with shockwave lithotripsy. J Endourol. 2017;31(7):694–700. PubMedCrossRef
11.
Williams JC Jr, Paterson RF, Kopecky KK, Lingeman JE, McAteer JA. High resolution detection of internal structure of renal calculi by helical computerized tomography. J Urol. 2002;167(1):322–6. PubMedCrossRef
12.
Patel T, Kozakowski K, Hruby G, Gupta M. Skin to stone distance is an independent predictor of stone-free status following shockwave lithotripsy. J Endourol. 2009;23(9):1383–5. PubMedCrossRef
13.
Handa RK, McAteer JA, Connors BA, Liu Z, Lingeman JE, Evan AP. Optimising an escalating shockwave amplitude treatment strategy to protect the kidney from injury during shockwave lithotripsy. BJU Int. 2012;110(11 Pt C):E1041-1047. PubMedPubMedCentralCrossRef
14.
Pace KT, Ghiculete D, Harju M, Honey RJ. Shock wave lithotripsy at 60 or 120 shocks per minute: a randomized, double-blind trial. J Urol. 2005;174(2):595–9. PubMedCrossRef
15.
Davenport K, Minervini A, Keoghane S, Parkin J, Keeley FX, Timoney AG. Does rate matter? The results of a randomized controlled trial of 60 versus 120 shocks per minute for shock wave lithotripsy of renal calculi. J Urol. 2006;176(5):2055–8 (discussion 2058). PubMedCrossRef
16.
Kroczak T, Scotland KB, Chew B, Pace KT. Shockwave lithotripsy: techniques for improving outcomes. World J Urol. 2017;35(9):1341–6. PubMedCrossRef
17.
Suramo I, Paivansalo M, Myllyla V. Cranio-caudal movements of the liver, pancreas and kidneys in respiration. Acta Radiol. 1984;25(2):129–31.
18.
Kuwahara M, Kambe K, Taguchi K, Saito T, Shirai S, Orikasa S. Initial experience using a new type extracorporeal lithotripter with an anti-misshot control device. J Lithotr Stone Dis. 1991;3(2):141–6. PubMed
19.
Chen CJ, Hsu HC, Chung WS, Yu HJ. Clinical experience with ultrasound-based real-time tracking lithotripsy in the single renal stone treatment. J Endourol. 2009;23(11):1811–5. PubMedCrossRef
20.
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. PubMedCrossRef
21.
Turk C, Petrik A, Sarica K, Seitz C, Skolarikos A, Straub M, Knoll T. EAU Guidelines on Interventional Treatment for Urolithiasis. Eur Urol. 2016;69(3):475–82. PubMedCrossRef
22.
Pradere B, Doizi S, Proietti S, Brachlow J, Traxer O. Evaluation of guidelines for surgical management of urolithiasis. J Urol. 2018;199(5):1267–71. PubMedCrossRef
23.
Wiesenthal JD, Ghiculete D, Ray AA, Honey RJ, Pace KT. A clinical nomogram to predict the successful shock wave lithotripsy of renal and ureteral calculi. J Urol. 2011;186(2):556–62. PubMedCrossRef
24.
Handa RK, Bailey MR, Paun M, Gao S, Connors BA, Willis LR, Evan AP. Pretreatment with low-energy shock waves induces renal vasoconstriction during standard shock wave lithotripsy (SWL): a treatment protocol known to reduce SWL-induced renal injury. BJU Int. 2009;103(9):1270–4. PubMedCrossRef
25.
Honey RJ, Schuler TD, Ghiculete D, Pace KT. A randomized, double-blind trial to compare shock wave frequencies of 60 and 120 shocks per minute for upper ureteral stones. J Urol. 2009;182(4):1418–23. PubMedCrossRef
26.
Li K, Lin T, Zhang C, Fan X, Xu K, Bi L, Han J, Huang H, Liu H, Dong W, et al. Optimal frequency of shock wave lithotripsy in urolithiasis treatment: a systematic review and meta-analysis of randomized controlled trials. J Urol. 2013;190(4):1260–7. PubMedCrossRef
27.
Yilmaz E, Batislam E, Basar M, Tuglu D, Mert C, Basar H. Optimal frequency in extracorporeal shock wave lithotripsy: prospective randomized study. Urology. 2005;66(6):1160–4. PubMedCrossRef
28.
Lee C, Best SL, Ugarte R, Monga M. Impact of learning curve on efficacy of shock wave lithotripsy. Radiol Technol. 2008;80(1):20–4. PubMed
29.
Okada A, Yasui T, Taguchi K, Niimi K, Hirose Y, Hamamoto S, Ando R, Kubota Y, Umemoto Y, Tozawa K, et al. Impact of official technical training for urologists on the efficacy of shock wave lithotripsy. Urolithiasis. 2013;41(6):487–92. PubMedCrossRef
30.
Chang CC, Liang SM, Pu YR, Chen CH, Manousakas I, Chen TS, Kuo CL, Yu FM, Chu ZF. In vitro study of ultrasound based real-time tracking of renal stones for shock wave lithotripsy: part 1. J Urol. 2001;166(1):28–32. PubMedCrossRef
31.
Chang CC, Manousakas I, Pu YR, Liang SM, Chen CH, Chen TS, Yu FM, Yang WH, Tong YC, Kuo CL. In vitro study of ultrasound based real-time tracking for renal stones in shock wave lithotripsy: part II—a simulated animal experiment. J Urol. 2002;167(6):2594–7. PubMedCrossRef
32.
Smith HE, Bryant DA, KooNg J, Chapman RA, Lewis G. Extracorporeal shockwave lithotripsy without radiation: ultrasound localization is as effective as fluoroscopy. Urol Ann. 2016;8(4):454–7. PubMedPubMedCentralCrossRef
33.
Van Besien J, Uvin P, Hermie I, Tailly T, Merckx L. Ultrasonography is not inferior to fluoroscopy to guide extracorporeal shock waves during treatment of renal and upper ureteric calculi: a randomized prospective study. Biomed Res Int. 2017;2017:7802672. PubMedPubMedCentral
34.
Richardson RB. Stem cell niches and other factors that influence the sensitivity of bone marrow to radiation-induced bone cancer and leukaemia in children and adults. Int J Radiat Biol. 2011;87(4):343–59. PubMedPubMedCentralCrossRef
35.
Goren MR, Goren V, Ozer C. Ultrasound-guided shockwave lithotripsy reduces radiation exposure and has better outcomes for pediatric cystine stones. Urol Int. 2017;98(4):429–35. PubMedCrossRef
Metadata
Title
Comparison of ultrasound-assisted and pure fluoroscopy-guided extracorporeal shockwave lithotripsy for renal stones
Authors
Tsung-Hsin Chang
Wun-Rong Lin
Wei-Kung Tsai
Pai-Kai Chiang
Marcelo Chen
Jen-Shu Tseng
Allen W. Chiu
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Urology / Issue 1/2020
Electronic ISSN: 1471-2490
DOI
https://doi.org/10.1186/s12894-020-00756-6

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