Extremely-slow, half-number shockwave lithotripsy for asymptomatic renal stones <20 mm

다국어 초록 (Multilingual Abstract)

Purpose: To compare the treatment success rate and safety of reduced (30 shocks/min, 1,200 shocks/session) versus standard (60 shocks/min, 2,400 shocks/session) extracorporeal shockwave lithotripsy for the management of renal stones.
Materials and Methods: We retrospectively analyzed 404 patients who underwent extracorporeal shockwave lithotripsy for 5–20-mm renal stones between April 2011 and March 2019. Patients selected the reduced or standard protocol (group R and S) after explaining the potential benefits and disadvantages. The primary outcome was treatment success within 12 weeks, which was defined as no residual fragment or fragments <4 mm on ultrasonography and plain radiograph.
Results: In total, 94 and 310 patients underwent shockwave lithotripsy with a reduced and standard protocol, respectively. The background characteristics of the participants did not significantly differ. The treatment success within 12 weeks was achieved in 78 (83.0%) patients in group R and 259 (83.5%) in group S (p=0.88). The median number of the session was 3 (interquartile range, 2–4) in both groups (p=0.53). The total complication rates were 5.4% in group R and 6.1% in group S. Three (1.0%) patients in group S experienced perirenal hematoma, which was conservatively treated. The reduced protocol was not associated with treatment success in the multivariate analysis adjusted for potential confounders (odds ratio, 0.91; 95% confidence interval, 0.46–1.80; p=0.78).
Conclusions: The new treatment amendment with a slower delivery rate successfully reduced the total number of shocks need to fragment renal stones <20 mm without compromising the stone-free rate.

참고문헌 (Reference)

1 Pishchalnikov YA, "Why stones break better at slow shockwave rates than at fast rates : in vitro study with a research electrohydraulic lithotripter" 20 : 537-541, 2006

2 Al-Dessoukey AA, "Ultraslow full-power shock wave lithotripsy versus slow power-ramping shock wave lithotripsy in stones with high attenuation value : a randomized comparative study" 27 : 165-170, 2020

3 Kanno T, "The utility of the kidneys-ureters-bladder radiograph as the sole imaging modality and its combination with ultrasonography for the detection of renal stones" 104 : 40-44, 2017

4 Sugino Y, "The usefulness of the maximum Hounsfield units(HU)in predicting the shockwave lithotripsy outcome for ureteral stones and the proposal of novel indicators using the maximum HU" 48 : 85-91, 2020

5 Semins MJ, "The effect of shock wave rate on the outcome of shock wave lithotripsy : a meta-analysis" 179 : 194-197, 2008

6 Madbouly K, "Slow versus fast shock wave lithotripsy rate for urolithiasis : a prospective randomized study" 173 : 127-130, 2005

7 Kroczak T, "Shockwave lithotripsy : techniques for improving outcomes" 35 : 1341-1346, 2017

8 Pace KT, "Shock wave lithotripsy at 60 or 120 shocks per minute : a randomized, doubleblind trial" 174 : 595-599, 2005

9 Lingeman JE, "Shock wave lithotripsy : advances in technology and technique" 6 : 660-670, 2009

10 Evan AP, "Renal injury during shock wave lithotripsy is significantly reduced by slowing the rate of shock wave delivery" 100 : 624-627, 2007

11 Connors BA, "Reducing shock number dramatically decreases lesion size in a juvenile kidney model" 20 : 607-611, 2006

12 Pearle MS, "Prospective, randomized trial comparing shock wave lithotripsy and ureteroscopy for lower pole caliceal calculi 1 cm or less" 173 : 2005-2009, 2005

13 Chongruksut W, "Prognostic factors for success in treating kidney stones by extracorporeal shock wave lithotripsy" 94 : 331-336, 2011

14 Robert M, "Piezoelectric lithotripsy of ureteral stones : influence of shockwave frequency on sedation and therapeutic efficiency" 13 : 157-160, 1999

15 Lee SM, "Optimisation of shock wave lithotripsy: a systematic review of technical aspects to improve outcomes" 8 (8): S389-S397, 2019

16 Li K, "Optimal frequency of shock wave lithotripsy in urolithiasis treatment : a systematic review and meta-analysis of randomized controlled trials" 190 : 1260-1267, 2013

17 Yilmaz E, "Optimal frequency in extracorporeal shock wave lithotripsy : prospective randomized study" 66 : 1160-1164, 2005

18 Kanda Y, "Investigation of the freely available easy-to-use software 'EZR' for medical statistics" 48 : 452-458, 2013

19 Wiksell H, "Implications of cavitation phenomena for shot intervals in extracorporeal shock wave lithotripsy" 75 : 720-723, 1995

20 Muhammad Waqas, "Evaluating the importance of different computed tomography scan-based factors in predicting the outcome of extracorporeal shock wave lithotripsy for renal stones" 대한비뇨의학회 59 (59): 25-31, 2018

21 Türk C, "EAU Guidelines on urolithiasis" EAU Guidelines Office

22 Davenport K, "Does rate matter? The results of a randomized controlled trial of 60 versus 120 shocks per minute for shock wave lithotripsy of renal calculi" 176 : 2055-2058, 2006

23 Nishiyama R, "Does SWL for ureteral stone with less than 60 shock waves per minute improve treatment results?" 105 : 97-101, 2014

24 Vakalopoulos I, "Development of a mathematical model to predict extracorporeal shockwave lithotripsy outcome" 23 : 891-897, 2009

25 Li WM, "Clinical predictors of stone fragmentation using slow-rate shock wave lithotripsy" 79 : 124-128, 2007

26 Budía Alba A, "Analysis of the safety profile of treatment with a large number of shock waves per session in extracorporeal lithotripsy" 39 : 291-295, 2015

27 López-Acón JD, "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" 31 : 1289-1294, 2017

28 Ganesan V, "Accuracy of ultrasonography for renal stone detection and size determination : is it good enough for management decisions?" 119 : 464-469, 2017

29 Dhar NB, "A multivariate analysis of risk factors associated with subcapsular hematoma formation following electromagnetic shock wave lithotripsy" 172 (172): 2271-2274, 2004

30 Nussberger F, "A low or high BMI is a risk factor for renal hematoma after extracorporeal shock wave lithotripsy for kidney stones" 45 : 317-321, 2017