PD23-07 PROSPECTIVE, RANDOMIZED CONTROLLED TRIAL COMPARING THREE DIFFERENT MODALITIES OF LITHOTRITES FOR INTRACORPOREAL LITHOTRIPSY IN PCNL
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You have accessJournal of UrologyStone Disease: Surgical Therapy IV1 Apr 2016PD23-07 PROSPECTIVE, RANDOMIZED CONTROLLED TRIAL COMPARING THREE DIFFERENT MODALITIES OF LITHOTRITES FOR INTRACORPOREAL LITHOTRIPSY IN PCNL Nadya York, Michael S. Borofsky, Casey A. Dauw, and James E. Lingeman Nadya YorkNadya York More articles by this author , Michael S. BorofskyMichael S. Borofsky More articles by this author , Casey A. DauwCasey A. Dauw More articles by this author , and James E. LingemanJames E. Lingeman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1746AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Percutaneous nephrolithotomy (PCNL) is the standard treatment for large renal calculi. A number of intracorporeal devices are used to fragment the stones. We compared the efficiency and complications of three models of lithotrites in treating stones >2cm. METHODS From October 2009 to July 2015, 241 patients were enrolled at 10 centers in North America. Patients were randomized to one of three lithotriptor devices, the Cyberwand (Olympus, Center Valley, PA), a dual probe ultrasonic device, Lithoclast Select (Boston Scientific, Marlborough, MA) combining the pneumatic and ultrasonic modalities, and the StoneBreakerTM (Cook Medical, Bloomington, IN), a portable pneumatic device powered by CO2 cartridges. Power calculations to detect a 25% difference in devices with 82% power required 70 subjects in each of the three study groups. We present study results for the 241 patients who have completed the study so far. RESULTS Of the total of 241 patients, 190 were treated with one of the three lithotriptor models. 9 patients were excluded before randomization (7 due to consent issues, 2 not meeting eligibility criteria). Another 42 patients did not proceed once randomized; this was due to device failure/unavailability (13), poor access/visibility (10), consent/eligibility issues (6) and other reasons (13). 81 patients were randomized to Cyberwand device, 73 to Lithoclast Select and 78 to Stonebreaker. The results are presented in Table 1. The baseline characteristics of the patient groups were similar. The stone clearance rate (mm2/min) varied from 23.0 for StoneBreaker to 29.1 for Lithoclast Select to 31.4 for Cyberwand. The stone-free rate at the completion of the primary procedure ranged from 51.7% for StoneBreaker to 66.7% for Lithoclast Select. Post operative complication rates were similar at 14.1-15.9%. CONCLUSIONS The interim results of this prospective randomized multicentre study reveal stone clearance rates from 23.0 mm2/min to 31.4 mm2/min between the three brands of lithotriptor devices tested. Complications and stone clearance rates were comparable. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e508 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Nadya York More articles by this author Michael S. Borofsky More articles by this author Casey A. Dauw More articles by this author James E. Lingeman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...Keywords:
Modalities
Treatment modality
Shock wave lithotripsy
Shock wave lithotripsy has been considered a mainstay of therapy for renal calculi for the last 20 years. Shock wave lithotripsy is noninvasive and requires the least anesthesia of the treatment modalities for treatment of renal calculi and therein lies its popularity. In the last decade, however, there have been changes in thinking regarding methods of patient selection for shock wave lithotripsy, changes in the technique of the existing shock wave lithotriptors and new technologies designed to increase the efficacy of shock wave lithotriptors.New studies have shown that shock wave lithotripsy may be less effective than other modalities for treating lower pole stones. Other existing technologies, such as computerized tomography, are being used to more effectively select patients for shock wave lithotripsy. Ongoing studies are evaluating changing the shock wave rate to increase stone fragmentation. In addition, efforts are being made to improve lithotripsy by designing more effective lithotriptors.Shock wave lithotripsy has become a widely used modality for treating renal calculi due to its noninvasive nature and ease of application. Although success rates are reasonable, there is room for improvement. With appropriate patient selection, significant improvements in stone-free rates may be achieved. It is anticipated that, with further research, improvements in lithotriptor design will result in higher treatment success rates with reduced renal trauma and improved patient comfort.
Shock wave lithotripsy
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Objective To investigate the clinical efficacy and safety of kidney stones minimally invasive percutaneous nephrolithotomy holmium laser lithotripsy.Methods 397 cases patients with kidney stones were randomly divided into the control group and the experimental group,the control group were treated with the extracorporeal shock wave lithotripsy treatment,and the later group were treated with holmium laser lithotripsy for percutaneous nephrolithotomy.Results The experimental group of taking the net rate was 97.48％,and the time of taking the net rate was 87.15 ％,higher than those of the control group(x2 =14.72,24.78,all P ＜ 0.05).Compared with the control group,the shortened operation time,(t =2.36,P ＜ 0.05),the reducing amount of bleeding (t =3.27,P ＜ 0.05),the shortened length of stay hospital (t =1.28,P ＜ 0.05),low complication rate (x2 =17.06,P ＜ 0.05) took place in the experimental group.Conclusion Minimally invasive percutaneous nephrolithotomy holmium laser lithotripsy treatment of kidney stones is safe and effective,fewer complications,faster recovery,which is worthy of promotion.
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Kidney calculi; Lithotripsy,laser
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Shock wave lithotripsy
Nephrology
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Shock wave lithotripsy
Nephrology
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Lithotripsy by shock wave was performed in 12 patients with choledocholithiasis using the authors' own apparatus. The shock wave is created by an electric spark and the concentration is made by a rotational semi-elipsoid. The pressures attained in the second focus are 150 MPa. The focusing of the stones and the setting to the site of maximal pressures is made by means of two X-ray projections. Patients were indicated for the procedure when the method of endoscopic extraction had failed. Before the procedure a nasobiliary drain was inserted and after administration of analgesia on average 520 shocks were applicated. During the procedure no complications were observed. Fragmentation was achieved in 11 patients. Spontaneous release of fragments was recorded in five of the patients and in 6 during the check-up ERCP endoscopic extraction was made.
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Shock wave lithotripsy
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Urinary stone
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No AccessJournal of UrologyClinical Urology: Original Article1 Jan 1995Effect of Medical Management and Residual Fragments on Recurrent Stone Formation Following Shock Wave Lithotripsy Joshua K. Fine, Charles Y.C. Pak, Glenn M. Preminger, Joseph W. Segura, and Michael Marberger Joshua K. FineJoshua K. Fine , Charles Y.C. PakCharles Y.C. Pak , Glenn M. PremingerGlenn M. Preminger , Joseph W. SeguraJoseph W. Segura , and Michael MarbergerMichael Marberger View All Author Informationhttps://doi.org/10.1097/00005392-199501000-00010AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Minimal emphasis has been placed on the clinical sequelae of residual stone fragments following shock wave lithotripsy. Moreover, there are no studies investigating the role of medical therapy on the course of stone disease in patients with residual fragments. In this retrospective, nonrandomized review, we evaluated 80 patients who had undergone shock wave lithotripsy at various institutions in Texas and were referred to our mineral metabolism clinic for metabolic evaluation and medical management of the stone disease. Of the patients 31 were determined to be stone-free following lithotripsy, while 49 had residual stone fragments. All patients were contacted an average of 43.2 months (range 9 to 79) following shock wave lithotripsy and the radiographs were reviewed. Patients were placed into 4 groups after shock wave lithotripsy: stone-free or residual fragments on or off medical therapy. In the stone-free group (19 patients), medical treatment produced a significant decrease in stone formation from a median of 0.67 to 0.0 stones per patient per year (p <0.001). In 36 patients with residual fragments stone formation before shock wave lithotripsy was higher than in the stone-free group but there was also a significant decrease in the stone formation rate from a median of 2.47 to 0.00 stones per patient per year while on medical therapy (p <0.001). Of the 12 stone-free patients who did not remain on medical therapy there was a slight decrease in the stone formation rate from a mean of 0.83 to 0.40 stones per patient per year, although this decrease was not significant (p = 0.07). In 13 patients with residual fragments not on medical treatment there was only a minimal decrease in the stone formation rate from a median of 1.33 to 0.77 stones per patient per year (p = 0.06). We also assessed the significance of so-called clinically insignificant residual fragments (smaller than 5 mm.) following shock wave lithotripsy in 26 of the 36 patients with residual fragments. More than half of the 26 patients with clinically insignificant fragments in the group that did not continue on medical therapy demonstrated significant stone growth during followup, suggesting that these fragments were not insignificant. Moreover, only 16% of the patients with fragments smaller than 5 mm. demonstrated an increase in fragment size while on medical therapy, again suggesting that appropriate medical treatment can decrease the risk of recurrent stone formation or growth (p <0.05). Our findings suggest that appropriate medical therapy may control active stone formation in patients with or without residual stone fragments following shock wave lithotripsy. Moreover, residual fragments after shock wave lithotripsy place patients at higher risk for recurrent stone formation or growth. References 1 : First clinical experience with extracorporeally induced destruction of kidney stones by shock waves. J. Urol.1982; 127: 417. Link, Google Scholar 2 : Percutaneous nephrolithotomy. An approach to branched and staghorn renal calculi. J.A.M.A.1983; 250: 73. Google Scholar 3 : Two-year follow-up of patients treated with extracorporeal shock wave lithotripsy. J. Endourol.1988; 2: 163. Google Scholar 4 : Five-year follow-up of urinary stone patients treated with extracorporeal shock wave lithotripsy. J. Endourol.1988; 2: 157. Google Scholar 5 : Long-term followup in 1,003 extracorporeal shock wave lithotripsy patients. J. Urol.1988; 140: 479. Link, Google Scholar 6 : Effect of lithotripsy on stone-forming risk factors. J. Urol.1989; 141: 207A. abstract 151. Google Scholar 7 : Metabolic evaluation in stone patients in relation to extracorporeal shock wave lithotripsy treatment. J. Urol.1991; 146: 1478. Abstract, Google Scholar 8 : Is selective therapy of recurrent nephrolithiasis possible? Amer. J. Med.1981; 71: 615. Google Scholar 9 : Renal calculi: pathogenesis, diagnosis, and medical therapy. Sem. Nephrol.1992; 12: 200. Google Scholar 10 : Medical management of nephrolithiasis. J. Urol.1982; 128: 1157. Link, Google Scholar 11 : Ambulatory evaluation of nephrolithiasis: classification, clinical presentation and diagnostic criteria. Amer. J. Med.1980; 69: 19. Google Scholar 12 : Evidence justifying a high fluid intake in treatment of nephrolithiasis. Ann. Intern. Med.1980; 93: 36. Google Scholar 13 : Dietary management of idiopathic calcium urolithiasis. J. Urol.1984; 131: 850. Link, Google Scholar 14 : Long-term treatment of calcium nephrolithiasis with potassium citrate. J. Urol.1985; 134: 11. Link, Google Scholar 15 : Management of cystine nephrolithiasis with alpha-mercaptopropionylglycine. J. Urol.1986; 136: 1003. Link, Google Scholar 16 : The fate of residual fragments after extracorporeal shock wave lithotripsy. J. Endourol.1992; 6: 217. Google Scholar 17 : Long-term followup after extracorporeal shock wave lithotripsy treatment of kidney stones in solitary kidneys. J. Urol.1992; 148: 1011. part 2. Link, Google Scholar 18 : Treatment philosophy and retreatment rates following piezoelectric lithotripsy. J. Urol.1993; 149: 12. Abstract, Google Scholar 19 : Economic impact of kidney stones in white male adults. Urology1984; 24: 327. Google Scholar 20 : Percutaneous nephrostolithotomy vs open surgery for renal calculi. A comparative study. J.A.M.A.1985; 254: 1054. Google Scholar 21 : Comparison of the costs and morbidity of percutaneous and open flank procedures. J. Urol.1986; 135: 1150. Link, Google Scholar 22 : Incidence and economic factors in urolithiasis. In: Stone Disease: Diagnosis and Management. Edited by . Orlando: Grune & Stratton, Inc.1987: 3. chapt. 1. Google Scholar 23 : Cost-effectiveness study of the extracorporeal shock-wave lithotriptor. Int. J. Technol. Assess. Health Care1990; 6: 623. Google Scholar 24 : Medical management of nephrolithiasis in Dallas: update 1987. J. Urol.1988; 140: 461. Link, Google Scholar 25 : Incidence of upper urinary tract stones. Min. Electrolyte Metab.1987; 13: 220. Google Scholar 26 : The current role of medical treatment of nephrolithiasis: the impact of improved techniques of stone removal. J. Urol.1985; 134: 6. Link, Google Scholar 27 : The case for a more aggressive approach to staghorn stones. J. Urol.1976; 115: 505. Link, Google Scholar 28 : Percutaneous removal of kidney stones: review of 1,000 cases. J. Urol.1985; 134: 1077. Link, Google Scholar 29 : Extracorporeal shock wave lithotripsy: the Methodist Hospital of Indiana experience. J. Urol.1986; 135: 1134. Link, Google Scholar 30 : Report of the United States cooperative study of extracorporeal shock wave lithotripsy. J. Urol.1986; 135: 1127. Link, Google Scholar 31 : Methodology, results and complications in 2000 extracorporeal shock wave lithotripsy procedures. Brit. J. Urol.1988; 61: 9. 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Link, Google Scholar From the Division of Urology, Department of Surgery and Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas. Department of Urology, Mayo Clinic, Rochester, Minnesota. 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Honey R, McLaughlin J, Bull S and Logan A (2007) Ethnic Differences in Relative Risk of Idiopathic Calcium Nephrolithiasis in North AmericaJournal of Urology, VOL. 178, NO. 5, (1992-1997), Online publication date: 1-Nov-2007.Clayman R (2018) Urolithiasis, Endourology and LaparoscopyJournal of Urology, VOL. 177, NO. 5, (1790-1792), Online publication date: 1-May-2007.Kang D, Maloney M, Haleblian G, Springhart W, Honeycutt E, Eisenstein E, Marguet C and Preminger G (2018) Effect of Medical Management on Recurrent Stone Formation Following Percutaneous NephrolithotomyJournal of Urology, VOL. 177, NO. 5, (1785-1789), Online publication date: 1-May-2007.Mariani A (2018) Combined Electrohydraulic and Holmium:YAG Laser Ureteroscopic Nephrolithotripsy of Large (Greater Than 4 cm) Renal CalculiJournal of Urology, VOL. 177, NO. 1, (168-173), Online publication date: 1-Jan-2007.PEARLE M, LINGEMAN J, LEVEILLEE R, KUO R, PREMINGER G, NADLER R, MACALUSO J, MONGA M, KUMAR U, DUSHINSKI J, ALBALA D, WOLF J, ASSIMOS D, FABRIZIO M, MUNCH L, NAKADA S, AUGE B, HONEY J, OGAN K, PATTARAS J, McDOUGALL E, AVERCH T, TURK T, PIETROW P and WATKINS S (2018) PROSPECTIVE, RANDOMIZED TRIAL COMPARING SHOCK WAVE LITHOTRIPSY AND URETEROSCOPY FOR LOWER POLE CALICEAL CALCULI 1 CM OR LESSJournal of Urology, VOL. 173, NO. 6, (2005-2009), Online publication date: 1-Jun-2005.LOTAN Y, CADEDDU J, ROERHBORN C, PAK C and PEARLE M (2018) COST-EFFECTIVENESS OF MEDICAL MANAGEMENT STRATEGIES FOR NEPHROLITHIASISJournal of Urology, VOL. 172, NO. 6 Part 1, (2275-2281), Online publication date: 1-Dec-2004.AFSHAR K, McLORIE G, PAPANIKOLAOU F, MALEK R, HARVEY E, PIPPI-SALLE J, BAGLI D, KHOURY A and FARHAT W (2018) OUTCOME OF SMALL RESIDUAL STONE FRAGMENTS FOLLOWING SHOCK WAVE LITHOTRIPSY IN CHILDRENJournal of Urology, VOL. 172, NO. 4 Part 2, (1600-1603), Online publication date: 1-Oct-2004.MARIANI A (2018) COMBINED ELECTROHYDRAULIC AND HOLMIUM:YAG LASER URETEROSCOPIC NEPHROLITHOTRIPSY FOR 20 TO 40 MM RENAL CALCULIJournal of Urology, VOL. 172, NO. 1, (170-174), Online publication date: 1-Jul-2004.MUSLUMANOGLU A, TEFEKLI A, SARILAR O, BINBAY M, ALTUNRENDE F and OZKUVANCI U (2018) Extracorporeal Shock Wave Lithotripsy as First Line Treatment Alternative for Urinary Tract Stones in Children: A Large Scale Retrospective AnalysisJournal of Urology, VOL. 170, NO. 6, (2405-2408), Online publication date: 1-Dec-2003.Clayman R (2018) UROLITHIASIS, ENDOUROLOGY AND LAPAROSCOPYJournal of Urology, VOL. 169, NO. 2, (790-799), Online publication date: 1-Feb-2003.MUNVER R, DELVECCHIO F, NEWMAN G and PREMINGER G (2018) CRITICAL ANALYSIS OF SUPRACOSTAL ACCESS FOR PERCUTANEOUS RENAL SURGERYJournal of Urology, VOL. 166, NO. 4, (1242-1246), Online publication date: 1-Oct-2001.FIALKOV J, HEDICAN S and FALLON B (2018) REASSESSING THE EFFICACY OF THE DORNIER MFL-5000 LITHOTRIPTORJournal of Urology, VOL. 164, NO. 3 Part 1, (640-643), Online publication date: 1-Sep-2000.PEARLE M, WATAMULL L and MULLICAN M (2018) SENSITIVITY OF NONCONTRAST HELICAL COMPUTERIZED TOMOGRAPHY AND PLAIN FILM RADIOGRAPHY COMPARED TO FLEXIBLE NEPHROSCOPY FOR DETECTING RESIDUAL FRAGMENTS AFTER PERCUTANEOUS NEPHROSTOLITHOTOMYJournal of Urology, VOL. 162, NO. 1, (23-26), Online publication date: 1-Jul-1999.KUO R, ASLAN P, ABRAHAMSE P, MATCHAR D and PREMINGER G (2018) INCORPORATION OF PATIENT PREFERENCES IN THE TREATMENT OF UPPER URINARY TRACT CALCULI: A DECISION ANALYTICAL VIEWJournal of Urology, VOL. 162, NO. 6, (1913-1919), Online publication date: 1-Dec-1999.Meretyk S, Gofrit O, Gafni O, Pode D, Shapiro A, Verstandig A, Sasson T, Katz G and Landau E (2018) Complete Staghorn Calculi: Random Prospective Comparison Between Extracorporeal Shock Wave Lithotripsy Monotherapy and Combined With Percutaneous NephrostolithotomyJournal of Urology, VOL. 157, NO. 3, (780-786), Online publication date: 1-Mar-1997.Zanetti G, Seveso M, Montanari E, Guarneri A, Del Nero A, Nespoli R and Trinchieri A (2018) Renal Stone Fragments Following Shock Wave LithotripsyJournal of Urology, VOL. 158, NO. 2, (352-355), Online publication date: 1-Aug-1997.Streem S, Yost A and Mascha E (2018) Clinical Implications of Clinically Insignificant Stone Fragments After Extracorporeal Shock Wave LithotripsyJournal of Urology, VOL. 155, NO. 4, (1186-1190), Online publication date: 1-Apr-1996.Preminger G (2018) Editorial: Nephrolithiasis—Solutions for Emerging ProblemsJournal of Urology, VOL. 156, NO. 3, (910-911), Online publication date: 1-Sep-1996.Sun B, Lee Y, Jiaan B, Chen K, Chang L and Chen K (2018) Recurrence rate and risk factors for urinary calculi after extracorporeal shock wave lithotripsyJournal of Urology, VOL. 156, NO. 3, (903-906), Online publication date: 1-Sep-1996.Chen R and Streem S (2018) Extracorporeal Shock Wave Lithotripsy for Lower Pole Calculi: Long-term Radiographic and Clinical OutcomeJournal of Urology, VOL. 156, NO. 5, (1572-1575), Online publication date: 1-Nov-1996. Volume 153Issue 1January 1995Page: 27-33 Advertisement Copyright & Permissions© 1995 by American Urological Association, Inc.MetricsAuthor Information Joshua K. Fine More articles by this author Charles Y.C. Pak More articles by this author Glenn M. Preminger More articles by this author Joseph W. Segura More articles by this author Michael Marberger More articles by this author Expand All Advertisement PDF downloadLoading ...
Shock wave lithotripsy
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Shock wave lithotripsy
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We compared the results of percutaneous nephrolithotomy and shock wave lithotripsy for the treatment of 1 to 2 cm renal stones in children.The study included 166 children with renal stones 1 to 2 cm. A total of 75 patients (82 kidneys) were treated with percutaneous nephrolithotomy and 91 (93 kidneys) were treated with shock wave lithotripsy. Mean followup was 31 +/- 10 months (range 6 to 84). Both groups were compared regarding stone-free rate, re-treatment rate, complications and incidence of stone recurrence.Both groups were comparable regarding preoperative characteristics. Of the units treated with percutaneous nephrolithotomy 4 (4.9%) were associated with minor complications. Stone-free rate after a single session of percutaneous nephrolithotomy was 86.6% (71 units), and the remaining 11 kidneys with residual stones were successfully treated with repeat percutaneous nephrolithotomy in 7 and shock wave lithotripsy in 4. Therefore, a total of 78 units (95%) were stone-free after percutaneous nephrolithotomy monotherapy, and the overall stone-free rate at 3 months was 100%. Of the patients undergoing shock wave lithotripsy 1 (1.1%) had development of steinstrasse and was successfully treated with ureteroscopy. The overall re-treatment rate after shock wave lithotripsy was 55%. A total of 79 units (84.9%) were stone-free after shock wave lithotripsy monotherapy, whereas 7 (7.5%) with no gross response to treatment were treated with percutaneous nephrolithotomy and 7 with insignificant stones less than 4 mm were followed. Therefore, the overall stone-free rate at 3 months was 92.5%. The differences in stone-free rates and re-treatment rates significantly favored percutaneous nephrolithotomy, while the incidence of complications and stone recurrence at last followup were not significantly different between the groups.For treatment of 1 to 2 cm renal stones in children percutaneous nephrolithotomy is better than shock wave lithotripsy, yielding higher stone-free and lower re-treatment rates.
Shock wave lithotripsy
Renal stone
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