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

BMC Urology

Tsung-Hsin Chang¹  Jen-Shu Tseng¹  Wei-Kung Tsai²  Wun-Rong Lin²  Pai-Kai Chiang²  Marcelo Chen³  Allen W. Chiu⁴ 

[1] Department of Urology, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., 10449, Taipei City, Taiwan;Department of Urology, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., 10449, Taipei City, Taiwan;Mackay Medical College, No.46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., 252, New Taipei City, Taiwan;Department of Urology, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., 10449, Taipei City, Taiwan;Mackay Medical College, No.46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., 252, New Taipei City, Taiwan;Mackay Junior College of Medicine, Beitou District, Nursing, and Management, No.92, Shengjing Road, 11272, Taipei City, Taiwan;Department of Urology, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., 10449, Taipei City, Taiwan;School of Medicine, National Yang-Ming University, No.145, Zhengzhou Rd., Datong Dist., 10341, Taipei City, Taiwan;

关键词: Shock wave lithotripsy;    Nephrolithiasis;    Kidney;    Ultrasonography;   

DOI  :  10.1186/s12894-020-00756-6

来源: Springer

【 摘 要 】

BackgroundIn 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.MethodsWe 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.ResultsThe 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.ConclusionSWL 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.

【 授权许可】

CC BY