Optimization of extracorporeal shock wave lithotripsy delivery rates achieves excellent outcomes in ureteral stones. Results of a prospective, randomized trial

Nguyen, Daniel Truong Phat; Hnilicka, Stefanie; Kiss, Bernhard; Seiler, Roland; Thalmann, George; Roth, Beat (2015). Optimization of extracorporeal shock wave lithotripsy delivery rates achieves excellent outcomes in ureteral stones. Results of a prospective, randomized trial. Journal of urology, 194(2), pp. 418-423. Elsevier 10.1016/j.juro.2015.01.110

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PURPOSE Management of ureteral stones remains controversial. To determine whether optimizing extracorporeal shock wave lithotripsy (ESWL) delivery rates improves treatment of solitary ureteral stones, we compared outcomes of two SW delivery rates in a prospective, randomized trial. MATERIALS AND METHODS From July 2010 to October 2012, 254 consecutive patients were randomized to undergo ESWL at SW delivery rates of either 60 pulses (n=130) or 90 pulses (n=124) per min. The primary endpoint was stone-free rate at 3-month follow-up. Secondary endpoints included stone disintegration, treatment time, complications, and the rate of secondary treatments. Descriptive statistics were used to compare endpoints between the two groups. Adjusted odds ratios and 95% confidence intervals were calculated to assess predictors of success. RESULTS The stone-free rate at 3 months was significantly higher in patients who underwent ESWL at a SW delivery rate of 90 pulses per min than in those receiving 60 pulses (91% vs. 80%, p=0.01). Patients with proximal and mid-ureter stones, but not those with distal ureter stones, accounted for the observed difference (100% vs. 83%; p=0.005; 96% vs. 73%, p=0.03; and 81% vs. 80%, p=0.9, respectively). Treatment time, complications, and the rate of secondary treatments were comparable between the two groups. In multivariable analysis, SW delivery rate of 90 pulses per min, proximal stone location, stone density, stone size and the absence of an indwelling JJ stent were independent predictors of success. CONCLUSIONS Optimization of ESWL delivery rates can achieve excellent results for ureteral stones.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Dermatology, Urology, Rheumatology, Nephrology, Osteoporosis (DURN) > Clinic of Urology

UniBE Contributor:

Nguyen, Daniel Truong Phat; Hnilicka, Stefanie; Kiss, Bernhard; Seiler, Roland; Thalmann, George and Roth, Beat

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0022-5347

Publisher:

Elsevier

Language:

English

Submitter:

Katharina Morgenegg

Date Deposited:

26 Feb 2015 13:25

Last Modified:

26 Feb 2016 02:30

Publisher DOI:

10.1016/j.juro.2015.01.110

PubMed ID:

25661296

Uncontrolled Keywords:

HM-3 extracorporeal shock wave lithotripsy prospective randomized trial shock wave delivery rate ureteral stones

BORIS DOI:

10.7892/boris.63399

URI:

https://boris.unibe.ch/id/eprint/63399

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