Comparison of Ultrasound-assisted and Pure Fluoroscopy-guided Extracorporeal Shockwave Lithotripsy for Renal Stones

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 <1cm stratified group. In the stone size >1cm 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.

Comparison of ultrasonography and fluoroscopy as guides for extracorporeal shock wave lithotripsy in nephrolithiasis patients: a systematic review

“…Fourth, there were differences in stone composition, such as stone density (ranged between 600-1,000 Hounsfield units [HU], except for four studies that did not include stone density data) and stone type (mentioned in two studies). 3,7,8,[12][13][14] Chang et al 4 found that using USG combined with fluoroscopy resulted in a much better SFR, with lower rates of re-treatment and complications. However, it should be noted that several factors have not been assessed in this study, such as stone composition, computed tomography (CT) values, and skin-to-stone distance, which may affect the final result.…”

“…However, it should be noted that several factors have not been assessed in this study, such as stone composition, computed tomography (CT) values, and skin-to-stone distance, which may affect the final result. 4 Abid et al 17 also conducted a study comparing the addition of USG to fluoroscopy with fluoroscopy alone to assess the reduction in the duration of fluoroscopy on ESWL. From a comparison of 40 total samples of adults with kidney stones, adding USG to fluoroscopy could significantly reduce the fluoroscopic time (p<0.0001), indirectly reducing the amount of radiation exposure in the patient.…”

“…Chang et al 4 in 2020 concluded that combined USG and fluoroscopy had significantly superior results than fluoroscopy alone (Table 1). Most studies have assessed the complication rate of each procedure.…”

“…mji.ui.ac.id patient positioning, and lithotripter power and frequency. 4 On the other hand, postprocedural complications vary in number and can occur in various forms, ranging from mild symptoms such as fever and mild bleeding to severe symptoms that require additional treatment. These complications can be influenced by the operator's technique in performing the therapy, which indirectly requires proper imaging guidance to obtain optimal results.…”

“…3,[7][8][9] Along with the times, technological developments have also started to combine both modalities in the same machine, which may help the operators perform better treatments than a single modality. 4 The existing studies have begun to compare modalities for ESWL therapy. However, no guidelines have specifically mentioned which modality is superior and better to use.…”