Complications in extracorporeal shockwave lithotripsy: a cohort study

Wagenius, Magnus; Jakobsson, Jon; Stranne, Johan; Linder, Adam

doi:10.1080/21681805.2017.1347821

Cited by 13 publications

(9 citation statements)

References 26 publications

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“…The most common complications in our cohort were UTIs. In our cohort, 2.2% of all patients undergoing ESWL were diagnosed with a UTI, which is comparable to other series ranging from 0.5 to 2.5% [ 28–30 ]. Similarly, UTIs were found in 6.4% of all URS patients, which is comparable to previously published cohorts reporting UTI rates ranging from around 7.4 to 7.7% [ 31 , 32 ].…”

Section: Discussionsupporting

confidence: 88%

Extracorporeal shock wave lithotripsy versus flexible ureterorenoscopy in the treatment of untreated renal calculi

Fankhauser

Hermanns

Lieger

et al. 2018

Clinical Kidney Journal

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BackgroundThe reported success rates for treatments of kidney stones with either extracorporeal shock wave lithotripsy (ESWL) or flexible ureterorenoscopy (URS) are conflicting. We aimed to compare the efficacy and safety of ESWL and URS for previously untreated renal calculi.MethodsAll patients treated with ESWL or URS at our tertiary care centre between 2003 and 2015 were retrospectively identified. Patients with previously untreated kidney stones and a stone diameter of 5–20 mm were included. Stone-free, freedom from reintervention and complication rates were recorded. Independent predictors of stone-free and freedom from reintervention rates were identified by multivariable logistic regression and a propensity score-matched analysis was performed.ResultsA total of 1282 patients met the inclusion criteria, of whom 999 (78%) underwent ESWL and 283 (22%) had URS. During post-operative follow-up, only treatment modality and stone size could independently predict stone-free and freedom from reintervention rates. After propensity score matching, ESWL showed significantly lower stone-free rates [ESWL (71%) versus URS (84%)] and fewer patients with freedom from reintervention [ESWL (55%) versus URS (79%)] than URS. Complications were scarce for both treatments and included Clavien Grade 3a in 0.8% versus 0% and Grade 3b in 0.5% versus 0.4% of ESWL and URS treated patients, respectively.ConclusionsTreatment success was mainly dependent on stone size and treatment modality. URS might be the better treatment option for previously untreated kidney stones 5–20 mm, with similar morbidity but higher stone-free rates and fewer reinterventions than ESWL.

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Section: Discussionsupporting

confidence: 88%

Extracorporeal shock wave lithotripsy versus flexible ureterorenoscopy in the treatment of untreated renal calculi

Fankhauser

Hermanns

Lieger

et al. 2018

Clinical Kidney Journal

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“…The most common complications following SWL and URS are UTIs. In the present cohort, 4% of all SWL and URS patients were diagnosed with a UTI, which is comparable with other SWL or URS series reporting UTI incidences between 0.5% and 2.5% [23] , [24] , [25] or between 6.4% and 7.7% [22] , [26] , [27] , respectively. This highlights the importance of preoperative urine cultures, which should optimally be performed several days ahead of either procedure.…”

Section: Discussionsupporting

confidence: 88%

Effectiveness of Flexible Ureterorenoscopy Versus Extracorporeal Shock Wave Lithotripsy for Renal Calculi of 5–15 mm: Results of a Randomized Controlled Trial

Fankhauser

Weber

Müntener

et al. 2021

European Urology Open Science

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Background Primary flexible ureterorenoscopy (URS) and extracorporeal shock wave lithotripsy (SWL) are treatment options in patients with renal calculi of 5–15 mm. Objective To compare effectiveness, complication rates, and pain scores between primary URS and SWL. Design, setting, and participants Between 2011 and 2016, patients with renal calculi between 5 and 15 mm were randomized to undergo either primary URS or SWL. Outcome measurements and statistical analysis Stone-free rate and size of residual fragments assessed by computed tomography after 3 mo, complications, and pain scores were evaluated. Results and limitations The study was prematurely closed after randomizing 44 patients due to poor accrual. The 3-mo stone-free rate and mean residual stone size were, respectively, 61% and 1.8 mm after URS and 48% and 2.4 mm after SWL. Early post-treatment pain scores were significantly higher after URS than after SWL on day 1 (3.3 vs 1.6, p = 0.02) and day 7 (5.2 vs 3.4, p = 0.04), but were no longer detectable after 3 wk and 3 mo, respectively. One Clavien-Dindo grade II complication was observed after URS (5%) and SWL (4%), while one (4%) grade IIIb complication was observed after SWL. Conclusions URS appears to be associated with higher early post-treatment discomfort, which could be associated with routine postoperative stenting. Owing to premature closure of this trial, the power was insufficient to formally compare URS and SWL; however, the present data might be informative to counsel patients about treatment outcomes and allow future meta-analyses. Patient summary This study was ended prematurely, but it contributes data about efficacy and side effects of different treatment options in patients with renal calculi.

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“…In fact, even if it is not invasive, ESWL is characterized by the risk of complications that may affect renal function and may be risky in patients with solitary kidneys due to a lack of functional compensation by the contralateral kidney. Ureteral obstruction by residual stone fragments (steinstrasse), urinary tract infection and sepsis, asymptomatic renal hematoma, kidney nephron losses, may vary between 6-10% in total and may be a more important risk for patients with solitary kidneys (9). While percutaneous nephrolithotomy (PCNL) is the first surgical option that can be considered for kidney stones larger than 2 cm, RIRS is more preferred in patients with solitary kidney stones to prevent organ loss and greater risk of complications.…”

Section: Discussionmentioning

confidence: 99%

Do we have a limit for retrograde intrarenal surgery for solitary kidney stone?

Kati

Pelit

Demir

et al. 2021

Arch Ital Urol Androl

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Objective: The management of urolithiasis in patients with a solitary kidney is challenging for urologists. This study aimed to evaluate the safety of retrograde intrarenal surgery (RIRS) in the treatment of stones in patients with solitary kidney and to reply to the question if there is any limit for this surgery. Methods: Between January 2016 and December 2019, we enrolled 52 patients who had a solitary kidney and underwent RIRS. We collected data on preoperative patient characteristics, stone dimensions, and postoperative outcomes. Stone size, duration of operation, duration of fluoroscopy, type of anesthesia, and degree of surgical complication were evaluated retrospectively. Surgeries performed in less and more than 60 minutes and with and without complications were compared. Results: A total of 52 patients with a kidney stone and a solitary kidney were evaluated. The mean stone size was 14 ± 0.4 cm and surgical success rate was 87.3%. In our study, 13 patients (24.5%) had grade 1 minor complications, and none required a blood transfusion. The mean operation time was 51.9 ± 17.3 minutes. The postoperative creatinine value increased in 6 patients. The duration of operation in the group with complications was significantly higher than that in the group without complications. In patients who underwent an operation lasting ≥ 60 minutes, stone size, fluoroscopy time, and complication rate were significantly higher than in patients who underwent an operation lasting ≤ 60 minutes. Conclusion: Our opinion is to be careful in patients with a solitary kidney with a big stone and we recommend assigning these procedure to experienced hands for not exceeding 60 minutes in one session.

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Complications in extracorporeal shockwave lithotripsy: a cohort study

Cited by 13 publications

References 26 publications

Extracorporeal shock wave lithotripsy versus flexible ureterorenoscopy in the treatment of untreated renal calculi

Extracorporeal shock wave lithotripsy versus flexible ureterorenoscopy in the treatment of untreated renal calculi

Effectiveness of Flexible Ureterorenoscopy Versus Extracorporeal Shock Wave Lithotripsy for Renal Calculi of 5–15 mm: Results of a Randomized Controlled Trial

Do we have a limit for retrograde intrarenal surgery for solitary kidney stone?

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