Painless Extracorporeal Shock Wave Lithotripsy for Outpatients:
A New Option

Puppó, P.; Bottino, Paolo; Germinale, F.; Caviglia, C.; Ricciotti, G.; Giuliani, L.

doi:10.1159/000471520

Cited by 7 publications

(5 citation statements)

References 2 publications

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“…This was incredible progress when compared to the first prototype created only nine years prior. The reported stone-free rate was 83.3%, whereas the retreatment rate was as low as 1.16% for pyelic stones, and 1.53% for ureteral stones, slightly higher [15,19].…”

Section: The Rise Of Urs/rirs and The Downfall Of Lithotripter-myth O...mentioning

confidence: 91%

“…The Lithotripter's Golden Era started in 1989 and lasted until 2004 when we treated at least 800 patients annually [15,19]. This was possible thanks to the introduction of piezoelectric lithotripters that offered the possibility of less painful treatments.…”

Section: The Lithotripter's Golden Agesmentioning

confidence: 99%

“…In that period, with the new lithotripters, anesthesia was a thing of the past, and ESWL became an outpatient treatment. Beforehand, the hospital stay was around 2.8 days [15,19]. Prior to the treatment, the only medication used was promazine for sedation, and metamizol for analgesia.…”

Section: The Lithotripter's Golden Agesmentioning

confidence: 99%

“…Our urologists were chosen to test it because of the experience they had accumulated with the Dornier's lithotripter, and the fame they had gained all over the country. This was not an isolated case, they were asked to test almost all the innovative devices in the field of endourology as well, such as the first flexible ureterorenoscope and more [19,23]. Our 'Kidney-stone' center became the national referral center, and urologists such as Dr. Puppo and Dr. Bottino, became nationally acknowledged experts.…”

Section: The Lithotripter's Golden Agesmentioning

confidence: 99%

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The Lifetime History of the First Italian Public Extra-Corporeal Shock Wave Lithotripsy (ESWL) Lithotripter as a Mirror of the Evolution of Endourology over the Last Decade

Malinaric

Mantica

Martini

et al. 2023

IJERPH

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Extracorporeal shockwave lithotripsy (ESWL) is the only non-invasive treatment for kidney stones. It does not require an operating room, anesthesia, or hospital stay. Its role evolved over the years and nowadays ESWL is slowly disappearing from many stone centers and urologic departments. We present the history and the role of ESWL treatment since its birth in 1959 and its development through the following years. We also present details of its application and impact on the first Italian stone center in 1985. ESWL has had different roles over the centuries: in the early years it was a great alternative to open surgery and percutaneous nephrolithotripsy (PCNL), then it had its decline with the introduction of the miniscopes. Currently, although ESWL is not considered a treatment of excellence, newer models are emerging. With the application of new technologies and artificial intelligence, this technique can become a good option alongside endourologic treatments.

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Section: The Rise Of Urs/rirs and The Downfall Of Lithotripter-myth O...mentioning

confidence: 91%

Section: The Lithotripter's Golden Agesmentioning

confidence: 99%

Section: The Lithotripter's Golden Agesmentioning

confidence: 99%

Section: The Lithotripter's Golden Agesmentioning

confidence: 99%

See 2 more Smart Citations

The Lifetime History of the First Italian Public Extra-Corporeal Shock Wave Lithotripsy (ESWL) Lithotripter as a Mirror of the Evolution of Endourology over the Last Decade

Malinaric

Mantica

Martini

et al. 2023

IJERPH

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“…Majority of patients undergoing lithotripsy are outpatients and discharged on the same day of procedure. [19] During the procedure patients experience sharp, stinging pain produced by the impact of the shock waves at the cutaneous entry site. Due to this sharp pain, patient may move leading to the need of repeated radiographic localization of the stone(s) for an effective lithotripsy.…”

Section: Introductionmentioning

confidence: 99%

Paravertebral block is a proper alternative anesthesia for outpatient lithotripsy

et al. 2013

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Context:This study evaluated the effectiveness of paravertebral block as an alternative anesthetic technique for extracorporeal shock wave lithotripsy (ESWL) procedure. A total of 50 patients with renal stones, aged 20-60 years, were randomly allocated into two groups; 25 patients in group P; received unilateral paravertebral block from T8 through L1 with injection of 5 mL 0.5% bupivacaine and 25 patients in group L; received local infiltration by bupivacaine 0.25% (2 mg/kg) into the 30 cm2 area after localizing the stones site, 10 min before the session. A total of 10 mm visual analogue scale (VAS) was used to evaluate pain every 10 min during the session. At the end of the procedure, total doses of rescue analgesia, the number of shockwaves, their power, and the total duration of shockwave treatment were recorded. After completion of the procedure, the patient was assessed for pain and nausea in the postanesthesia care unit (PACU) using the VAS. Patient's satisfaction and time needed to discharge patients to home also were recorded. Time to do the anesthetic technique was significantly higher (P < 0.001) in group-P than group-L, it was 12.7 ± 2.3 min versus 6.9 ± 1.9 min, respectively; intraoperative rescue analgesia by fentanyl was lesser (P < 0.001) in group-P than group-L, 26.7 ± 6.32 mcg versus 78.6 ± 5.41 mcg, respectively, also time interval between ends of the procedure till discharge to home was significantly higher (P < 0.001) in group-P than group-L, it was 99 ± 17 min versus 133 ± 31 min, respectively. VAS was not significant difference between both groups either intraoperative or postoperative in first hour. Patient's satisfaction was significantly higher (P < 0.05) in group-P than group-L, it was 8.8 ± 1.1 versus 6.1 ± 0.6, respectively. Adverse events were lesser, but not significant in group-P than in group-L. Two patients (8%) in group-L and one patient (4%) in the group-P experienced episodes of postoperative nausea and vomiting (PONV).Paravertebral block is an effective alternative anesthesia for outpatient lithotripsy; multiple level paravertebral blocks provide an optimal anesthetic condition, with acceptable adverse events for ESWL. And, providing proper analgesia during the procedure and in first hour after finishing of the procedure, early discharge to home and providing better patient's satisfactions.Aims:This study evaluated the effectiveness of paravertebral block as an alternative anesthetic technique for ESWL procedure.Settings and Design:Prospective open label study.Subject and Methods:A total of 50 patients with renal stones, aged 20-60 years, were randomly allocated into two groups; 25 patients in group P; received unilateral paravertebral block from T8 through L1 with injection of 5mL 0.5% bupivacaine and 25 patients in group L; received local infiltration by bupivacaine 0.25% (2 mg/kg) into the 30 cm2 area after localizing the stones site, 10 min before the session. A total of 10 mm VAS was used to evaluate pain every 10 min during the session. At the end of the procedure, total...

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Analgesia in Anesthesia-Free Extracorporeal Shock Wave Lithotripsy: A Standardized Protocol

et al. 1991

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We treated 101 patients at our stone facility with the Dornier HM3 lithotriptor modified with the anesthesia-free design upgrade. A protocol designed by our anesthesiologists consisting of intravenous and intramuscular injections for sedation was used without any general or regional anesthesia required. Pre-medication with intramuscular meperidine and promethazine, and oral diazepam was sufficient sedation in 43 patients, while 37 required additional intravenous meperidine and/or midazolam during the procedure, 16 were treated with intraprocedural medication alone and 5 required no medication at all. Care before, during and after the procedure was rendered by the urology staff for patients in American Society of Anesthesiologists risk category I or II. Treatment was successfully completed in all patients without complications. We compared this group to the 99 patients treated consecutively before the modification. Voltage used, number of shocks and stone burden were comparable in the 2 groups but average treatment time was prolonged with the upgraded equipment (39.2 versus 27.1 minutes) to a significant degree (p less than 0.001).

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Painless Extracorporeal Shock Wave Lithotripsy for Outpatients: A New Option

Cited by 7 publications

References 2 publications

The Lifetime History of the First Italian Public Extra-Corporeal Shock Wave Lithotripsy (ESWL) Lithotripter as a Mirror of the Evolution of Endourology over the Last Decade

The Lifetime History of the First Italian Public Extra-Corporeal Shock Wave Lithotripsy (ESWL) Lithotripter as a Mirror of the Evolution of Endourology over the Last Decade

Paravertebral block is a proper alternative anesthesia for outpatient lithotripsy

Analgesia in Anesthesia-Free Extracorporeal Shock Wave Lithotripsy: A Standardized Protocol

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