Renal and Hypertensive Complications of Extracorporeal Shock Wave Lithotripsy: Who Is at Risk?

Bataille, Pierre; Cardon, G.; Bouzernidj, M; Esper, N. El; Prună, A; Ghazali, Anis Kausar; Westeel, Pierre-François; Achard, Jean Michel; Fournier, A

doi:10.1159/000030394

Cited by 17 publications

(10 citation statements)

References 34 publications

(37 reference statements)

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“…A number of clinical studies have suggested that new-onset hypertension is a potential longterm consequence of SWL 1,[62][63][64][65][66][67] . Among these, one prospective study showed age as a significant risk factor, with an increase in intrarenal resistive index in patients 60 years of age and older 62 .…”

Section: The Potential For Long-term Adverse Effects Due To Swl: Hypementioning

confidence: 99%

The Acute and Long-Term Adverse Effects of Shock Wave Lithotripsy

McAteer

Evan

2008

Seminars in Nephrology

152

105

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Shock wave lithotripsy (SWL) has proven to be a highly effective treatment for the removal of kidney stones. Shock waves (SW's) can be used to break most stone types, and because lithotripsy is the only non-invasive treatment for urinary stones SWL is particularly attractive. On the downside SWL can cause vascular trauma to the kidney and surrounding organs. This acute SW damage can be severe, can lead to scarring with a permanent loss of functional renal volume, and has been linked to potentially serious long-term adverse effects. A recent retrospective study linking lithotripsy to the development of diabetes mellitus has further focused attention on the possibility that SWL may lead to life-altering chronic effects 1 . Thus, it appears that what was once considered to be an entirely safe means to eliminate renal stones can elicit potentially severe unintended consequences. The purpose of this review is to put these findings in perspective. The goal is to explain the factors that influence the severity of SWL injury, update current understanding of the long-term consequences of SW damage, describe the physical mechanisms thought to cause SWL injury, and introduce treatment protocols to improve stone breakage and reduce tissue damage. Keywordslithotripsy; shock waves; urinary stones; kidney; injury; vascular trauma The Advantages and Limitations of SWLShock wave lithotripsy employs high energy acoustic pulses (shock waves) generated outside the body to break stones within the kidney and ureter. As such SWL is the only non-invasive method available to remove stones. In the early years following its introduction SWL was considered an option for the treatment of virtually any stone type in any anatomical location. Urologists soon learned, however, that the urinary tract has a limited ability to clear stone fragments and that ureteral obstruction could occur if the mass of stone debris was too high. As such SWL is now used to treat otherwise uncomplicated solitary stones, or a combined stone burden of less than 2 cm (on KUB), located in the upper urinary tract (renal pelvis or proximal ureter) 2 . Not all mineral types respond well to SW's. Some calcium oxalate monohydrate stones, brushite stones and a sub-type of cystine can be highly SW-resistant 3. A noteworthy drawback of SWL is that in many cases stone fragments left behind can serve as foci for the development of new stones 4. As such, stone free rates are lower and stone Please address correspondence to: James A. McAteer, Ph.D., Professor, Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, mcateer@anatomy.iupui.edu, (FAX) 317-278-2040. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process ...

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Section: The Potential For Long-term Adverse Effects Due To Swl: Hypementioning

confidence: 99%

The Acute and Long-Term Adverse Effects of Shock Wave Lithotripsy

McAteer

Evan

2008

Seminars in Nephrology

152

105

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“…Clearly this topic has stimulated spirited debate, but the implications posed by reports showing a link between SWL and hypertension cannot help but be cause for concern [2,7,9,[35][36][37][38][39][40][41][42]. A prospective study by Janetscheck and colleagues shows an alarming increase in intrarenal resistive index in patients 60 years of age and older [36].…”

Section: New-onset Hypertension Has Been Reported With Increased Rismentioning

confidence: 99%

“…That is, since acoustic output is different for different lithotripters, the threshold for injury should be different, and should depend on treatment parameters. Further, just as kidney size and the health of experimental animals have been shown to affect the renal response to SW's, the health status of the subject should also affect the threshold for injury [4,13,36,42,60].…”

Section: Injury Is Dose-dependent and There Appears To Bementioning

confidence: 99%

Shock Wave Injury to the Kidney in SWL: Review and Perspective

McAteer

Evan

Willis

et al. 2007

AIP Conference Proceedings

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Abstract. Shock wave lithotripsy (SWL) is a first-line option for treatment for urinary calculiparticularly effective for the removal of uncomplicated stones from the upper urinary tract. The success of lithotripsy is tempered, however, by the occurrence of acute injury that has been reported to progress to long-term complications. SW trauma to the kidney is a vascular lesion characterized by parenchymal and subcapsular bleeding. The acute lesion is dose-dependent, and typically localized to the focal volume of the lithotripter. Cavitation has been implicated in vessel rupture, but SW-shear has the potential to be a primary mechanism for damage as well. Possible chronic adverse effects of SWL may include new-onset hypertension, development of diabetes, and exacerbation of stone disease. If acute trauma could be reduced, it seems likely that serious long-term effects could be minimized, or even eliminated. Reducing the dose of SW's needed for stone breakage is one option. Improved coupling improves stone breakage, and slowing SW rate significantly improves stone-free outcomes. Experiments with animals now show that treatment protocols can be designed to protect against tissue injury. Initiating treatment with low energy SW's dramatically reduces lesion size, and reducing the rate of SW delivery virtually eliminates SW trauma altogether. SWL stands to gain from new advances in technology, as lithotripters become safer and more effective. Perhaps the greatest progress will be made when we have determined the physical mechanisms of SW action both for stone breakage and tissue damage, and have better characterized the biological response to SW's-as this will provide the principles needed to achieve the best combination of safety and efficiency with whatever lithotripter is at hand.

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“…Hypertension in few cases is caused by the compressive effect of a perirenal hematoma. [18] Increased number of shockwaves has been attributed to cause permanent hypertension.…”

Section: Introductionmentioning

confidence: 99%

“…[12,16] Although addressed in some studies, the effects of SWL on blood pressure, patients' tolerance to pain and perirenal hematoma are still controversial isssues. [18,19] We try to show our experience in these subjects in a single center during April, 2007 to April, 2009.…”

Section: Introductionmentioning

confidence: 99%

The effect of shockwave lithotripsy on blood pressure, patients’ tolerance to pain and perirenal hematoma in renal stone patients

Aghaways

Ghareeb²,

Fryad³

et al. 2015

JER

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Purpose: To assess the effect of extracorporeal shockwave lithotripsy (SWL) on blood pressure, patients' tolerance to pain and perirenal hematoma in patients with renal stones. Patients and methods: One hundred eighty nine patients between 2007-2009 underwent SWL procedures at 4.5 and 5.5 KV with shockwaves of up to 4,000 and 5,000 shockwaves, they were followed up for post procedure pain, hypertension and perirenal hematoma. For statistical analysis, chi square test was used. Results: One hundred fifty three (81%) patients developed post procedure pain. The degree of pain was of mild that relieved by analgesia to severe that required hospitalization, increasing energy level did not increase the chance of post SWL pain while the larger stones caused more post SWL pain (p = .003). Fifteen patients (7.9%) developed post SWL hypertension, female patients and age more than 50 years found to increase the risk of post SWL hypertension. Post SWL hypertension is not affected by increasing energy level and number of shockwaves. Only one patient (0.52%) developed post SWL perirenal hematoma. Conclusion: SWL has a high incidence of post SWL pain. Females and age above 50 years are more prone to develop post SWL hypertension. However the number of shockwaves and energy level did not increase the risk of developing post SWL hypertension. Perirenal hematoma is a rare complication of SWL.

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Renal and Hypertensive Complications of Extracorporeal Shock Wave Lithotripsy: Who Is at Risk?

Cited by 17 publications

References 34 publications

The Acute and Long-Term Adverse Effects of Shock Wave Lithotripsy

The Acute and Long-Term Adverse Effects of Shock Wave Lithotripsy

Shock Wave Injury to the Kidney in SWL: Review and Perspective

The effect of shockwave lithotripsy on blood pressure, patients’ tolerance to pain and perirenal hematoma in renal stone patients

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