Standardized Grading of Shock Wave Lithotripsy Complications with Modified Clavien System

Mittal, Varun; Srivastava, Anesh; Kappor, Rakesh; Ansari, M. Sib; Patidar, Nitesh; Arora, Sohrab; Kumar, Manoj; Kudchadkar, Sharmad; Raj, Anuradha

doi:10.1159/000446968

Cited by 9 publications

(5 citation statements)

References 18 publications

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“…Sepsis after SWL is higher in patients with untreated UTIs or in those who present with infected stones. A previous study mentioned that the incidence of low‐grade fever after SWL was 19.4% of patients, which was conservatively managed in the majority of cases [23]. In our study the incidence of post‐SWL fever was 3% in the narrow‐focus group and 2.9% in the wide‐focus group.…”

Section: Discussionsupporting

confidence: 46%

The effect of piezoelectric shockwave lithotripsy with 2‐ and 8‐mm focus sizes on stone disintegration and renal injury

et al. 2023

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ObjectivesTo compare the efficacy and safety of shockwave lithotripsy (SWL) using a narrow focus or wide focus for renal stones.Patients and MethodsA double‐blind randomised trial included adult patients with a solitary radio‐opaque renal pelvic stone of 1–2 cm. Patients were randomised into two groups: narrow‐focus (2 mm) SWL and wide‐focus (8 mm) SWL. The stone‐free rate (SFR) and presence of complications such as haematuria, fever, pain, and peri‐renal haematoma were evaluated. Pre‐ and postoperative urinary markers (neutrophil gelatinase‐associated lipocalin [NGAL] and kidney injury molecule 1 [KIM‐1]) concentrations were compared to assess renal injury.ResultsA total of 135 patients were recruited for this study. The SFR after the first SWL session was 79.2% and 69.1% in narrow‐ and wide‐focus groups, respectively. There was a comparable rise in the median 2‐h NGAL concentration in both groups (P = 0.62). However, the rise in the median (interquartile range [IQR]) 2‐h KIM‐1 concentration was significantly higher in the narrow‐focus group at 4.9 (4.6, 5.8) ng/mL compared with the wide‐focus group at 4.4 (3.2, 5.7) ng/mL (P = 0.02). Nevertheless, the 3‐day NGAL and KIM‐1 urinary marker concentrations were significantly improved (P = 0.263 and P = 0.963, respectively). The overall SFR after three sessions was 86.6% and 86.8% in the narrow‐ and wide‐focus groups, respectively (P = 0.77). Both groups were comparable for complications, apart from the median pain score and the percentage of high‐grade haematuria, which were significantly higher in the narrow‐focus group (P < 0.001 and P = 0.03, respectively).ConclusionNarrow‐ and wide‐focus SWL were associated with comparable outcomes and re‐treatment rates. However, narrow‐focus SWL was associated with significantly higher morbidity in terms of pain and haematuria.

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Section: Discussionsupporting

confidence: 46%

The effect of piezoelectric shockwave lithotripsy with 2‐ and 8‐mm focus sizes on stone disintegration and renal injury

et al. 2023

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“…Extracor- [1,8] . Meanwhile, Mittal et al [9] suggested the use of Modified Clavien System in adults for determining SWL complication rates and standardizing procedural errors. In contrast to adult studies, studies with children reporting the effects of urinary catheterization during SWL with nephrolithiasis are rare.…”

Section: Discussionmentioning

confidence: 99%

Do JJ Stents Increase the Effectiveness of Extracorporeal Shock Wave Lithotripsy for Pediatric Renal Stones?

et al. 2016

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Purpose: We aimed to evaluate the effects of preoperative urinary catheterization in nephrolithiasis treatment with extracorporeal shock wave lithotripsy (SWL). Methods: Patients admitted to the Department of Pediatric Surgery for renal stones between June 2012 and June 2014 were evaluated retrospectively. Patients were divided into 2 groups based on JJ stent placements. Group 1 did not receive JJ stents, while group 2 did. The recorded demographic data for each group included age, gender, stone size, location, sessions, and complications. The Elmed Complit ESWL system was used with 11-13 kV, and 1,000-1,200 shots in patients 2-4 years of age, and 11-14 kV, and 1,000-1,500 shots for patients over 4 years. Results: In group 1, 18 sessions of SWL were performed on 8 female and 2 male children with a mean age of 4.5 (range 2-12) years and stone diameter of 9 (range 7-15) mm. The locations of the renal stones were in the upper pole in 1 patient, 7 in the lower pole, and 2 in the pelvis renalis. Postoperatively, 1 patient had hematuria, 2 had dysuria, and one had a stone in the external urethral meatus. Eighty percent of patients were stone free; there were no fragmentations in 2 patients, and 1 patient discontinued treatment. In group 2, 15 SWL sessions were performed on 5 female and 5 male children aged 4 (range 3-5) and the stone diameter was 9 (range 7-16) mm. The locations of the renal stones were in the upper pole in 6 patients, in the lower pole in 3 patients, and in the ureteropelvic junction in one patient. JJ stents were placed in all patients preoperatively. Postoperatively, 3 patients had hematuria and one had dysuria. At the end of the study, all of the patients were stone free. Statistically, there were no differences in age, gender, stone size, location, and the number of sessions. Conclusions: Our results indicate that SWL without preoperative ureteral stenting is an effective and safe procedure that can be carried out in the pediatric population. Preoperative JJ stenting is unnecessary in patients, especially in those with smaller stone diameters.

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“…All radiographic images were evaluated by the same radiologist and urologist to minimize interobserver variability. Clavien-Dindo classification was used in the evaluation of complications [15].…”

Section: Methodsmentioning

confidence: 99%

Comparison of Fixed and Ramping Voltage Extracorporeal Shockwave Lithotripsy with Acute Kidney Injury Biomarkers: Prospective Randomized Clinical Study

Şeker,

Atar,

Kural

et al. 2023

Grand J Urol

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Objective: To compare extracorporeal shock wave lithotripsy (ESWL) induced renal injury in patients undergoing different ESWL treatment protocols by measuring urinary tissue metalloproteinase-2 inhibitor (TIMP-2) and insulin-like growth factor binding protein 7 (IGFBP7) excretion. Materials and Methods: This prospective, randomized study was conducted between April 2016 and June 2016 in group 1 patients undergoing fixed voltage ESWL and group 2 patients undergoing ramping voltage ESWL. Urinary TIMP-2 and IGFBP7 levels were analyzed before ESWL and 2 hours after ESWL, and urinary beta-2-microglobulin (β2-MG) and albumin were analyzed before ESWL and 1 week after ESWL to assess renal injury. The primary outcome was to compare the effect of ESWL on early renal injury with biochemical markers in the different treatment protocols, and the secondary outcome was to compare the two treatment protocols in terms of stone free rate and complications. Results: There was no statistically significant difference between groups in terms of demographic and stone characteristics. There were statistically significant differences in serum creatinine and e-GFR at baseline and one week after treatment (p<0.05). There was no significant change in serum urea, urinary β2-MG and albumin levels before and after ESWL. There was a statistically significant increase in urinary TIMP-2, IGFBP7 and TIMP-2 x IGFBP7/1000 levels in both groups compared to baseline (p<0.05). There was no statistically significant difference in the rates of stone free and complications between the groups (p>0.05). Conclusion:In this prospective randomized study, we observed a significant increase in TIMP-2, IGFBP7 and combination levels after ESWL treatment in both groups, suggesting that these two biomarkers could be used to identify acute kidney injury due to ESWL. However, the comprehensive evaluation of clinical parameters and urinary markers did not differ in the rates of renal injury, success, and complications after ESWL in both protocols.

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Standardized Grading of Shock Wave Lithotripsy Complications with Modified Clavien System

Cited by 9 publications

References 18 publications

The effect of piezoelectric shockwave lithotripsy with 2‐ and 8‐mm focus sizes on stone disintegration and renal injury

The effect of piezoelectric shockwave lithotripsy with 2‐ and 8‐mm focus sizes on stone disintegration and renal injury

Do JJ Stents Increase the Effectiveness of Extracorporeal Shock Wave Lithotripsy for Pediatric Renal Stones?

Comparison of Fixed and Ramping Voltage Extracorporeal Shockwave Lithotripsy with Acute Kidney Injury Biomarkers: Prospective Randomized Clinical Study

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