Ultraslow full‐power shock wave lithotripsy protocol in the management of high attenuation value upper ureteric stones: A randomized comparative study
Autor: | Rabie Abdallah, Amr M. Massoud, Mohammed S. ElSheemy, Osama Sayed, Ahmed Abdelbary, Ahmed Ragheb, Ayman S. Moussa, Waleed Ghoneima, Ahmad A Al-Dessoukey, Akram A Elmarakbi, Mahmoud Abdallah, Mohamed H Abdelhamid |
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Rok vydání: | 2020 |
Předmět: |
Shock wave
Ureteral Calculi business.industry Urology Significant difference 030232 urology & nephrology Shock wave lithotripsy Independent factor 03 medical and health sciences Treatment Outcome 0302 clinical medicine Primary outcome Lithotripsy 030220 oncology & carcinogenesis Odds Ratio Humans Medicine Urinary Calculi business Nuclear medicine Randomized Controlled Trials as Topic High attenuation |
Zdroj: | International Journal of Urology. 28:33-39 |
ISSN: | 1442-2042 0919-8172 |
Popis: | Objectives To evaluate the efficacy and safety of ultraslow full-power shock wave lithotripsy protocol in the management of high attenuation value upper ureteric stones compared with slow-rate, power-ramping shock wave lithotripsy. Methods This was a randomized trial enrolling patients with a single high attenuation value (≥1000 HU) upper ureteric stones between January 2019 and July 2019. Ultraslow full-power shock wave lithotripsy (54 patients) was applied at a rate of 30 shock waves/min with power ramping from 6 to 18 kV for 100 shock waves, then a safety pause for 2 min, followed by ramping 18-22 kV for 100 shock waves, then a safety pause for 2 min. Then, full power (22 kV) was maintained until the end of the session. Slow-rate, power-ramping shock wave lithotripsy (47 patients) was applied at a rate of 60 shock waves/min with power ramping from 6 to 10 kV during the first 500 shock waves, then from 11 to 22 kV during the next 1000 shock waves, then maintained on 22 kV in the last 1500 shock waves. Up to three sessions were carried out with a follow up 3 months after the last session. The primary outcome was the stone-free rate. Perioperative data of the two protocols were compared. Results There was no significant difference in preoperative data. The stone-free rate was significantly higher in ultraslow full-power shock wave lithotripsy after single (92.6% vs 23.4%) and multiple (96.3% vs 63.8%) sessions. Most complications were mild, with no significant difference between both groups (9.3% vs 12.8%; P = 0.573). Logistic regression analysis identified ultraslow full-power shock wave lithotripsy protocol as the only significant independent factor for the stone-free rate (odds ratio 12.589, P = 0.025). Conclusion Ultraslow full-power shock wave lithotripsy for high attenuation value upper ureteric stones is associated with a significantly higher stone-free rate, and with mild complications that are comparable to those of standard shock wave lithotripsy. |
Databáze: | OpenAIRE |
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