Article on comparison of ESWL (Siemens Lithostar) with Flexible uretreoscopy (RIRS).

Abstract

To compare the outcomes of flexible ureterorenoscopy (F-URS) with extracorporeal shock wave lithotripsy (ESWL) for the treatment of upper or mid calyx kidney stones of 10 to 20 mm.

A total of 174 patients with radioopaque solitary upper or mid calyx stones who underwent ESWL or F-URS with holmium:YAG laser were enrolled in this study. Each group treated with ESWL and F-URS for upper or mid calyx kidney stones were retrospectively compared in terms of retreatment and stone free rates, and complications.

87% (n = 94) of patients who underwent ESWL therapy was stone free at the end of 3rd month. This rate was 92% (n = 61) for patients of F-URS group (p = 0.270 p > 0.05). Retreatment was required in 12.9% of patients (n = 14) who underwent ESWL and these patients were referred to F-URS procedure after 3rd month radiologic investigations. The retreatment rate of cases who were operated with F-URS was 7.5% (n = 5) (p = 0.270 p > 0.05). Ureteral perforation (Clavien grade 3B) was occured in 3 patients (4.5%) who underwent F-URS. Fever (Clavien grade 1) was noted in 7 and 5 patients from ESWL and F-URS group, respectively (6.4% vs 7.5%) (p = 0.78 p > 0.05).

F-URS and ESWL have similar outcomes for the treatment of upper or mid calyx renal stones of 10–20 mm. ESWL has the superiority of minimal invasiveness and avoiding of general anethesia. F-URS should be kept as the second teratment alternative for patients with upper or mid caliceal stones of 10–20 mm and reserved for cases with failure in ESWL.

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Master of Lithotripsy (ESWL) and ESWT: Classification of Lithotripter

Master of Lithotripsy (ESWL) and ESWT: Classification of Lithotripter

Classification of Lithotripter

we started first lithotripter with energy produced using under water spark gap.
In modern lithotripters  water tub is been replaced by the therapy head balloon enclosing the energy source. Based on technologies available today I have made my own classification of lithotripters. I have reviewed many medical literature in past few decades newer technologies have emerged. This new technologies cannot be generalised they have their own identity and specificity. Hence I have prepared my own classification of lithotripters hope you agree to it.

Retrograde Intrarenal Surgery (RIRS) vs Extra Corporeal Shockwave Lithotripsy (ESWL)

Today we see lots of debate in the conference and seminar may be one of the most discussed topic on treating kidney stone with RIRS (fURS) vs. ESWL or mini-PCNL vs. RIRS (fURS). However at any point during the debate there is no emphasis on the technology by which shockwave is produced Electrohydraulic (EH) / Electromagnetic (EM) (most common technology of shockwave generation with few piezoelectric lithotripters). Since the maximum installations are of EH, they are cheaper than EM lithotripsy system. EH lithotripter have major market share.

It is not fair to compare RIRS with EH lithotripter. A fair trial would be to compare RIRS with USG guided ESWL on EM lithotripsy system. Today with such advancement in shockwave technology and better understanding of physics of stone fragmentation we fail to deliver results like HM3. One of the prime reason is we have left the therapeutic application in hands of Technicians and fail to take efforts to learn lithotripsy technology.

After all said we compare results of ESWL done by a technician or junior most residents. Technicians and junior residents who probably have never received any formal training on lithotripsy, they have learned on his own by trial and error basis to the results of RIRS which is done by a Surgeon and who has put his efforts to learn RIRS. A well trained and groomed Lithotripsy Technician will always deliver better results doing ultrasound guided ESWL on EM lithotripter when compared to RIRS with much lesser morbidity and financial burden on then patient and to the healthcare insurance provider.

Medical Shockwave was introduced long before it was used to treat stone disease. First Use of Shockwave Not many people know of..........

A patent application for the first shock wave generator to be used for the treatment of brain tumours was filed in the United States by F. Rieber as long ago as 1947. (click here to read more)

It started with soft tissue therapy and all the I need to say that today majority of the development and applications are in field of Shockwave Therapy.

USG guided SWL

Ultrasound guided SWL for lower ureteric calculus. 35 years old patient presented with dysuria. On investigation was diagnosed to have 24 mm right lower ureteric calculus.
Patient was treated with USG guided SWL. patient was given total of 3500 shockwaves under USG guidance.
Post SWL patient passed all the calculus fragments in 48 hours.

Treatment of kidney stone

All kidney stone below 20 mm can be treated with lithotripsy provided anatomy is favorable.

Investigation required prior to lithotripsy
1) Intravenous pyelography or CT Urography.
2) Urine culture and sensitivity.
3) Coagulation profile.

Results depends on type of lithotripay machine hence system should meeting following points.

1) Electromagnetic lithotripsy system.
2) Large focal zone (focal zone is area where energy ia delived)
-"IT IS MYTH THAT LARGE FOCAL CAUSES RENAL DAMAGE, IN FACT NARROW FOCAL ZONE MACHINE CAUSES MORE RENAL DAMAGE"
3) Dynamic viewing that is Ultrasound as imaging modality.
4) Energy ramping where sufficient number of energy level stepa are available to fragment stone.

If above this are fullfilled you stone is will definitely be cleared.

"IT IS NOT ONLY DOCTOR BUT SYSTEM COMTRIBUTES TO 75% When lithotripsy is advised. "