Recent advances in lithotripsy technology and treatment strategies: A systematic review update

Comparative effectiveness radial shockwave therapy versus focused linear shockwave therapy as an erectile dysfunction treatment systematic review and meta-analysis

Low-intensity shockwave therapy (SWT) is a promising non-invasive treatment for vasculogenic erectile dysfunction (ED). Two primary modalities, focused linear shockwave therapy (fSWT) and radial shockwave therapy (rSWT), differ in energy delivery and tissue penetration. While fSWT is well-studied, rSWT remains less explored for ED despite its growing use. This study compares the effectiveness of fSWT and rSWT in improving erectile function. A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines. Relevant studies published between 2009 and 2024 were identified through searches in PubMed, ScienceDirect, and Cochrane Library. Studies assessing erectile function using the International Index of Erectile Function (IIEF-5), Sexual Health Inventory for Men (SHIM), or Erection Hardness Score (EHS) were included. A random-effects model was applied to analyze standardized mean differences (SMD) and address heterogeneity. Fifteen studies met the inclusion criteria. Meta-analysis revealed that fSWT demonstrated superior efficacy compared to rSWT, with an SMD of 0.45 (95% CI: 0.04-0.86; P < 0.005). High heterogeneity was observed (I² = 80% for rSWT; I² = 99% for fSWT). fSWT and rSWT improved erectile function, but fSWT consistently produces better outcomes across IIEF-5, SHIM, and EHS scores.

Exploring the Impact of Gender-Specific Approaches inRetrograde Intrarenal Surgery: Effects on Operative Efficiency and Patient Recovery

Objective

Very limited data are available exploring the potential influence of gender on Retrograde Intrarenal Surgery outcomes. This study investigates the gender-specific influence of ShuoTongureteroscopy (ST-urs) and Flexible Ureteroscopy (F-urs) surgeries on operation efficacy and patient recovery in a sample of the Somali population.

Materials and Methods

We enrolled 390 participants. Participants were stratified into four gender-specific subgroups based on ureteroscopy operation type: 27.7% males in S-urs (group1), 44.4% females in S-urs (group2), 18.7% males in F-urs (group3), and 9.2% females in F-urs (group4). Primary outcomes included operation time, postoperative hospital stay duration, and VAS Pain Score. Multivariate logistic regression was used to assess associations.

Results

The mean age was 29.53 ± 7.61 years, 72.1% male and 27.9% female, with 46.4% of the patients undergoing ST-urs and 53.6% undergoing F-urs. Women had higher odds of prolonged hospital stays (OR = 2.62, 95% CI: 1.43-4.82, p < 0.001) and post-operation pain (OR = 5.06, 95% CI: 2.95-8.68, p = 0.002). Among men who underwent F-urs procedure, there was a significantly higher odds ratio (OR) of 6.14 (95% CI: 2.86-13.19, p < 0.001) for experiencing a long operation time. Conversely, for females, those who underwent S-urs surgery had a notably lower OR of 0.32 (95% CI: 0.13-0.79, p = 0.013) for long operation time, whereas those who underwent F-urs surgery exhibited a substantially elevated OR of 5.36 (95% CI: 1.85-15.53, p < 0.001). Both females undergoing F-urs surgery (OR: 5.16, 95% CI: 2.61-10.21, p < 0.001) and those undergoing F-urs surgery (OR: 5.25, 95% CI: 2.17-12.73, p < 0.001) experienced significantly higher post-operative pain.

Conclusion

Our research reveals gender disparities in retrograde intrarenal surgery outcomes. Women experience longer hospital stays and higher postoperative pain levels compared to men. F-urs procedures are associated with longer operation times and hospital stays, particularly affecting women. Contrarily, ST-urs offers shorter operation times for women but leads to prolonged hospital stays and heightened postoperative pain.

Pooled-analysis of tadalafil and tamsulosin for ureteral calculi

Objective

Urolithiasis is a common urological diseases and affects the daily life of patients. Medical expulsive therapy has become acceptable for many parents. We conducted a meta-analysis to determine the efficacy and safety of tadalafil compared with tamsulosin for treating distal ureteral stones less than 10 mm in length.

Methods

Related studies were identified via searches of the PubMed, Embase, and Cochrane Library databases. All the articles that described the use of tadalafil and tamsulosin for treating distal ureteral stones were collected.

Results

A total of 14 studies were included in our meta-analysis. Our results revealed that tadalafil enhanced expulsion rate [odds ratio (OR) = 0.68, 95% confidence interval (CI): 0.47 to 0.98, p = 0.04]; reduced expulsion time [mean difference (MD) = 1.22, 95% CI (0.13, 2.30), p = 0.03]; lowered analgesia use [MD = 38.66, 95% CI (7.56, 69.77), p = 0.01] and hospital visits [MD = 0.14, 95% CI (0.06, 0.22), p = 0.0006]. According to our subgroup analysis, either tadalafil 5 mg or 10 mg did not promote expulsion rate and accelerate expulsion time compared with tamsulosin. But patients receiving 5 mg tadalafil decreased analgesia usage [MD = 101.04, 95% CI (67.56, 134.01), p < 0.00001].

Conclusion

Compared with tamsulosin, tadalafil demonstrates a higher expulsion rate and less expulsion time for patients with distal ureteral stones less than 10 mm with a favorable safety profile.

Is extracorporeal lithotripsy a first-line treatment for urinary stones today?

OBJECTIVE

To evaluate the efficacy and complications of extracorporeal lithotripsy (SWL) as a first-line treatment for renal and ureteral stones METHODS: Retrospective and observational study of all the patients treated with lithotripsy in a third level center between January 2014 and January 2021; characteristics of the patients, the stones, complications and results of SWL is recollected. Multivariate logistic regression of the factors associated with stone size reduction was performed. A statistical analysis of the factors associated with additional treatment after SWL and factors associated with complications is also executed.

RESULTS

1727 patients are included. Stone mean size was 9,5mm. 1540 (89.4%) patients presented reduction in stone size. In multivariate analysis, stone size (OR=1.13; p=0.00), ureteral location of the lithiasis (OR=1.15; p=0.052) and number of waves (p=0.002; OR=1.00) used in SWL are the factors associated with reduction of stone size. Additional treatment after lithotripsy was needed in 665 patients (38.5%). The factors associated with the need for retreatment were stone size (OR=1.131; p=0.000), number of waves (OR=1.000; p=0.000), energy (OR=1.005; p=0.000). 153 patients (8.8%) suffered complications after SWL. A statistically significant association was found between the size of the lithiasis (p=0.024, OR=1.054) and the previous urinary diversion (P=0.004, OR=0.571).

CONCLUSION

Lithotripsy remains an effective treatment as the first line of therapy for reno-ureteral lithiasis with a low percentage of complications.

Extracorporeal shock wave lithotripsy for lower calyx stones: predicting treatment success

INTRODUCTION

The use of extracorporeal shock wave lithotripsy (ESWL) for lower calyx stones is associated with a high rate of residual fragments. Our aim is to analyse the effectiveness and complications of ESWL for lower calyx stones.

METHODS

Retrospective review of patients with lower renal calyx stones treated with ESWL between January-2014 and December-2020. Measurement of infundibular length, infundibular width and infundibulopelvic angle in lower renal pole to determine favourable anatomy. ESWL failure: fragments >3 mm detected in plain abdominal film, CT scan and/or renal ultrasound 3 months after treatment. Complications after ESWL, auxiliary procedures along with risk factors associated with perirenal haematoma were analysed. SPSS statistical software was used.

RESULTS

512 patients with lower calyx stones were treated with ESWL. 80.3% of patients had a favourable anatomy. Overall stone-free rate was 70.5%. Regarding main complications after ESWL, stainstrasse was described in 5 patients and urinary tract infection in 3 patients. 10 perirenal haematomas (2%) were reported. Statistical association was found between antiplatelet treatment and the risk of perirenal haematoma (p = 0.004). Logistic binary regression proved the association between unfavourable anatomy of the lower renal pole (p = 0.000), size of the stone (p = 0.001), number of shock waves (p = 0.003), energy applied (p = 0.038) and the need for additional treatment after ESWL.

CONCLUSIONS

ESWL can still be considered as the initial treatment option for lower renal pole stones. The size of the stone, an unfavourable anatomy of the lower renal calyx, number of shock waves and energy applied can help predict the need for additional treatment.

Survey of the quality and origins of websites on penile low-intensity shockwave therapy in Canada

INTRODUCTION

The aim of this study was to establish the quality of patient-facing websites advertising low-intensity shockwave therapy (LISWT) for erectile dysfunction (ED) and Peyronie's disease (PD) patients in Canada.

METHODS

Canadian websites offering LIWST for ED or PD were identified using online web searches. The characteristics of these websites were reviewed, along with examining the presence of HONCode certification, assigning a brief DISCERN score (a tool designed to evaluate health information online) and readability scores. We also examined the LIWST technology advertised, as well as benefits of LIWST cited by the websites.

RESULTS

Twenty-five unique websites linked to 46 clinics were identified and reviewed. Twenty-four percent of websites were run by a urologist. Other specialties offering LISWT included general practitioners, anesthesiologists, naturopaths, nurse practitioners, physiotherapists, and registered massage therapists. Twenty-four percent of the websites advertised the use of a focused shockwave generator. Forty percent of the websites had peer-reviewed references. The average brief DISCERN score was 14 (standard deviation 3.4). There was no association between the physician-or non-physician-led websites and the use of peer-reviewed references, readability scores, the number of clinic locations, or higher brief discern scores.

CONCLUSIONS

LISWT is readily advertised online for ED and PD patients in Canada; however, only a minority use a focused shockwave generator. There is a wide diversity of practitioners offering LISWT. Websites offering LISWT are generally of poor quality and do not provide adequate information for patients to make educated treatment decisions.

The Use of a Virtual Reality Device (HypnoVR) During Extracorporeal Shockwave Lithotripsy for Treatment of Urinary Stones: Initial Results of a Clinical Protocol

OBJECTIVE

To assess the impact of a Virtual Reality Device (VRD, HypnoVR, Strasbourg, France) on patient-reported pain and anxiety during extracorporeal shockwave lithotripsy (ESWL).

MATERIALS AND METHODS

We enrolled 30 patients submitted to ESWL for urinary stones. Patients with either epilepsy or migraine were excluded. ESWL procedures were performed using the same lithotripter (Lithoskop; Siemens, AG Healthcare, Munich, Germany) at a frequency of 1 Hz delivering 3000 shock waves per procedure. The VRD was installed and started 10 minutes before the procedure. Tolerability of pain and treatment-related anxiety represented the primary efficacy outcomes and were evaluated using: (1) a visual analogue scale (VAS), (2) the short version of the McGill pain questionnaire (MPQ), and (3) the short version of the surgical fear questionnaire (SFQ). Secondary outcomes were VRD ease of use and patient satisfaction.

RESULTS

Median (IQR) age was 57 (51-60) years and body mass index (BMI) was 23 (22-27) kg/m². Median (IQR) stone size was 7 (6-12) mm with a median (IQR) density of 870 (800-1100) HU. Stone location was kidney in 22 (73%), and ureter in 8 (27%) patients. Median (IQR) extra time for installation was 6.5 (4-8) minutes. Overall, 20 (67%) patients were at their first ESWL treatment. Side effects were experienced by only 1 patient. Comprehensively, 28 (93%) patients would recommend and would use VRD again during ESWL.

CONCLUSION

VRD application during ESWL is safe and feasible. The initial report from patients is positive in terms of pain and anxiety tolerance. Further comparative studies are needed.

A clinical observational study of effectiveness of a solid coupling medium in extracorporeal shock wave lithotripsy

This study aimed to investigate clinical effectiveness of stone disintegration by using isolation coupling pad (“icPad”) as coupling medium to reduce trapped air pockets during extracorporeal shock wave lithotripsy (ESWL). Patients underwent ESWL between Oct. 2017 and May 2018 were enrolled in this clinical observational study. An electromagnetic lithotripter (Dornier MedTech Europe GmbH Co., Germany) was used in this study. Patients were divided into icPad group P1, P2 and semi-gel group C by different coupling medium. The energy level and total number of shock wave (SW) for group P1 and C was set at level 2 and 3000 and group P2 at level 3 and 2500. The successful stone disintegration rate (SSDR) was determined to evaluate the treatment outcome. All patients were evaluated by KUB film and ultrasonography after 90 days. Complications during ESWL were recorded. A total of 300 patients satisfied the inclusion criteria. There were no significant differences in characteristics of patients and stone among three groups. The corresponding SSDRs for patients in group P1, P2 and C was 73.0%, 73.2% and 55.3%, respectively. The SSDR in group P1 was statistically higher than Group C. Comparing to semi-liquid gel, coupling medium using by icPad could achieve better treatment outcome of stone disintegration in ESWL.

Far field during sonication experiments in vitro - Is it really far enough?

In many in vitro experiments studying ultrasound bioeffects the sonicated samples are placed to far field with intention of exposing them to as uniform ultrasound field as possible. The main aim of this work is to assess whether the sonicated samples really experience what they are believed to. Also we would like to suggest basic rules for construction of sonication vessels. We used 3.5 MHz and 7 MHz ultrasound transducers for measurements. We measured ultrasound field inside and behind common culture plates and special 3D printed plates placed to last axial maximum in water sonication tank with use of a needle hydrophone. Our results show that even though the sonication vessels with sonicated samples are placed into far field, the sonicated samples are actually exposed to some kind of a near field pattern which develops due to the interaction between ultrasound and well of culture plate. The variability of local acoustic intensity can reach up to several hundreds of percent. Our results are also supported by theoretical calculation and software for simulation of ultrasound fields. Even though the sonicated samples may have actually been exposed to some kind of near field pattern in many past studies, the whole phenomenon of creation of near field pattern can be controlled to some extent for future studies. Thus, we suggest that the sonication vessel should always be designed for particular ultrasound transducer.

Newly designed solid coupling medium for reducing trapped air pockets during extracorporeal shock wave lithotripsy_ a phantom study

INTRODUCTION

Air pockets between the lithotripter head and body surface are almost inevitably generated when applying a handful of gel onto the contact portion of the treatment head and that on the patient's skin during coupling procedure. These air pockets can compromise the transmission of acoustic energy of shock wave and may significantly affect efficacy of stone disintegration. Comparing to conventional gel, this study aims to investigate efficacy of stone disintegration by using a proprietary isolation-coupling pad ("icPad") as the coupling medium to reduce trapped air pockets during ESWL procedure.

METHOD

In this phantom study, Dornier lithotripter (Delta-2 RC, Dornier MedTech Europe GmbH Co., Germany) was used with a proprietary gel pads (icPad, Diameter = 150 mm, Thickness = 4 mm and 8 mm). The lithotripter was equipped with inline camera to observe the trapped air pockets between the contact surface of the lithotripter head. A testing and measuring device were used to observe experimental stone disintegration using icPad and semi-liquid gel. The conventional semi-liquid gel was used as control for result comparison.

RESULTS

The stone disintegration rate of icPad 4 mm and 8 mm after 200 shocks of energy at level 2 were significantly higher than that of the semi-liquid gel (disintegration rate 92.3%, 85.0% vs. 45.5%, respectively, p < 0.001). The number of shocks for complete stone disintegration by icPad of 4 mm and 8 mm at the same energy level 2 were significantly lower than that of the semi-liquid gel (the number of shocks 242.0 ± 13.8, 248.7 ± 6.3 vs. 351.0 ± 54.6, respectively, p = 0.011). Furthermore, quantitative comparison of observed air pockets under Optical Coupling Control (OCC) system showed that the area of air pockets in semi-liquid group was significantly larger than that of the group using icPad (8 mm) and that of the group using icPad (8 mm) after sliding (332.7 ± 91.2 vs. 50.3 ± 31.9, 120.3 ± 21.5, respectively, p < 0.05).

CONCLUSION

The advantages of icPad includes: (1) reduced the numbers of shock wave and increased stone disintegration rate due to icPad's superior efficacy; (2) significantly reduce trapped air pockets in ESWL coupling. Due to the study limitation, more data are needed to confirm our observations before human trials.

Efficacy and safety of various surgical treatments for proximal ureteral stone ≥10mm: A systematic review and network meta-analysis

Purpose

Various surgical options are available for large proximal ureteral stones, such as extracorporeal shock wave lithotripsy (ESWL), ureteroscopic lithotripsy (URSL), percutaneous nephrolithotomy (PCNL) and laparoscopic ureterolithotomy (LU). However, the best option remains controversial. Therefore, we conducted a network meta-analysis comparing various surgical treatments for proximal ureteral stones ≥10mm to address current research deficiencies.

Materials and methods

We searched PubMed, Ovid, Scopus (up to June 2019), as well as citation lists to identify eligible comparative studies. All clinical studies including patients comparing surgical treatments for proximal ureteral stones ≥10mm were included. A standard network meta-analysis was performed with Stata SE 14 (Stata Corp, College Station, TX, USA) software to generate comparative statistics. The quality was assessed with level of evidence according to the Oxford Centre for Evidence-based Medicine and risk of bias with the Cochrane Collaboration’s Review Manager (RevMan) 5.3 software.

Results

A total of 25 studies including 2.888 patients were included in this network meta-analysis. Network meta-analyses indicated that LU and PCNL had better stone-free rates and auxiliary procedures. PCNL could result in major complications and severe bleeding. In initial stone-free rate, final stone-free rate, and auxiliary procedures results, SUCRA ranking was: LU> PCNL> URSL> ESWL. In Clavien Dindo score ≥3 complications, SUCRA ranking was: LU> ESWL> URSL> PCNL. In fever, SUCRA ranking was: ESWL> LU> URSL> PCNL. In transfusion, SUCRA ranking was: LU> URSL> ESWL> PCNL. In Cluster analysis, LU had the highest advantages and acceptable side effects. Considering the traumatic nature of PCNL, it should not be an option over URSL. ESWL had the lowest advantages.

Conclusions

LU have the potential to be considered as the first treatment choice of proximal ureteral stone ≥10mm.

Retrospective comparison of focused shockwave therapy and radial wave therapy for men with erectile dysfunction

Background

Low-intensity shockwave therapy (SWT) is an emerging treatment for erectile dysfunction (ED). Devices used for SWT include focused shockwave therapy (fSWT) or radial wave therapy (rWT), which differ in how the waves are generated, their tissue penetration, and the shape of their pressure waves. Most studies of SWT for ED to date have utilized fSWT. Although widely used, the efficacy of rWT for ED is unknown. Our objective is to compare the efficacy of rWT and fSWT for ED at our institution.

Methods

A retrospective chart review was performed to identify all men with ED treated by fSWT or rWT. Men with history suggesting non-vasculogenic ED were excluded. All men received 6 consecutive weekly treatments. The fSWT group received 3,000 shocks per treatment at 0.09 mJ/mm². The rWT group received 10,000 shocks per treatment at 90 mJ and 15 Hz. Pre-treatment and 6-week post-treatment Sexual Health Inventory in Men (SHIM) scores were measured. Treatment response was categorized on a scale of 1–3 (1 if no improvement, 2 if erections sufficient for intercourse with phosphodiesterase 5 inhibitors (PDE5i), or 3 if sufficient erections without PDE5i). Primary endpoint was self-reported improvement score of 2 or greater.

Results

A total of 48 men were included: 24 treated by fSWT and 24 by rWT. There were no significant differences in age, duration of ED, pre-treatment PDE5i use, or pre-treatment SHIM scores between the groups. Following treatment with rWT, the mean SHIM score improved from 9.3 to 16.1 (P<0.001). The mean SHIM following fSWT improved from 9.3 to 15.5 (P<0.001). The mean improvement in SHIM score did not differ between rWT (6.8) and fSWT (6.2) (P=0.42). 54% of men treated by fSWT experienced a significant clinical improvement (≥ grade 2 response) compared to 75% in the rWT group (P=0.42). There were no reported side effects with either device.

Conclusions

In our patient population, both fSWT and rWT were moderately effective treatments for arteriogenic ED with no observable difference in efficacy between the two modalities.

The role of extracorporeal shock wave lithotripsy in the future of stone management

PURPOSE OF REVIEW

The most relevant recent findings on the use of extracorporeal shock wave lithotripsy (ESWL) in adult population to provide an insight of its role in the current and future of stone treatment. Comparing ESWL with other modalities is not in the scope of this review.

RECENT FINDINGS

We conducted a PubMed/Embase search and reviewed recent publications that include relevant information on the development of ESWL. Low-rate shock waves improve stone breakage, ramping energy modalities improve stone fragmentation and have lower incidence of hematoma and kidney injury. Transgluteal approach is suggested to improve stone-free rates for distal ureteral stones in a single session. Proper coupling is the most important technical aspect of the treatment and coupling improvement can be achieved by optical monitorization. Triple D score is a promising tool in proper patient selection, but external validation is needed. Predictive information arising from computed tomography scans has been refined by the variant coefficient of stone density and 3D texture analysis that might improve outcomes in the future.

SUMMARY

Recent evidence suggests that modifying techniques and protocols, and better patient selection are the current trends for improving ESWL outcomes. EWSL will keep its role as the single noninvasive treatment in stone management with room for outcome improvement in the future.

Treatment of renal calculi without hydronephrosis using a standard channel assisted by a visual puncture system

Objective

To study the safety and efficacy of standard channel establishment using a visual puncture system in the treatment of renal calculi without hydronephrosis.

Methods

We retrospectively analyzed data from 46 patients undergoing percutaneous nephrolithotomy via a standard channel assisted by a visual puncture system, including number of punctures, duration of procedure, hemoglobin level after surgery, calculi clearance rate, and postoperative complications.

Results

Sixty-nine channels were established, including a single channel in 26 cases, double channel in 17 cases, and three channels in 3 cases. The mean number of punctures was 1.50, mean time to establish the standard channel was 2.6 minutes, and duration of surgery was 31.3 minutes. No significant change in hemoglobin was observed after surgery. Forty-three patients had no residual calculi and three had small residual calculi on the day after surgery, representing a first-phase clearance rate of 93.48% (43/46). No significant complications were observed.

Conclusions

Hemorrhage during operation can be significantly reduced by establishing a standard channel using a visual puncture system. Moreover, the number of standard channels can be reduced and the incidence of complications lowered using this approach, which should be adopted widely for the treatment of renal calculi without hydronephrosis.

Optimisation of shock wave lithotripsy: a systematic review of technical aspects to improve outcomes

Shock wave lithotripsy (SWL) remains an important treatment option for the management of upper urinary tract stones. The optimisation of certain technical principles can help to improve the results of SWL. We performed a systematic review based on preferred reporting items for systematic review and meta-analysis (PRISMA) standards for studies reporting on technical aspects of SWL. A literature search was conducted on the PubMed database between January 1984 and November 2018 using 'shockwave lithotripsy' and 'stone' as keywords. Summaries and manuscripts of relevant articles were reviewed in order to select studies with the best level of evidence in each theme covered during the review. From 4,135 titles, 165 abstracts and full-text articles were reviewed. Overall, SWL has good outcomes in the treatment of upper urinary tract stones. It remains the only truly non-invasive stone treatment. While stone-free rate (SFR) might not be equivalent to ureteroscopy or percutaneous nephrolithotomy outcomes, SWL can be optimised by changing several technical factors, including type of machine, patient position, number, rate and energy of shocks, stone targeting, and patient analgesia. For each of these included SWL themes, relevant and selected studies with the highest level of evidence were described and discussed. Paired with these improved technical factors and appropriate patient selection, SWL, with its low complication rates, remains an excellent treatment option in 2019.

Update on Surgical Management of Pediatric Urolithiasis

Urolithiasis has always been a fascinating disease, even more so in children. There are many intriguing facets to this pathology. This article is a nonsystematic review to provide an update on the surgical management of pediatric urolithiasis. It highlights the pros and cons of various minimally invasive surgical options such as extracorporeal shockwave lithotripsy (ESWL), retrograde intrarenal surgery (RIRS), percutaneous nephrolithotomy (PCNL), laparoscopy, and robotics. This article also describes the various intracorporeal disintegration technologies available to fragment the stone, including the newer advancements in laser technology. It also emphasizes the cost considerations especially with reference to the emerging economies. Thus, this manuscript guides how to select the least-invasive option for an individual patient, considering age and gender; stone size, location, and composition; and facilities and expertise available.

OBESITY: A DELICATE ISSUE CHOOSING THE ESWL TREATMENT FOR PATIENTS WITH KIDNEY AND URETERAL STONES?

CONTEXT

Urolithiasis and obesity are now public health problems with an increased incidence worldwide. Management of urolithiasis in patients with morbid obesity is usually associated with higher morbidity and mortality compared to non-obese patients. ESWL is a nonsurgical procedure for the treatment of lithiasis. In obese patients the ESWL efficacy is influenced by the skin-to-stone distance or poorer detection of the calculus because of the fatty tissue.

OBJECTIVE

To highlight the overweight or obese lithiasic patient profile that could be best treated by ESWL.

SUBJECTS AND METHODS

We evaluated ESWL results in 1393 patients with kidney or ureteral stones between 5 and 20 mm. They were divided into 4 groups according to the BMI: Group A-overweight (BMI=25-30 kg/m2); Group B-grade I obesity (BMI=30-35 kg/m2); Group C-grade II obesity (BMI=35-40 kg/m2) and a control group of normal weight (BMI=18-25 kg/m2).

RESULTS

Patients with a higher BMI required a greater number of ESWL sessions. A statistically significant greater number of patients with a waist circumference of >102 cm required more than 2 SWL sessions (p=0.007). Location of the stones in the pelvic ureter had the highest rate of success for obese patients (p=0.00001). The ESWL success rate in overweight and obese patients can be negatively influenced by BMI, abdominal circumference over 102 cm, and hardness of calculi reflected in the radiopacity on KUB.

CONCLUSIONS

In patients with grade II obesity, pyelocaliceal calculus and increased hardness, other urological alternatives to lithiasis should be considered from the beginning.

Extracorporeal shock wave lithotripsy under intravenous sedation for treatment of urolithiasis

BACKGROUND

In contrast to treatment with oral or intramuscular analgesics, extracorporeal shock wave lithotripsy (E.S.W.L.) can be performed with patients under sedation too. Besides the advantage of increased shock energy, patients tend to have more constant breathing excursions and are more idle during treatment, potentially increasing the stone-free ratio (S.F.R.) after treatment.

METHODS

This study presents the results of 310 patients who underwent 400 E.S.W.L. procedures under sedation, with a stationary lithotripter.

RESULTS

After one procedure, the S.F.R. was 54.8% (170/310). A second treatment was successful in 42.1% (32/76), a third treatment in 21.4% (3/14). Therefore, 66.1% (205/310) of patients eventually became stone-free. Kidney stones were successfully treated in 65.4% (161/246), ureteral stones in 68.8% (44/64) of cases. Patients with stones ≤15 mm were successfully treated in 67.4% (194/288), patients with stones >15 mm in 50% (11/22) of cases. Considering each procedure individually, 45.3% (181/400) of procedures were successful after 3 weeks. Extending follow-up to 3 months is important, since 26.7% of stones (24/90) eventually still disappeared, increasing S.F.R. to 51.3% after one procedure. Complications occurred after 5.5% E.S.W.L.-procedures.

CONCLUSIONS

E.S.W.L. is a well-tolerated, non-invasive procedure that produces reasonable stone clearance of both upper and lower urinary tract calculi. Performing the procedure whilst patients are intravenously sedated results in an acceptable S.F.R. Strong selection based on unfavourable factors could increase the chance on successful treatment and spare patients a pointless procedure. However, considering E.S.W.L.'s elegant nature, sometimes a more tolerant approach seems justifiable.

Single extracorporeal shock-wave lithotripsy for proximal ureter stones: Can CT texture analysis technique help predict the therapeutic effect?

PURPOSE

To explore whether the computed tomography texture analysis (CTTA) technique can help predict the curative effects of a single extracorporeal shock-wave lithotripsy (ESWL) for proximal ureteral stones.

MATERIALS AND METHODS

In all, 100 patients with proximal ureteral stone underwent non-enhanced multi-detector computed tomography (MDCT) before ESWL. The patients were divided into success and failure groups. Success of ESWL was defined as the patients being stone-free or having residual stone fragments of ≤2 mm. Traditional characteristics, such as stone size, body mass index (BMI), and skin-to-stone distance (SSD), and CTTA metrics, such as the mean Hounsfield unit (HU) density, entropy, kurtosis, and skewness, were analyzed and compared between two groups by univariate and multivariate logistic regression analyses. Receiver operating characteristic (ROC) curves were generated to determine Youden index-based cutoff values.

RESULT

Failure of stone removal was observed in 36 patients (36%). Stone height, stone cross-sectional diameter, largest cross-sectional area, stone volume, stone density (mean HU), and CTTA metrics (kurtosis and entropy) were the significant independent predictors of ESWL success on univariate analysis (p < 0.05). On multivariate analysis, mean HU, skewness, and kurtosis were shown to be significant predictors of ESWL success (p < 0.05). In subgroup analysis based on the cutoff value of mean stone density (HU = 857), the only significant independent factor associated with both subgroups was kurtosis (p < 0.05).

CONCLUSIONS

As a quantitative analysis method, CTTA may be helpful in selecting appropriate ESWL patients. High kurtosis and low mean HU values simultaneously indicate a relatively higher ESWL success rate.

Trends in the treatment of urinary stone disease in Turkey

Introduction

In this study, a survey was prepared for urologists that asked about their primary choice of treatment for urolithiasis in daily practice and their answers were evaluated.

Methods

The survey was prepared on the Google Docs website and it was sent to 1,016 urologists via email with 752 confirmed deliveries. In addition to the demographic questions about each participant's age, gender, and institution, the survey presented case scenarios focusing on their preferred treatment modalities for distal ureteric, proximal ureteric, and renal calculi. The participating urologists were divided into two groups according to the frequency that they treat urolithiasis patients.

Results

Of the 752 surveys delivered, 211 urologists (28.05%) responded and 204 answered all questions. According to the results, there were no significant differences between the treatment approaches and the other localizations, but there was a statistically significant difference for treatment approaches to lower pole stones between two groups. In response to the question of which stone treatment method was used less frequently, 124 (60.7%) participants answered that they used shock wave lithotripsy less in the last 10 years.

Conclusion

The present study has shown that while the management of renal and ureteric calculi by Turkish urologists is highly varied, the overall treatment patterns are in accordance with the European Association of Urology guidelines. However, similar to the global trend extracorporeal shock wave lithotripsy is less preferred by Turkish urologists.

Nanoparticle-assisted ultrasound: A special focus on sonodynamic therapy against cancer

At present, ultrasound radiation is broadly employed in medicine for both diagnostic and therapeutic purposes at various frequencies and intensities. In this review article, we focus on therapeutically-active nanoparticles (NPs) when stimulated by ultrasound. We first introduce the different ultrasound-based therapies with special attention to the techniques involved in the oncological field, then we summarize the different NPs used, ranging from soft materials, like liposomes or micro/nano-bubbles, to metal and metal oxide NPs. We therefore focus on the sonodynamic therapy and on the possible working mechanisms under debate of NPs-assisted sonodynamic treatments. We support the idea that various, complex and synergistics physical-chemical processes take place during acoustic cavitation and NP activation. Different mechanisms are therefore responsible for the final cancer cell death and strongly depends not only on the type and structure of NPs or nanocarriers, but also on the way they interact with the ultrasonic pressure waves. We conclude with a brief overview of the clinical applications of the various ultrasound therapies and the related use of NPs-assisted ultrasound in clinics, showing that this very innovative and promising approach is however still at its infancy in the clinical cancer treatment.