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A prospective randomized comparison between early (<48 hours of onset of colicky pain) versus delayed shockwave lithotripsy for symptomatic upper ureteral calculi: a single center experience.
J Endourol 2010; 24(12):2059-66JE

Abstract

BACKGROUND AND PURPOSE

The role of early/emergency shockwave lithotripsy (SWL) in symptomatic upper ureteral calculi has still not been established. We have performed a randomized comparison between early (<48 hours) vs delayed (>48 hours) SWL for symptomatic upper ureteral stones less than 1 cm to evaluate the feasibility, safety, and efficacy of early SWL in these patients.

PATIENTS AND METHODS

One hundred and sixty consecutive patients with a single radiopaque upper ureteral stone <1 cm, who presented with an episode of colicky pain and who were undergoing treatment between July 2008 and June 2009 in our department were included. The patients were hospitalized and randomized into two groups-group A: SWL was performed within 48 hours of onset of colicky pain (early SWL) using the electromagnetic lithotripter (Dornier Alpha Compact) along with analgesics and hydration therapy; group B: SWL was performed after 48 hours (delayed SWL) along with analgesics and hydration therapy. The statistical analysis was performed in two groups regarding the patient demographic profile, presence of hydronephrosis, time to stone clearance, success rates, number of sessions needed, auxiliary procedures, modified efficiency quotient (EQ), and complications.

RESULTS

Eighty patients were enrolled in each group. The mean stone size was 7.3 mm in group A vs 7.5 mm in group B (P = 0.52). The stone fragmentation rate was 88.75% in group A vs 91.2% in group B (P = 0.35). The overall 3-month stone-free rate was 86.3% (69/80) for group A vs 76.2% (61/80) for group B (P = 0.34). The mean time taken for stone clearance was significantly less in group A than in group B (10.2 days vs 21.1 days; P = 0.01). The number of sessions needed in group A were significantly less than in group B (1.3 vs 2.7; P = 0.01). The auxiliary procedure rate was also significantly lesser in group A than group B (16.3% vs 32.5%; P = 0.001). The modified EQ (in %) was 67.2 in group A vs 59.4 in group B (P = 0.21). The steinstrasse formation and requirement for percutaneous nephrostomy (PCN) were significantly less in group A (P:0.02 and P:0.01 respectively).

CONCLUSIONS

Early SWL (within 48 hours of onset of colicky pain) is feasible, safe, and highly efficacious in the management of symptomatic proximal ureteral stones <1 cm, resulting in a lesser requirement of number of SWL sessions, time taken for stone clearance, auxiliary procedure rate, and fewer complications in comparison with delayed SWL.

Authors+Show Affiliations

Department of Urology, Vardhman Mahaveer Medical College and Safdarjang Hospital, New Delhi, India.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

20973739

Citation

Kumar, Anup, et al. "A Prospective Randomized Comparison Between Early (<48 Hours of Onset of Colicky Pain) Versus Delayed Shockwave Lithotripsy for Symptomatic Upper Ureteral Calculi: a Single Center Experience." Journal of Endourology, vol. 24, no. 12, 2010, pp. 2059-66.
Kumar A, Mohanty NK, Jain M, et al. A prospective randomized comparison between early (<48 hours of onset of colicky pain) versus delayed shockwave lithotripsy for symptomatic upper ureteral calculi: a single center experience. J Endourol. 2010;24(12):2059-66.
Kumar, A., Mohanty, N. K., Jain, M., Prakash, S., & Arora, R. P. (2010). A prospective randomized comparison between early (<48 hours of onset of colicky pain) versus delayed shockwave lithotripsy for symptomatic upper ureteral calculi: a single center experience. Journal of Endourology, 24(12), pp. 2059-66. doi:10.1089/end.2010.0066.
Kumar A, et al. A Prospective Randomized Comparison Between Early (<48 Hours of Onset of Colicky Pain) Versus Delayed Shockwave Lithotripsy for Symptomatic Upper Ureteral Calculi: a Single Center Experience. J Endourol. 2010;24(12):2059-66. PubMed PMID: 20973739.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A prospective randomized comparison between early (<48 hours of onset of colicky pain) versus delayed shockwave lithotripsy for symptomatic upper ureteral calculi: a single center experience. AU - Kumar,Anup, AU - Mohanty,Nayan K, AU - Jain,Manoj, AU - Prakash,Sanjay, AU - Arora,Rajender P, Y1 - 2010/10/25/ PY - 2010/10/27/entrez PY - 2010/10/27/pubmed PY - 2011/3/31/medline SP - 2059 EP - 66 JF - Journal of endourology JO - J. Endourol. VL - 24 IS - 12 N2 - BACKGROUND AND PURPOSE: The role of early/emergency shockwave lithotripsy (SWL) in symptomatic upper ureteral calculi has still not been established. We have performed a randomized comparison between early (<48 hours) vs delayed (>48 hours) SWL for symptomatic upper ureteral stones less than 1 cm to evaluate the feasibility, safety, and efficacy of early SWL in these patients. PATIENTS AND METHODS: One hundred and sixty consecutive patients with a single radiopaque upper ureteral stone <1 cm, who presented with an episode of colicky pain and who were undergoing treatment between July 2008 and June 2009 in our department were included. The patients were hospitalized and randomized into two groups-group A: SWL was performed within 48 hours of onset of colicky pain (early SWL) using the electromagnetic lithotripter (Dornier Alpha Compact) along with analgesics and hydration therapy; group B: SWL was performed after 48 hours (delayed SWL) along with analgesics and hydration therapy. The statistical analysis was performed in two groups regarding the patient demographic profile, presence of hydronephrosis, time to stone clearance, success rates, number of sessions needed, auxiliary procedures, modified efficiency quotient (EQ), and complications. RESULTS: Eighty patients were enrolled in each group. The mean stone size was 7.3 mm in group A vs 7.5 mm in group B (P = 0.52). The stone fragmentation rate was 88.75% in group A vs 91.2% in group B (P = 0.35). The overall 3-month stone-free rate was 86.3% (69/80) for group A vs 76.2% (61/80) for group B (P = 0.34). The mean time taken for stone clearance was significantly less in group A than in group B (10.2 days vs 21.1 days; P = 0.01). The number of sessions needed in group A were significantly less than in group B (1.3 vs 2.7; P = 0.01). The auxiliary procedure rate was also significantly lesser in group A than group B (16.3% vs 32.5%; P = 0.001). The modified EQ (in %) was 67.2 in group A vs 59.4 in group B (P = 0.21). The steinstrasse formation and requirement for percutaneous nephrostomy (PCN) were significantly less in group A (P:0.02 and P:0.01 respectively). CONCLUSIONS: Early SWL (within 48 hours of onset of colicky pain) is feasible, safe, and highly efficacious in the management of symptomatic proximal ureteral stones <1 cm, resulting in a lesser requirement of number of SWL sessions, time taken for stone clearance, auxiliary procedure rate, and fewer complications in comparison with delayed SWL. SN - 1557-900X UR - https://www.unboundmedicine.com/medline/citation/20973739/A_prospective_randomized_comparison_between_early__<48_hours_of_onset_of_colicky_pain__versus_delayed_shockwave_lithotripsy_for_symptomatic_upper_ureteral_calculi:_a_single_center_experience_ L2 - https://www.liebertpub.com/doi/full/10.1089/end.2010.0066?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -