Efficacy of extracorporeal shockwave lithotripsy with patients rotated supine or rotated prone for treating ureteral stones: a case-control study.
OBJECTIVE
To improve the therapeutic efficacy of extracorporeal shockwave lithotripsy (SWL) for ureteral stones by attempting semilateral/rotated approaches. There has been no study that shows the advantage of rotated positions.


METHODS
Two hundred forty-eight (group 1) and 156 (group 1R) patients with proximal-ureteral stones were treated by the Dornier Lithotriptor U15/50 in the supine and rotated-supine position, respectively. When residual calculi remained in the middle-distal ureter, group 1 subjects underwent subsequent sessions in the ordinary prone position, and Group 1R patients were treated in the rotated-prone position. Sixty-two (group 2) and 60 (group 2R) patients with primary middle-ureteral stones were treated in the prone and rotated- prone position, respectively, while 110 (group 3) and 98 (group 3R) patients with distal-ureteral stones were treated in the prone and rotated-prone position, respectively.


RESULTS
Although the stone-free rate was not different in group 1 (94.8%) and 1R (97.4%), the number of sessions required for Group 1R patients to be stonefree (mean 1.49) was less than for Group 1 patients (mean 1.74; p=0.023). Group 1R patients tolerated a higher shockwave intensity than group 1 patients for sessions in the proximal ureter (p=0.042). The stone-free rate for Groups 1 and 1R for booster sessions in the middle- distal ureter was 85.4% and 100%, respectively (p=0.059). The stone-free rate for groups 2R (95.0%) and 3R (98.0%) was higher than that for groups 2 (83.9%) and 3 (89.1%) (p=0.046; p=0.011).


CONCLUSIONS
These effortless modifications bring about a superior outcome when treating ureteral calculi with SWL.
Hara
Noboru
N
Department of Urology, Labor Welfare Niigata Rousai Hospital, Joetsu, and Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Japan. harasho@med.niigata-u.ac.jp
Koike
Hiroshi
H
Bilim
Vladimir
V
Takahashi
Kota
K
Nishiyama
Tsutomu
T
D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008096:Lithotripsy / Q000379:methods*; D016015:Logistic Models; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010149:Postoperative Pain / Q000503:physiopathology; D017060:Patient Satisfaction; D016684:Prone Position; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016683:Supine Position; D016896:Treatment Outcome; D014514:Ureteral Calculi / Q000175:diagnosis* / Q000628:therapy*