A Pilot Study to Evaluate Haemostatic Function, following Shock Wave Lithotripsy (SWL) for the Treatment of Solitary Kidney Stones.
OBJECTIVE
The number of patients undergoing shock wave lithotripsy (SWL) in the UK for solitary unilateral kidney stones is increasing annually. The development of postoperative complications such as haematuria and sepsis following SWL is likely to increase. Comparing a range of biological markers with the aim of monitoring or predicting postoperative complications following SWL has not been extensively researched. The main purpose of this pilot-study was to test the hypothesis that SWL results in changes to haemostatic function. Subsequently, this pilot-study would form a sound basis to undertake future investigations involving larger cohorts.


METHODS
Twelve patients undergoing SWL for solitary unilateral kidney stones were recruited. From patients (8 male and 4 females) aged between 31-72 years (median-43 years), venous blood samples were collected pre-operatively (baseline), at 30, 120 and 240 minutes postoperatively. Specific haemostatic biomarkers [platelet counts, prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, D-dimer, von Willebrand Factor (vWF), sE-selectin and plasma viscosity (PV)] were measured.


RESULTS
Platelet counts and fibrinogen concentration were significantly decreased following SWL (p = 0.027 and p = 0.014 respectively), while D-dimer and vWF levels significantly increased following SWL (p = 0.019 and p = 0.001 respectively). PT, APTT, sE-selectin and PV parameters were not significantly changed following SWL (p>0.05).


CONCLUSIONS
Changes to specific biomarkers such as plasma fibrinogen and vWF suggest that these represent a more clinically relevant assessment of the extent of haemostatic involvement following SWL. Analysis of such markers, in the future, may potentially provide valuable data on "normal" response after lithotripsy, and could be expanded to identify or predict those patients at risk of coagulopathy following SWL. The validation and reliability will be assessed through the assessment of larger cohorts.
Department of Biological Sciences, University of Chester, Chester, United Kingdom; North Wales & North West Urological Research Centre (NW2URC), University of Chester, Chester, United Kingdom.
Stephen Fôn
SF
Hughes
Haematology Department, BCUHB Wrexham Maelor Hospital, Wrexham, North Wales, United Kingdom.
Samantha Jayne
SJ
Thomas-Wright
Clinical Biochemistry Department, BCUHB Wrexham Maelor Hospital, Wrexham, North Wales, United Kingdom.
Joseph
J
Banwell
Department of Biological Sciences, University of Chester, Chester, United Kingdom.
Rachel
R
Williams
Department of Biological Sciences, University of Chester, Chester, United Kingdom; North Wales & North West Urological Research Centre (NW2URC), University of Chester, Chester, United Kingdom; Department of Urology, BCUHB Wrexham Maelor Hospital, Wrexham, North Wales, United Kingdom.
Alyson Jayne
AJ
Moyes
North Wales & North West Urological Research Centre (NW2URC), University of Chester, Chester, United Kingdom; Department of Clinical Sciences & Nutrition, University of Chester, Chester, United Kingdom.
Sohail
S
Mushtaq
North Wales & North West Urological Research Centre (NW2URC), University of Chester, Chester, United Kingdom; Department of Urology, BCUHB Wrexham Maelor Hospital, Wrexham, North Wales, United Kingdom.
Mohamed
M
Abdulmajed
North Wales & North West Urological Research Centre (NW2URC), University of Chester, Chester, United Kingdom; Department of Urology, BCUHB Wrexham Maelor Hospital, Wrexham, North Wales, United Kingdom.
Iqbal
I
Shergill
D000328:Adult; D000368:Aged; D001780:Blood Coagulation Tests; D005260:Female; D005340:Fibrinogen; D006487:Hemostasis; D019220:High-Energy Shock Waves; D006801:Humans; D007669:Kidney Calculi / Q000097:blood* / Q000628:therapy*; D008096:Lithotripsy; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D010976:Platelet Count; D016896:Treatment Outcome
D005340:Fibrinogen