Comparison of escalating, constant, and reduction energy output in ESWL for renal stones: multi-arm prospective randomized study.
This study was designed to find out the optimized energy delivery strategy in Shock Wave Lithotripsy (SWL) that yield to the best stone-free rate (SFR). In this clinical trial, 150 consecutive patients were randomized into three groups: (a) Dose escalation, 1500 SW at 18 kV, followed by 1500 SW at 20 kV then 1500 SW at 22 kV. (b) Constant dose, 4500 SW at 20 kV. All patients undergo plain X-ray film of the urinary tract at day 1, 14, and 90 to assess stone-free rate (SFR) which was defined as no stones or painless fragments less than 4 mm. (c) Dose reduction, 1500 SW at 22 kV, followed by 1500 SW at 20 kV and then 1500 SW at 18 kV. The three treatment groups were comparable in terms of age, sex, stone size and distribution of the kidneys, and the need for Double J stent use. On day 90, the SFR achieved was 82, 90, and 84 % in the escalating, constant, and reduction energy groups, respectively. However, this rate was not statistically significant (x2= 1.38, p level = 0.28). At a slow rate of 60 shocks, there was no difference in stone-free rate between different voltages at 1, 14, and 90 days. Our randomized clinical trial showed no statistically significant difference in SFR between the three groups while using the slow SWL rate. Our trial is the first randomized trial comparing the three strategies. As such, a dose adjustment strategy while delivering SWL in slow rate was not recommended.
Surgery Department, Cancer Research Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Danny M
DM
Rabah
Surgery Department, Cancer Research Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Mohamed S
MS
Mabrouki
Cancer Research Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia. kfarhat@ksu.edu.sa.
Karim H
KH
Farhat
Sharjah University Hospital, Sharjah, United Arab Emirates.
Mohamed A
MA
Seida
Cancer Research Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Mostafa A
MA
Arafa
Surgery Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Riyadh F
RF
Talic
D000328:Adult; D004307:Dose-Response Relationship, Radiation; D005260:Female; D019220:High-Energy Shock Waves / Q000627:therapeutic use*; D006801:Humans; D007668:Kidney / Q000528:radiation effects; D007669:Kidney Calculi / Q000601:surgery*; D008096:Lithotripsy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015607:Stents; D016896:Treatment Outcome; D014513:Ureter / Q000528:radiation effects
Dose constant; Dose escalating; Dose reduction; Renal stones; Shock wave lithotripsy; Stone-free rate
Rev Urol. 2013;15(2):49-60
24082843
J Urol. 2005 Jan;173(1):127-30
15592053
Urology. 2005 Dec;66(6):1160-4
16360432
Arab J Urol. 2011 Jun;9(2):101-5
26579276
Eur Urol. 2000 Jan;37(1):18-22
10671779
J Endourol. 2006 Sep;20(9):603-6
16999607
BJU Int. 2016 Apr;117 Suppl 4:76-81
26923107
J Endourol. 2011 Sep;25(9):1507-11
21834658
Urology. 2011 Oct;78(4):759-63
21550641
Eur Urol. 1989;16(1):41-4
2714316
J Urol. 2004 Jul;172(1):349-54
15201809
J Urol. 2010 Feb;183(2):580-4
20018316
Eur Urol. 2016 Feb;69(2):267-73
26119561