Is There Any Improvement In Efficacy Of Xtracorporeal Shockwave Lithotripsy Therapy For Treating Renal Stones With Invent Of New Shockwave Machines?

BACKGROUND: Renal stone disease is a very common medical problem in general population. As with invent of newer therapeutic modalities, ESWL is already losing its popularity. But we believe it as an effective way of treating renal stones. This study was conducted to evaluate any improvement in success rate of ESWL therapy for treating renal stones with latest shockwave lithotripsy machines. METHODS: Study conducted from June 2016 until November 2017 in Alkhor hospital, Hamad Medical Corporation, Qatar. All patients undergoing ESWL for renal stones in mentioned period were included. Total 197 patients underwent ESWL using newer machines. Factors already studied to affect the success rate like stone size, location, consistency (measured by Hounsfield units on CT), presence of stent were taken in consideration. After a period of 3 months either complete stone clearance or stone fragments smaller than 4 mm were considered as a treatment success. These results were compared to the results from literature. RESULTS: Patients were followed until 3 months after treatment. 170 patients (86.29%) had complete stone clearance. Eleven patients (5.58%) had residual stone less than 4 mm, thus achieving an overall success of 181 patients (91.88%). 42 patients (21.32%) needed repeat session of ESWL with a maximum number of 3 sessions. 16 patient's (8.12%) required auxiliary procedures like flexible ureteroscopy. Post-ESWL complications were recorded in 12 patients (6.09%). Success rate was affected mainly by stone size with negligible effect of stone location. Presence of stent affected the number of sessions but has no impact on stone clearance.. CONCLUSIONS: Although the stone size and to a negligible extent, the stone location and presence of stent may affect the stone clearance, nevertheless a significant improvement in success rate has been observed by use of new shockwave lithotripsy machines.

Percutaneous nephrolithotomy in complete supine flank-free position in comparison to prone position: A single-centre experience.

OBJECTIVES: To assess the outcomes of performing percutaneous nephrolithotomy (PCNL) in a modified supine position, more feasible for surgeons, anaesthetists, and operating theatre staff, as well as for the patient himself, and evaluating it in comparison to the standard prone position. PATIENT AND METHODS: A retrospective, case-control study was conducted between January 2011 and December 2015. In all, 197 patient's records were reviewed. The initial 101 patients were operated upon in prone position. From mid-2013, 96 patients were operated upon in a complete supine, flank-free position. The groups were compared in terms of operation time, calculated from positioning the patient after anaesthesia induction, insertion of ureteric catheter, puncture of renal system, until the end of procedure; stone-free rate; hospital stay; and postoperative complications, such as transfusion rate, fever, and urinary leakage. RESULTS: There were two significant differences between the groups. Firstly, the operation time was a mean (SD) 32.3 (6.6) min shorter for the supine versus the prone position (P < 0.001). Secondly, hospital stay was a mean (SD) 1.2 (0.75) days shorter for the supine vs the prone position (P < 0.001). The complete stone clearance rate (85.4% for supine vs 79.2% for prone; P = 0.2) and postoperative complications (7.3% for supine vs 17.8% for prone; P = 0.02) were comparable in both groups. CONCLUSION: Supine PCNL is a feasible procedure with similar outcomes in terms of stone-free rate as well as postoperative complications, to the standard prone PCNL. It reduces unnecessary delay that occurs during change of position resulting in significant shortening of the total operation time and surgeons can perform supine PCNL whilst sitting.

Supine percutaneous nephrolithotomy in horseshoe kidney.

We report a case of a 45-year-old male who presented with recurrent left loin pain of three months' duration. A CT scan of his abdomen and pelvis showed a horseshoe kidney with two stones in the middle and lower calyx of the left kidney, each stone measuring approximately 1.5 cm in size. The patient had a past history of several unsuccessful attempts of extracorporeal shockwave lithotripsy (ESWL) on the same side. We treated the patient successfully by performing a percutaneous nephrolithotomy (PCNL) in the supine position that resulted in complete stone clearance. In addition, we report a shorter procedure time and hospital stay with no perioperative or post-operative complications.