Twenty-year prevalence of diabetes mellitus and hypertension in patients receiving shock-wave lithotripsy for urolithiasis.

OBJECTIVES: To compare the prevalence of hypertension and diabetes mellitus (DM) in patients treated with an unmodified HM-3 lithotripter (USWL) and a second-generation modified HM-3 lithotripter (MSWL) 20 years ago at our Centre with that in the provincial population. To determine whether the type of lithotripter was differentially associated with the development of these sequelae. PATIENTS AND METHODS: Retrospective review of 727 patients at Vancouver General Hospital who underwent shock-wave lithotripsy (SWL) between 1985 and 1989. Our study group was compared with Statistics Canada data describing the provincial prevalence of these diseases. Multivariate analysis was performed. RESULTS: The response rate was 37.3%. There was a greater proportion of overweight and obese individuals in the study group compared with the provincial average. In univariate analysis, lithotripsy with an unmodified HM-3 (USWL) was associated with a higher rate of DM than the provincial rate, whereas lithotripsy with the modified HM-3 (MSWL) was not. Hypertension was more prevalent in all lithotripsy subjects. On multivariate analysis the type of lithotripter was not associated with the development of either sequela. CONCLUSIONS: No association between lithotripsy and the development of either DM or hypertension in a multivariate analysis Metabolic syndrome may have elevated the prevalence of DM and hypertension observed in our subjects on univariate analysis, which is in keeping with the fact that our study population had statistically higher body mass indices than the provincial rate. Lithotripsy using the HM-3 was not associated with increased DM or hypertension.

The efficacy of the Dornier Doli S lithotripter for renal stones.

INTRODUCTION: There is little documentation of the efficacy of the Doli-S lithotripter. This study investigated the outcome of ESWL with the Doli-S lithotripter on previously untreated renal calculi. METHODS: Over a 12 month period, 105 consecutive patients with renal stones, treated by a single urologist were enrolled in the study. None of the stones were previously treated. Data gathered included stone characteristics and treatment characteristics. Treatment was to an endpoint of either fluoroscopically successful fragmentation or to 2500 shockwaves. Patients were followed with KUBs, ultrasounds, or CT-KUBs to assess residual stone burden. Treatment success was defined as complete clearing of the calculus, or residual fragments of less than 3 mm. RESULTS: One hundred five patients were treated and 16 were lost to follow-up. One hundred nineteen stones in 89 patients were included in our analysis. Mean follow-up was 115 days. The average stone size (expressed as mean of two measured stone dimensions) was 7.8 mm. After a single lithotripsy treatment, the overall treatment success rate was 47.9%. The left kidney accounted for 58% of the treated stones. Treatment success was greater for left renal stones than right-sided stones (55.1% versus 38.0%, p = 0.033). There was no significant difference in treatment success rates for calyceal location of stones. Lower pole stones were treated successfully in 57.9% of cases. Smaller stones (3 mm-10 mm) were more successfully treated than larger stones (10 mm-20 mm) (55.6% versus 24.1%, p = < 0.001). CONCLUSIONS: Success rates for the Doli-S lithotripter for a single treatment of previously untreated renal stones ranged from 24%-58%, depending on stone size and location. These rates are lower than success rates reported for other lithotripters. Inferior pole calculi had a higher treatment success rate than previously reported. Factors associated with treatment success included smaller stone size, left-sided stones, and ease of fluoroscopic visualization.