Keywords : ESWL
Early Detection of Bacteremia and Bacteriuria after Extracorporeal Shock Wave Lithotripsy By C-Reactive Protein Measurements
Iraqi Postgraduate Medical Journal,
2017, Volume 16, Issue 1, Pages 41-46
Extracorporeal shock wave lithotripsy (ESWL) has long been accepted as the least invasive and reliable method in the treatment of urolithiasis. The success rates have been very high in renal and upper ureteral stones .
Is early detection of bacteriuria and bacteriemia after extracorporeal shock wave lithotripsy (ESWL) of calcium and infection stones by measurement of plasma C-reactive protein (CRP) levels.
A total of 150 patients who had infection stones (n 54) and calcium stones (n 96) were included in the study. All patients had sterile urine before ESWL. The mean age was 41.6+_ 4.85 and male/female ratio was 2.12. Blood cultures were obtained within 1 hour post-ESWL period. Urine cultures were obtained 3 times just after and on the first and seventh day of ESWL.
Post-ESWL evaluations showed 6 positive blood cultures with 4(5.32%) patients in infection stone and 2 (2.66%) patient in calcium stone groups, whereas urine cultures revealed 12 (16%) positive results in infection stones and 8(10..66%) in calcium stones. The patients who had positive cultures also had elevated plasma CRP levels when compared to the levels in patients with negative cultures (p 0.000).
Bacteriuria and bacteriemia after ESWL have been well-identified entities and may be responsible from some of the post-ESWL complications. CRP can be useful for early detection of such complications.
Effect of Shock Wave Frequency on Treatment Outcomes in Patients with Renal Stone Treated by Extracorporeal Shock Wave Lithotripsy
Iraqi Postgraduate Medical Journal,
2016, Volume 15, Issue 2, Pages 197-202
since the introduction of ESWL in treatment of renal stones, it remained the first option for most renal and ureteric stones, with a success rate ranging from 60% to 90%. Multiple variables can affect treatment outcome, including those related to the machine, dose administered, and factors related to the patient; the exact role of most of these factors is still under study.
We investigated the effect of shock wave frequency on treatment outcomes in terms of success and complication rates.
PATIENTS AND METHOD:
139 patients with radio-opaque renal stones, presented to the Urology consultancy clinic during the period June 2010 through January 2012 and decided to undergo ESWL treatment were randomized into three groups, the first group (46 patients) received shock waves at a frequency of 120 waves per minute, the second (47 patients) at 90 w/m, and the third group (46 patients) at 60 w/m. Patients were followed for treatment outcome and appearance of complications at 1 week, 3 weeks, and 6 weeks. Stone free status or insignificant asymptomatic residual gravels of 5mm or less are considered as success. Durations of hematuria and analgesic requirement were the main complications looked for during follow up, while subcapsular and retroperitoneal hematomas were looked.
All patients received 3500-4000 shock waves per session at 17-18 KV energy. Success rate was significantly higher in the second and third groups, while the durations of hematuria and analgesic requirement were significantly shorter in groups 2 and 3. There was no significant difference between groups 2 and 3 in all outcome and complication parameters; however, the duration of treatment was significantly longer in groups 2 and 3.
ESWL efficacy in fragmenting renal stones is significantly improved by decreasing frequency from the standard 120 sw/min to slower rates (90 and 60 sw/min), with significantly decreased analgesic requirement and hematuria durations. There were no significant differences between the 60 and 90 sw/min frequencies. Taking in account the longer treatment duration for the 60 sw/min frequency; the 90 sw/min frequency would be optimal in terms of stone disintegration, complications, and duration of treatment.
KEY WORDS: ESWL, renal stone.