The Effectiveness of Extracorporeal Shockwave Lithotripsy in Treating Urinary Tract Stones.
Karim, Nouran |
Recenzentas / Reviewer | |
Komisijos pirmininkas / Committee Chairman | |
Komisijos narys / Committee Member | |
Komisijos narys / Committee Member | |
Komisijos narys / Committee Member | |
Komisijos narys / Committee Member |
Aim: To provide a review of literature assessing the effectiveness and complications of extracorporeal shockwave lithotripsy in treating urinary tract stones and to compare these results with other widely used methods used for the treatment of urolithiasis. Objectives:
- To assess success rates of extracorporeal shockwave lithotripsy in treating renal and ureteral calculi.
- To evaluate complications and the rate of complications after extracorporeal shockwave lithotripsy.
- To compare extracorporeal shockwave lithotripsy effectiveness with other methods of urinary tract stone removal.
- To assess the effect that adjuvant therapy has on the effectiveness of extracorporeal shockwave lithotripsy.
Methods: Research was conducted following the preferred approach to reporting items for systemic reviews and meta-analysis (PRISMA) method. Research databases such as PubMed, Google Scholar, Cochrane library and UpToDate were used. A combination of the following terms were used to formulate the search; Extracorporeal Shockwave lithotripsy, shock wave lithotripsy, urolithiasis, effectiveness, complications, reliability, stone free rate, success rate, renal stones, ureteric stones. Full text articles that were in English, included human adult models and within 10 years of the search date were manually sorted according to the inclusion and exclusion criteria. A review of these articles was performed on the basis of title and abstract and any duplicates found were removed. After extensive reviewing, by assessing the full article, a number of articles were deemed appropriate to be included in the literature review. The relevant information was extracted according to specific objectives.
Results: A review of literature has found that extracorporeal shockwave lithotripsy is effective at treating urinary tract stones with a success rate of 64-100% with minimal complication rates compared to other treatment modalities. The use of adjuvant therapy after shockwave lithotripsy significantly increases success rates. A total of 23 articles were selected to be included in this review. 5 articles evaluated effectiveness in renal stones, 4 articles assessed effectiveness in ureteral calculi, 5 articles evaluated complications, 6 articles evaluated the effect of adjuvant therapy, 2 articles evaluated other predictors of success and 1 study assessed effectiveness for renal and ureteral stones and complications.
Conclusions:
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Extracorporeal shockwave lithotripsy is most effective for smaller stones in the renal pelvis and distal ureter and is least effective for larger stones (>10mm), stones of higher density and stones in complex ureteral or renal areas such as inferior pole calyx or middle and proximal ureter.
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The majority of the complications that occur due to extracorporeal shockwave lithotripsy are benign and occur less than alternative treatment modalities. The most common complications that occur are colicky pain, macroscopic haematuria and obstruction due to steinstrasse.
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Retrograde intrarenal surgery (RIRS) and percutaneous nephrostolithotomy techniques (PNL) are more effective at managing renal and ureteral stones, however, they result in higher complication rates than extracorporeal shockwave lithotripsy.
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Tamsulosin increases effectiveness post extracorporeal shockwave lithotripsy by increasing stone clearance and decreasing time for stone passage for stones >10mm. It also reduces the incidence of complications such as colic and steinstrasse among patients.
Šioje literatūros apžvalgoje vertinamas ekstrakorporinės litotripsijos efektyvumas gydant inkstų ir šlapimtakių akmenis, atsižvelgiant į akmenų nebuvimą po taikyto gydymo ir nustatyta, kad ekstrakorporinė litotripsija yra efektyviausia mažesniems akmenims inkstų geldelėje, distalinėje šlapimtakio dalyje ir mažiausiai efektyvi didesniems (>10 mm), didesnio tankio akmenims ir esantiems sudėtingose šlapimtakių ar inkstų srityse, tokiose kaip apatinio poliaus taurelė arba vidurinis ir proksimalinis šlapimtakis.
Apžvelgiamos trumpalaikės ir ilgalaikės komplikacijos bei jų dažnis taikant ekstrakorporinę litotripsijją, kurios daugumai atvėjų yra lengvo laipsnio ir pasitaiko rečiau nei taikant alternatyvius gydymo metodus.
Šioje apžvalgoje lyginamas ekstrakorporinės litotripsijos efektyvumas su kitais šlapimo takų akmenligės gydymo metodais, tokiais kaip perkutaninė nefrolitotripsija ir ureteroskopija. Nustatyta, kad ekstrakorporinė litotripsija yra mažiau efektyvi nei perkutaninė nefrolitotripsija ir ureteroskopija.
Analizuojamas adjuvantinio gydymo (tamsulozino) poveikis ekstrakorporinės litotripsijos veiksmingumui ir nustatyta, kad jis padidina akmenų pasišalinimą ir sumažina komplikacijų, tokių kaip inksto diegliai ir „Steinstrasse“, dažnį tarp pacientų.