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Is there a place for extracorporeal shockwave lithotripsy (ESWL) in the endoscopic era?

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Abstract

This retrospective study aimed to evaluate whether there was still a place for ESWL therapy in the endourological era. From 1988 to 2018, ESWL therapy was performed with 3 successive types of lithotripters in our hospital. From 1988 to 1998, the electrohydraulic lithotripter NS-15 was used, and the electromagnetic lithotripter HK-V was put to use in 1999. Since 2010, the electromagnetic lithotripter HK-Vm has been used. Over the 30-year period, 16,969 urolithiasis patients underwent ESWL therapy, including 124 paediatric cases and 178 special cases. The stone clearance rate (SCR) and postoperative complications in the 3 lithotripter groups were recorded and analysed. The SCR was estimated by ultrasonography or plain X-ray, while the complications were recorded by the modified Clavien grading system. The primary stone clearance rate (pSCR) of ureteral and renal stones was significantly improved in the HK-Vm group compared with the NS-15 and HK-V groups. The final stone clearance rate (fSCR) of lower calyx stones was considerably higher in the HK-Vm group (55.9%) than in the NS-15 (41.1%) and HK-V (44.1%) groups. Most complications were grade I and II, while the incidence of grade III and above complications was less than 3%. Additionally, the fSCR in paediatric and special cases ranged from 66.5% to 83.5%, with no record of severe complications. As our data showed, ESWL was effective and safe for most urolithiasis patients, including paediatric patients and special cases. Therefore, ESWL is still the major treatment option in the current endourological era.

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Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Abbreviations

ESWL:

Extracorporeal shockwave lithotripsy

FUR:

Flexible ureteroscopy

PCNL:

Percutaneous nephrostolithotomy

pSCR:

Primary stone clearance rate

fSCR:

Final stone clearance rate

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Acknowledgements

The abstract of our data was presented as a poster at the 34th EAU congress in Barcelona, 2019. It was titled “What’s the role of extracorporeal shockwave lithotripsy (ESWL) in the endoscopic era?” -- a retrospective review of ESWL for urinary tract calculi in the past thirty years.” This abstract can be accessed at https://resource-centre.uroweb.org/resource. center/eau19/187016/Abstract.

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Contributions

XC: supervise the study and interpretation of data. JC: operation and record the data. XZ: operation and record the data. QL: acquisition and analysis. HH: revised the paper. XL: designed the study and drafted the work.

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Correspondence to Xiang Li.

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The authors declare that there are no conflicts of interest regarding the publication of this paper.

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All authors have seen the manuscript and approved its submission to your journal. The study was approved by our institutional review board and was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Chen, X., Chen, J., Zhou, X. et al. Is there a place for extracorporeal shockwave lithotripsy (ESWL) in the endoscopic era?. Urolithiasis 50, 369–374 (2022). https://doi.org/10.1007/s00240-022-01307-4

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