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Value of focal applied energy quotient in treatment of ureteral lithiasis with shock waves

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Abstract

The treatment of ureteral lithiasis by extracorporeal shock wave lithotripsy (ESWL) is progressively being abandoned owing to advances in endoscopic lithotripsy. The purpose of this paper is to analyze the causes as to why ESWL is less effective—with a measurable parameter: focal applied energy quotient (FAEQ) that allows us to apply an improvement project in ESWL results for ureteral lithiasis. A prospective observational cohort study with 3-year follow-up and enrollment period was done with three groups of cases. In Group A, 83 cases of ureteral lithiasis were treated by endoscopic lithotripsy using Holmiun:YAG laser. In Group B, 81 cases of ureteral lithiasis were treated by ESWL using Doli-S device (EMSE 220F-XXP). In Group C, 65 cases of ureteral lithiasis were treated by ESWL using Doli-S device (EMSE 220F-XXP) (FAEQ >10). Statistical study and calculation of RR, NNT, Chi-square test, Fisher’s exact test, and Student’s t test were done. Efficiency quotient (EQ) and focal applied energy quotient [FAEQ = (radioscopy seconds/number of shock waves) × ESWL session J] were analyzed. From the results, the success rate of the treatment using Holmium:YAG laser lithotripsy and ESWL is found to be 94 and 48%, respectively, with a statistically significant difference (p < 0.001). Success rate of endoscopic laser lithotripsy for lumbar ureteral stones was 82% versus 57% of ESWL (p = 0.611). In Group B, FAEQ was 8.12. In Group C, success rate was 93.84% with FAEQ of 10.64%. When we compare results from endoscopic lithotripsy with Holmium:YAG laser in Group B with results from ESWL with FAEQ >10, we do not observe absolute benefit choosing one or the other. In conclusion, the application of ESWL with FAEQ >10, that is, improving radiologic focalization of the calculus and increasing the number of Joules/SW, makes possible a treatment as safe and equally efficient as Holmium:YAG laser lithotripsy in ureteral lithiasis less than 13 mm.

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References

  1. Mobley TB, Myers DA, Jenkins JM, Grine WB, Jordan WR (1994) Effects of stents on lithotripsy of ureteral calculi: treatment results with 18,825 calculi using the Lithostar lithotriptor. J Urol 152:53–56

    PubMed  CAS  Google Scholar 

  2. Enguita CG, Perez JC, Fernandez FJC, Cardoso JG, Navarrete RV (2000) Efficient, immediate or emergency ESWL: an attractive strategic alternative to be considered in the treatment of renal colic! Actas Urol Esp 24:721–727

    Google Scholar 

  3. Eden CG, Mark IR, Gupta RR, Eastman J, Shrotri NC, Tiptaft RC (1998) Intracorporeal or extracorporeal lithotripsy for distal ureteral calculi? Effect of stone size and multiplicity on success rates. J Endourol 12:307–312

    Article  PubMed  CAS  Google Scholar 

  4. Biyani CS, Cornford PA, Powell CS (1998) Ureteroscopic holmium lasertripsy for ureteric stones, initial experience. Scand J Urol Nephrol 32:92–93

    Article  PubMed  CAS  Google Scholar 

  5. Bierkens AF, Hendrikx AJ, De La Rosette JJ, Stultiens GN, Beerlage HP, Arends AJ, Debruyne FM (1998) Treatment of mid and lower ureteric calculi: extracorporeal shock-wave lithotripsy versus laser ureteroscopy: a comparison of costs, morbidity and effectiveness. Br J Urol 81:31–35

    Article  PubMed  CAS  Google Scholar 

  6. Grasso M, Lang G, Taylor FC (1995) Flexible ureteroscopically assisted percutaneous renal access. Tech Urol 1:39–43

    PubMed  CAS  Google Scholar 

  7. Park H, Park M, Park T (1998) Two-year experience with ureteral stones: extracorporeal shockwave lithotripsy versus ureteroscopic manipulation. J Endourol 12:501–504

    Article  PubMed  CAS  Google Scholar 

  8. Kupeli B, Biri H, Isen K et al (1998) Treatment of ureteral stones: comparison of extracorporeal shock wave lithotripsy and endourologic alternatives. Eur Urol 34:474–479

    Article  PubMed  CAS  Google Scholar 

  9. Arrabal-Polo MA, Arrabal-Martín M, Miján-Ortiz JL, Valle-Díaz F, López-León V, Merino-Salas S, Zuluaga-Gómez A (2009) Treatment of ureteric lithiasis with retrograde ureteroscopy and holmium: YAG laser lithotripsy vs extracorporeal lithotripsy. BJU Int. 104:1144–1147

    Article  PubMed  Google Scholar 

  10. Wu CH, Shee JJ, Lin WY et al (2004) Comparison between estracorporeal shoxk wave lithotripsy and semirigid ureterorenoscope with Holmium:YAG laser lithotripsy for treating large proximal ureteral stones. J Urol 172:1899–1902

    Article  PubMed  Google Scholar 

  11. Huang CY, Chen SS, Chen LK (2009) Cost-effectiveness of treating ureteral stones in a Taipei City Hospital: shock wave lithotripsy versus ureteroscopy plus lithoclast. Urol Int 83:410–415

    Article  PubMed  Google Scholar 

  12. Arrabal Martín M, Ocete Martín C, Jiménez Pacheco A, Miján Ortiz JL, Pareja Vilches M, Zuluaga Gómez A (2006) Methodology and limits of outpatient ureteroscopy. Arch Esp Urol 59:261–272

    PubMed  Google Scholar 

  13. Lam JS, Greene TD, Gupta M (2002) Treatment of proximal ureteral calculi: holmium:YAG laser ureterolithotripsy versus extracorporeal shock wave lithotripsy. J Urol 167:1972–1976

    Article  PubMed  Google Scholar 

  14. Arrabal-Martín M, Pareja-Vilches M, Gutiérrez-Tejero F, Miján-Ortiz JL, Palao-Yago F, Zuluaga-Gómez A (2003) Therapeutic options in lithiasis of the lumbar ureter. Eur Urol 43:556–563

    Article  PubMed  Google Scholar 

  15. Parker BD, Frederick RW, Reilly TP, Lowry PS, Bird ET (2004) Efficiency and cost of treating proximal ureteral stones: shock wave lithotripsy versus ureteroscopy plus holmium:yttrium-aluminum-garnet laser. Urology 64:1102–1106

    Article  PubMed  Google Scholar 

  16. Bapat SS, Pai KV, Purnapatre SS, Yadav PB, Padye AS (2007) Comparison of holmium laser and pneumatic lithotripsy in managing upper-ureteral stones. J Endourol 21:1425–1427

    Article  PubMed  Google Scholar 

  17. Sighinolfi MC, Micali S, De Stefani S, Pini GA, Rivalta M, Cianci F, Bianchi G (2011) How effective is extracorporeal shock wave lithotripsy of ureteral stones with Dornier Lithotripter S EMSE 220F-XXP? A prospective and preliminary assessment. Surg Endosc. 25(3):943–946 (Epub ahead of print)

    Article  PubMed  Google Scholar 

  18. Tiselius HG (2005) Removal of ureteral stones with extracorporeal shock wave lithotripsy and ureteroscopic procedures: what can we learn from the literature in terms of results and treatment efforts? Urol Res 33:185–190

    Article  PubMed  Google Scholar 

  19. Shao Y, Zhuo J, Sun XW, Wen W, Liu HT, Xia SJ (2008) Nonstented versus routine stented ureteroscopic holmium laser lithotripsy: a prospective randomized trial. Urol Res 36:259–263

    Article  PubMed  Google Scholar 

  20. Hosking DH, Smith WE, McColm SE (2003) A comparison of extracorporeal shock wave lithotripsy and ureteroscopy under intravenous sedation for the management of distal ureteric calculi. Can J Urol 10:1780–1784

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Urology, San Cecilio University Hospital, Camino de Ronda Street, 143, 4°F, 18003, Granada, Spain

    Miguel Angel Arrabal-Polo, Miguel Arrabal-Martin, Francisco Palao-Yago, Jose Luis Mijan-Ortiz & Armando Zuluaga-Gomez

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  1. Miguel Angel Arrabal-Polo
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  2. Miguel Arrabal-Martin
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  3. Francisco Palao-Yago
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  4. Jose Luis Mijan-Ortiz
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  5. Armando Zuluaga-Gomez
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Correspondence to Miguel Angel Arrabal-Polo.

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Arrabal-Polo, M.A., Arrabal-Martin, M., Palao-Yago, F. et al. Value of focal applied energy quotient in treatment of ureteral lithiasis with shock waves. Urol Res 40, 377–381 (2012). https://doi.org/10.1007/s00240-011-0430-6

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  • DOI: https://doi.org/10.1007/s00240-011-0430-6

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