@article {10772, title = {Emergency extracorporeal shockwave lithotripsy as opposed to delayed shockwave lithotripsy for the treatment of acute renal colic due to obstructive ureteral stone: a prospective randomized trial.}, journal = {Minerva Urol Nefrol}, volume = {70}, year = {2018}, month = {2018 Oct}, pages = {526-533}, abstract = {

BACKGROUND: The aim of this study was to assess the efficacy of emergency extracorporeal shockwave lithotripsy (eSWL) as first-line treatment in patients with acute colic due to obstructive ureteral stone.

METHODS: Seventy-four patients were randomized to emergency SWL within 12 hours (eSWL group) and deferred SWL later than 3 days (dSWL group). Follow-up included ultrasound, KUB (kidney-ureter-bladder) radiography and CT (computed tomography) scan at 24 hours, 7 days, 1 and 3 months from the treatment. When necessary, repeated SWL (re-SWL) or ureteroscopy (auxiliary-URS) was performed. Preoperative and postoperative data were compared and stone free rates (SFR) and efficiency quotients (EQ) were evaluated. Analyses were performed using SAS software.

RESULTS: Complete data of 70 patients were collected. 36 underwent eSWL and 34 dSWL. The mean patient age was 48.7. Mean stone size was 9.8 mm (CI 95\%: 8.9-10.8). 25 (35.7\%) were proximal and 45 (64.3\%) distal. Mean SWL energy was 19.2 kV (CI 95\%: 18.5-19.9) and mean number of shocks was 2657 (CI 95\%: 2513-2802). eSWL patients needs less auxiliary-URS than dSWL patients (13.9\% vs. 44.1\%, P=0.039) and less re-SWL sessions (8.3\% vs. 32.4\%, P=0.093). SFR at 24 hours was 52.8\% and 11.8\% (P<0.001) and the EQ at 3 months was 79.1\% and 57.5\% in the eSWL and dSWL group respectively. Patients from the dSWL group spent more time in the hospital (2.21 vs. 1.36 days, P=0.046) and complication rates between the two groups were similar.

CONCLUSIONS: eSWL is a safe procedure and delivers high SFR even within 24 hours especially for <10 mm stones. It is able to reduce the number of auxiliary procedures and hospitalization.

}, keywords = {Aged, Calculi, Emergency Medical Services, Female, Humans, Length of Stay, Lithotripsy, Male, Middle Aged, Prospective Studies, Renal Colic, Time-to-Treatment, Tomography, X-Ray Computed, Ureteral Obstruction}, issn = {1827-1758}, doi = {10.23736/S0393-2249.18.03084-9}, author = {Bucci, Stefano and Umari, Paolo and Rizzo, Michele and Pavan, Nicola and Liguori, Giovanni and Barbone, Fabio and Trombetta, Carlo} }