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• W2010148077 abstract "You have accessJournal of UrologyStone Disease: SWL, Ureteroscopic or Percutaneous Stone Removal II1 Apr 20101570 THE EFFECT OF DIFFERENT DELIVERY RATE ON SHOCKWAVE LITHOTRIPSY TREATMENT OUTCOME, RENAL INJURY AND PAIN TOLERANCE Anthony Lo, Mayur Gohel, Ngn-yee Lee, and Chi-fai Ng Anthony LoAnthony Lo More articles by this author , Mayur GohelMayur Gohel More articles by this author , Ngn-yee LeeNgn-yee Lee More articles by this author , and Chi-fai NgChi-fai Ng More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1336AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Shockwave delivery rate has been stated to improve stone clearance, protect against induced renal injury and enhance pain tolerance but there is no comprehensive assessment on these three aspects in a single centre.Therefore, we would like to compare the effect of slow and fast shockwave delivery rates on three aspects mentioned above. METHODS Patients with radio-opaque renal stone sized from 5 mm to 20 mm were randomized to receive either 60 SWs/min or 120 SWs/min using a Sonolith Vision lithotripter (Technomed, France). Successful outcome was defined as either stone free or fragments < 4 mm at 12 weeks after SWL. Renal injury was assessed by measuring Interleukin-18 (IL-18), neutrophil gelatinase-associated lipocalin (NGAL) and N-acetyl-£]-D-glucosaminidase (NAG) in spot urine collected at a day before SWL (baseline), immediately (post-treatment), 2 days, 7 days and 4 weeks after SWL. Pain tolerance was quantified by the usage of alfentanil patient-controlled analgesia (PCA). Pain was assessed using numeric rating scale (NRS) scores (0-10). PCA demand and PCA administrated were recorded at every 250J until the end of treatment at 1000J or complete fragmentation. RESULTS 103 patients were recruited and randomly assigned to either group. The patient characteristics of the two groups were comparable. Successful rates were 48.98% at 60 SWs/min and 44.90% at 120 SWs/min (p = 0.686). For stone sized < 10 mm, the successful rates were 48.57% and 61.29% in 60 SWs/min and 120 SWs/min respectively (p = 0.302). However, 50% verse 16.7% successful outcome were found respectively at 60 SWs/min and 120 SWs/min for stone sized ≥ 10mm (p =0.052). There were higher IL-18 level at immediate after SWL in 60 SWs/min (p< 0.01), when compared to 120 SWs/min. The mean levels of NGAL and NAG at immediate after SWL did not reach the significant level. All the markers were back to pretreatment level at 4 weeks after treatment. Total PCA demand (12.1 ¡Ó 19.6 at 60 SWs/min verse 10.0 ¡Ó 27.9 at 120SWs/min), administrated (142.4 ¡Ó 171.6 & micro; g at 60 SWs/min verse 121.1 ¡Ó 131.6 µ g at 120SWs/min) and overall pain score medians (4 at 60 SWs/min verse 4.25 at 120 SWs/min) were not statistically different in both groups. CONCLUSIONS Better stone clearance is achieved in larger renal stone only. 60 SWs/min delivery rate may induce more renal damage than that caused by 120 SWs/min. Patients¡¦ pain tolerance in terms of pain perception and PCA usage is about the same. The future use of slower delivery rate may be reassessed. Hong Kong, Hong Kong© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e607 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anthony Lo More articles by this author Mayur Gohel More articles by this author Ngn-yee Lee More articles by this author Chi-fai Ng More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ..." @default.
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• W2010148077 title "1570 THE EFFECT OF DIFFERENT DELIVERY RATE ON SHOCKWAVE LITHOTRIPSY TREATMENT OUTCOME, RENAL INJURY AND PAIN TOLERANCE" @default.
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