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EAU 2018: Comparison Of Dual Shockwave Lithotripsy Effectiveness In Patients With And Without Indwelling Stents

Copenhagen, Denmark (UroToday.com) Dr. Gatkin, clinical urologist from the Zdorovie Clinics in Barnaul, Russia, presented his study determining the perioperative success rates of extracorporeal shock wave lithotripsy (ESWL) in patients with and without an indwelling stent at the time of the procedure. For this study, the researchers would be using a double shock wave lithotripter rather than the more common single shock wave. Dr. Gatkin claims that the double shock wave has the potential to increase stone destruction due to shock waves being applied at two different angles. The question of this study was important to investigate since the researchers believe that the presence of an indwelling stent is detrimental to the stone destruction ability of ESWL. Patients who frequently have an indwelling stent during the time of procedure include those who are late to undergo an ESWL procedure or those with concomitant diseases such as pyelonephritis or urinary system abnormalities.

In order to prospectively test this question, a Duet Magna/Dual Shockwave lithotripter was used in synchronous mode in patients with ureteral stones between January 2015 to December 2016. These patients were divided into two groups based on whether or not they had a current indwelling stent. In total, 528 patients were treated with dual shockwave ESWL. All patients received a 4-6 week follow-up X-ray examination. A successful ESWL treatment was defined as stone fragments 3mm or less.

Following analysis of the data, it was determined that the retreatment percentage for patients with stents vs. patients without stents was 21.6% vs. 10.4%, respectively. Number of shocks, perioperative hematoma percentage, and Steinstrasse percentage were all found to be considerably decreased in the patient group treated without stents.

In conclusion, Dr. Gatkin explained to the audience that the Duet Magna, when used in patients without an indwelling stent, allows successful treatment following ESWL with stone fragmentations of less than 3 mm and a reduced percentage of retreatment following surgery. He further encouraged his listeners to attempt to possibly treat patients with ESWL so that the stent does not interfere with the shockwaves and potentially reduce the success of ESWL treatment.

Speaker: M. Gatkin

Authors: Gatkin M. , Sopotov A.

Written by: Zachary Valley, Department of Urology, University of California-Irvine, at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark