ABSTRACT
<p><b>OBJECTIVE</b>To evaluate the strategy for management of urosepsis after extracorporeal shock wave lithotripsy (ESWL).</p><p><b>METHODS</b>The clinical data were analyzed in 4 cases of urosepsis caused by ESWL during the period from January, 2008 to October 2011.</p><p><b>RESULTS</b>Two of the patients had kidney stones and two had ureteral stones. Analysis of urine bacterial culture revealed the presence of E. coli in 2 cases, Klebsiella pneumoniae in 1 case and Pseudomonas putida combined E. coli in 1 case. All the 4 patients were monitored for ECG, blood pressure and oxygen saturation, and received fluid replacement and anti-inflammatory therapy. The vital signs of the patients became stable after 5-11 days (mean 6.75 days). Three patients underwent ureteroscopic lithotripsy, and 1 patient had emergency ureteral stent indwelling. All the 4 patients were cured and discharged.</p><p><b>CONCLUSION</b>ESWL is more likely to cause urosepsis in patients with ureteral stones and urinary infection, for which early nonsurgical interventions should be administered immediately after the diagnosis is established.</p>
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Lithotripsy , Retrospective Studies , Sepsis , Therapeutics , Ureteral Calculi , Therapeutics , Urinary Tract Infections , TherapeuticsABSTRACT
<p><b>OBJECTIVE</b>To evaluate the factors affecting the efficacy of extracorporeal shock wave lithotripsy (ESWL) and establish a model for predicting the success rate of a single ESWL session in the treatment of single renal calculus.</p><p><b>METHODS</b>Between January 2008 and February 2010, 325 patients underwent ESWL monotherapy and were followed up for at most 3 months. The correlations between the outcome of a single ESWL session and the patients' age, gender, body mass index (BMI), disease duration, pretreatment renal colic, hematuria, urinary irritation symptoms, stone location, stone laterality, stone length and stone width were analyzed. The statistically significant factors identifies were further analyzed by multivariate logistic regression, and the predictive model was established.</p><p><b>RESULTS</b>The stone-free rate of ESWL was 76.9%. Univariate analysis found that the patients' age, stone laterality, stone location, disease duration, pretreatment hematuria, stone length and width all significantly affected the outcome of the treatment. Logistic regression analysis indicated the factors including disease duration, pretreatment hematuria, stone length and stone width determined the success rate of the treatment. Hosmer and Lemeshow Test showed a good fitting of the predictive model (Χ(2)=18.144, df=8, P=0.168) with an overall accuracy of 87.4%.</p><p><b>CONCLUSION</b>Disease duration, pretreatment hematuria, stone length and width are independent factors affecting the outcome of a single ESWL session for single renal calculus.</p>
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Kidney Calculi , Therapeutics , Lithotripsy , Logistic Models , Treatment OutcomeABSTRACT
<p><b>OBJEVTIVE</b>To analyze the complications of extracorporeal shock wave lithotripsy (ESWL) for treatment of lower urinary tract stones and identify the factors contributing to the complications.</p><p><b>METHODS</b>We retrospectively analyzed the postoperative complications of ESWL in 83 patients with lower urinary tract stones and their association with the patients' age, height, body weight, body mass index (BMI), stone features, shock wave times, and shock wave energy.</p><p><b>RESULTS</b>Of the 83 cases treated with ESWL, 72.3% (60 cases) showed gross hematuria, 27.7% (23 cases) complained of pain, and 25.3% (21 cases) had both pain and gross hematuria. None of the patients reported vomiting, skin rash, flatulence, gastrointestinal bleeding or other complications. Patients with postoperative gross hematuria, pain, and both had significantly greater stone length, stone width and more shock body times than those without these complications (P<0.01 or P<0.05). Patients with gross hematuria had significantly lower height than those without complications (P<0.05).</p><p><b>CONCLUSION</b>The common complications of ESWL for lower urinary tract stones include hematuria and pain. The patient's height, stone length, stone width and shock times are important factors contributing to these postoperative complications.</p>