El bloqueo del plano del músculo erector espinal antes de la litotricia extracorpórea por ondas de choque reduce el tiempo de fluoroscopia y facilita el tratamiento de la litiasis renal: estudio prospectivo aleatorizado / Erector spinae plane block prior to extracorporeal shock wave lithotripsy decreases fluoroscopy time and promise a comfortable procedure for renal stones: a prospective randomized study

Introducción y objetivos Comparar la eficacia del bloqueo del plano del erector espinal (BPEE) y el diclofenaco sódico intramuscular (IM) en términos del manejo del dolor y su impacto sobre el estado libre de cálculos en pacientes sometidos a litotricia extracorpórea de ondas de choque (LEOCh). Pacientes y materiales El estudio incluyó a pacientes sometidos a LEOCh por litiasis renal en nuestro centro. Los pacientes fueron asignados aleatoriamente a los grupos de BPEE (Grupo 1: n = 31) y de 75 mg de diclofenaco sódico IM (Grupo 2: n = 30). Se registraron los datos demográficos de los pacientes, el tiempo de fluoroscopia durante la LEOCh, el número de focalizaciones, el total de disparos administrados, el voltaje, las tasas libre de cálculos (TLC), el método de analgesia, el número de sesiones de LEOCh, la puntuación de la Escala Visual Analógica (EVA) la localización de los cálculos, el tamaño máximo de los cálculos, el volumen de los cálculos y las unidades Hounsfield (UH). Resultados Un total de 61 pacientes fueron incluidos en el estudio. No hubo diferencias estadísticamente significativas entre los dos grupos en cuanto al tamaño, el volumen y la densidad de los cálculos, la duración de la LEOCh, el total de disparos administradas, el voltaje, el índice de masa corporal (IMC), el estado libre de cálculos y la localización de los cálculos. El tiempo de fluoroscopia y el número de veces que fue necesario focalizar el cálculo fueron significativamente inferiores en el grupo 1 con respecto al grupo 2 (p:0,002, p:0,021, respectivamente). La puntuación EVA fue significativamente inferior en el grupo 1 en comparación con el grupo 2 (p<0,001). Conclusiones Observamos que la puntuación EVA del grupo BPEE era menor que la del grupo de diclofenaco sódico IM y, aunque no de manera estadísticamente significativa, conseguimos una tasa libre de cálculos más alta en la primera sesión en el grupo BPEE. ... (AU)

Introduction and Objectives To compare the efficacy of erector spinae plane block (ESPB) and intramuscular (i.m.) diclofenac sodium in regard to pain management and impact on stone-free status in patients undergoing SWL. Patients or Materials The study included patients who underwent SWL for kidney stones in our institution. The patients were randomly assigned to the ESPB (Group 1: n = 31) and i.m. 75 mg diclofenac sodium (Group 2: n = 30) groups. The demographic data of the patients, fluoroscopy time during SWL, number of need of targeting, total shocks given, voltage, stone free rates (SFR), analgesy method, number of SWL sessions, VAS score, stone location, maximum stone size, stone volume and Hounsfield unit (HU) were also recorded. Results A total of 61 patients were included the study. There was no statistically significant difference between the two groups according to stone size, volume and density, SWL duration, total shocks given, voltage, BMI, stone-free status and stone location. Fluoroscopy time and number of need for stone targeting were significantly lower in group 1 than group 2 (p:0.002, p:0.021, respectively). The VAS score was significantly lower for group 1 compared to group 2 (p<0.001). Conclusions We observed that the VAS score was lower in the ESPB group compared to i.m. diclofenac sodium group and although it was not statistically significant, we achieved a higher rate of stone-free status in the first session in ESPB group. Most importantly, the patients in the ESPB group were exposed to less fluoroscopy and radiation. (AU)

Erector spinae plane block prior to extracorporeal shock wave lithotripsy decreases fluoroscopy time and promise a comfortable procedure for renal stones: A prospective randomized study.

INTRODUCTION AND OBJECTIVES: To compare the efficacy of erector spinae plane block (ESPB) and intramuscular (i.m.) diclofenac sodium in regard to pain management and impact on stone-free status in patients undergoing SWL. PATIENTS AND MATERIALS: The study included patients who underwent SWL for kidney stones in our institution. The patients were randomly assigned to the ESPB (Group 1: n = 31) and i.m. 75 mg diclofenac sodium (Group 2: n = 30) groups. The demographic data of the patients, fluoroscopy time during SWL, number of need of targeting, total shocks given, voltage, stone free rates (SFR), analgesy method, number of SWL sessions, VAS score, stone location, maximum stone size, stone volume and Hounsfield unit (HU) were also recorded. RESULTS: A total of 61 patients were included the study. There was no statistically significant difference between the two groups according to stone size, volume and density, SWL duration, total shocks given, voltage, BMI, stone-free status and stone location. Fluoroscopy time and number of need for stone targeting were significantly lower in group 1 than group 2 (p = 0.002, p = 0.021, respectively). The VAS score was significantly lower for group 1 compared to group 2 (p < 0.001). CONCLUSIONS: We observed that the VAS score was lower in the ESPB group compared to i.m. diclofenac sodium group and although it was not statistically significant, we achieved a higher rate of stone-free status in the first session in ESPB group. Most importantly, the patients in the ESPB group were exposed to less fluoroscopy and radiation.

¿Son suficientes los nomogramas actuales para predecir los resultados de la litotricia por ondas de choque? / Are the current nomograms sufficient to predict shockwave lithotripsy outcomes?

Introducción y objetivos: Investigar los factores que afectan los resultados del tratamiento con LEOCH, validar tres nomogramas actuales (Kim JK, Triple D y S3HoCKwave) y comparar la capacidad predictiva de los nomogramas para los resultados de la LEOCH en los cálculos del tracto urinario superior.Pacientes y métodosSe revisaron retrospectivamente las historias clínicas de los pacientes con cálculos renales y ureterales proximales tratados con LEOCH entre marzo de 2013 y octubre de 2020. Se analizaron los factores que afectan al éxito de LEOCH con un análisis de regresión logística multivariante y se compararon los tres sistemas de puntuación con el área bajo la curva (AUC).ResultadosNuestro estudio incluyó un total de 580 pacientes. La tasa global de eliminación de cálculos fue del 61% y 144/580 pacientes (24,8%) estaban libres de cálculos tras una sesión. En el análisis de regresión logística multivariante, la ubicación del cálculo en el cáliz superior (OR: 2,988; IC 95%: 1,350-6,612; p=0,007), en el cáliz medio (OR: 3,036; IC 95%: 1,472-6,258; p=0,003) y en el cáliz inferior (OR: 2,131; IC 95%: 1,182-3,839; p=0,012), así como el número de cálculos (OR: 1,663; IC 95%: 1,140-2,425; p=0,008), el diámetro máximo del cálculo (OR: 1,156; IC 95%: 1,098-1,217; p<0,001) y el valor máximo de unidades Hounsfield (OR: 1,001; IC 95%: 1,001-1,002; p<0,001) fueron factores de riesgo independientes del fracaso de LEOCH. Las AUC de las puntuaciones Kim JK, Triple D y S2HoCKwave para predecir el éxito de la LEOCH fueron de 0,678, 0,548 y 0,626, respectivamente (AU)

Introduction and objectives: To investigate factors affecting SWL outcomes, validate three current nomograms (Kim JK, Triple D and S3HoCKwave) and compare the predictive ability of the nomograms for SWL outcomes in upper urinary tract stones.Patients and methodsMedical records of patients with renal and proximal ureteral stones treated with SWL between March 2013 and October 2020 were retrospectively reviewed. Factors affecting SWL success were analyzed with multivariate logistic regression analysis and the three predictive scoring systems compared with the area under the curve (AUC).ResultsA total of 580 patients were included in our study. The overall stone free rate was 61% and 144/580 patients (24.8%) were stone free after one session. In multivariate logistic regression analysis, stone location at upper calyx (OR:2.988; 95%Cl: 1.350–6.612; p=0.007), middle calyx (OR:3.036; 95%Cl: 1.472–6.258; p=0.003), and lower calyx (OR:2.131; 95%Cl: 1.182–3.839; p=0.012), as well as number of stones (OR:1.663; 95%Cl: 1.140–2.425; p=0.008), maximum diameter of stone (OR:1.156; 95%Cl: 1.098–1.217; p<0.001) and maximum Hounsfield Unit (OR:1.001; 95%Cl: 1.001–1.002; p<0.001) were independent risk factors of SWL failure. The AUCs of the Kim JK, Triple D and S2HoCKwave scores for predicting SWL success were 0.678, 0.548, and 0.626 respectively.ConclusionsStone location, number, maximal diameter, and maximum HU were independent predictive factors for SWL outcome in the treatment of upper urinary tract stones. Current nomograms, Kim JK nomogram, Triple D score and S3HoCKwave score can predict treatment success after SWL, but all of them have poor discrimination according to AUC analysis. (AU)

Are the current nomograms sufficient to predict shockwave lithotripsy outcomes?

INTRODUCTION AND OBJECTIVES: To investigate factors affecting SWL outcomes, validate three current nomograms (Kim JK, Triple D and S3HoCKwave) and compare the predictive ability of the nomograms for SWL outcomes in upper urinary tract stones. PATIENTS AND METHODS: Medical records of patients with renal and proximal ureteral stones treated with SWL between March 2013 and October 2020 were retrospectively reviewed. Factors affecting SWL success were analyzed with multivariate logistic regression analysis and the three predictive scoring systems compared with the area under the curve (AUC). RESULTS: A total of 580 patients were included in our study. The overall stone free rate was 61% and 144/580 patients (24.8%) were stone free after one session. In multivariate logistic regression analysis, stone location at upper calyx (OR:2.988; 95%Cl: 1.350-6.612; p = 0.007), middle calyx (OR:3.036; 95%Cl: 1.472-6.258; p = 0.003), and lower calyx (OR:2.131; 95%Cl: 1.182-3.839; p = 0.012), as well as number of stones (OR:1.663; 95%Cl: 1.140-2.425; p = 0.008), maximum diameter of stone (OR:1.156; 95%Cl: 1.098-1.217; p < 0.001) and maximum Hounsfield Unit (OR:1.001; 95%Cl: 1.001-1.002; p < 0.001) were independent risk factors of SWL failure. The AUCs of the Kim JK, Triple D and S2HoCKwave scores for predicting SWL success were 0.678, 0.548, and 0.626 respectively. CONCLUSIONS: Stone location, number, maximal diameter, and maximum HU were independent predictive factors for SWL outcome in the treatment of upper urinary tract stones. Current nomograms, "Kim JK nomogram", "Triple D score" and "S3HoCKwave score" can predict treatment success after SWL, but all of them have poor discrimination according to AUC analysis.

Modelo novedoso basado en los parámetros de la tomografía para predecir el éxito de la litotricia por ondas de choque en los cálculos ureterales de diferentes localizaciones / A novel model using computed tomography parameters to predict shock wave lithotripsy success in ureteral stones at different locations

ObjetivoIncorporar los parámetros basados en la tomografía computarizada sin contraste (TCSC) a las características de los cálculos y de los pacientes comúnmente asociadas con el éxito de la litotricia por ondas de choque (LEOCH) para evaluar la efectividad de este nuevo modelo en la predicción del éxito de LEOCH en cálculos ureterales únicos situados en diferentes localizaciones.Materiales y métodosSe revisaron retrospectivamente los datos de los pacientes tratados con LEOCH por un único cálculo ureteral entre enero de 2017 y enero de 2019. Los parámetros basados en la TCSC se evaluaron junto con los parámetros demográficos de los pacientes y las características de los cálculos. Los parámetros basados en TCSC incluyeron la presencia o ausencia de hidronefrosis, trabeculación de la grasa perirrenal, edema periureteral, diámetro del uréter proximal, grosor de la pared ureteral (GPU) en el sitio del cálculo ureteral. Se utilizó el método de regresión logística para desarrollar un modelo predictivo útil. Posteriormente, se utilizó la curva ROC para determinar los puntos de corte, y se desarrolló un sistema de puntuación para la predicción del éxito de LEOCH.ResultadosLa tasa libre de cálculos fue del 77,1% (267/346) en toda la cohorte. El análisis univariante reveló que la edad, el volumen de los cálculos, la densidad, la trabeculación perirrenal, el diámetro del uréter proximal y el GPU se asociaron con el éxito de la LEOCH. En el análisis multivariante, la localización del cálculo ureteral proximal, el volumen del cálculo, la densidad y el GPU fueron predictores independientes del éxito de la LEOCH. La fórmula utilizada en el análisis de regresión logística fue: 1/[1+exp {-8,856+0,008(volumen del cálculo)+0,002 (densidad del cálculo)+0,673 (GPU)+1026 (cálculo ureteral proximal)}]. Las puntuaciones de 0, 1, 2, 3 y 4 se asociaron con un 97,8%, 83,4%, 60,8%, 33,2% y 11,1% de éxito, respectivamente, en el modelo de predicción basado en estos parámetros.

ObjectiveTo combine non-contrast computerized tomography (NCCT)-based parameters with stone and patient characteristics that are already known to affect shock wave lithotripsy (SWL) success and assess this novel model's effectiveness in predicting SWL success for single ureteral stones in different locations.Materials and methodsData of patients treated by SWL for a single ureteral stone between January 2017 and January 2019 were retrospectively reviewed. Demographic parameters of patients and stone characteristics were combined with NCCT-based parameters. NCCT-based parameters included the presence or absence of hydronephrosis, perinephric stranding, periureteral edema, diameter of the proximal ureter, ureteral wall thickness (UWT) at ureteral stone site. The logistic regression method was used for the development of a useful predictive model. Subsequently, the receiver operating curve was used to determine cut-off levels, and a scoring system was developed for prediction of SWL success.ResultsStone-free rate was 77,1% (267/346) in the entire cohort. Univariate analysis revealed that age, stone volume, density, perinephric stranding, diameter of proximal ureter, and UWT, were associated with SWL success. In multivariate analysis, proximal ureteral stone location, stone volume, density, and UWT were independent predictors of SWL success. The formula used during logistic regression analysis was: 1/[1+exp {-8.856+0.008(stone volume)+0.002 (stone density)+0.673 (UWT)+1026 (proximal ureteral stone)}]. The scores of 0, 1, 2, 3 and 4 were associated with 97,8%, 83,4%, 60,8%, 33,2% and 11,1% success rates, respectively, in the prediction model based on these parameters.ConclusionWe conclude that our model can facilitate decision-making for SWL treatment of ureteral stones in different locations (AU)

A novel model using computed tomography parameters to predict shock wave lithotripsy success in ureteral stones at different locations.

OBJECTIVE: To combine non-contrast computerized tomography (NCCT)-based parameters with stone and patient characteristics that are already known to affect shock wave lithotripsy (SWL) success and assess this novel model's effectiveness in predicting SWL success for single ureteral stones in different locations. MATERIALS AND METHODS: Data of patients treated by SWL for a single ureteral stone between January 2017 and January 2019 were retrospectively reviewed. Demographic parameters of patients and stone characteristics were combined with NCCT-based parameters. NCCT-based parameters included the presence or absence of hydronephrosis, perinephric stranding, periureteral edema, diameter of the proximal ureter, ureteral wall thickness (UWT) at ureteral stone site. The logistic regression method was used for the development of a useful predictive model. Subsequently, the receiver operating curve was used to determine cut-off levels, and a scoring system was developed for prediction of SWL success. RESULTS: Stone-free rate was 77,1% (267/346) in the entire cohort. Univariate analysis revealed that age, stone volume, density, perinephric stranding, diameter of proximal ureter, and UWT, were associated with SWL success. In multivariate analysis, proximal ureteral stone location, stone volume, density, and UWT were independent predictors of SWL success. The formula used during logistic regression analysis was: 1/[1 + exp {-8.856 + 0.008 (stone volume) + 0.002 (stone density) + 0.673 (UWT) + 1026 (proximal ureteral stone)}]. The scores of 0, 1, 2, 3 and 4 were associated with 97,8%, 83,4%, 60,8%, 33,2% and 11,1% success rates, respectively, in the prediction model based on these parameters. CONCLUSION: We conclude that our model can facilitate decision-making for SWL treatment of ureteral stones in different locations.

The analgesic efficacy of ultrasound guided unilateral transversus abdominis plane block in the pain management of shock wave lithotripsy. / Eficacia analgésica del bloqueo unilateral del plano del musculo transverso abdominal guiado por ecografía en el manejo del dolor de la litotricia por ondas de choque.

OBJECTIVES: We conducted this study to evaluate the analgesic efficacy of ultrasound guided unilateral transversus abdominis plane (TAP) block when used in combination with oral diclofenac administration during extracorporeal shock wave lithotripsy (SWL). DESIGN AND SETTING: The study is a retrospective clinical experimental study conducted in a university hospital between January 2017 and January 2018. METHODS: 42 SWL eligible patients were divided into three groups. Group 1 (n: 15) received no medication due to patient's preference. Group 2 (n: 15) received 50 mg oral diclofenac 30 minutes prior to the procedure, and Group 3 (n: 12) received both oral diclofenac and unilateral ultrasound (US) guided TAP block 30 minutes before the procedure. Patient`s characteristics, SWL data and "visual analogue pain scale" (VAS) scores were collected and compared between groups. RESULTS: A total of 44 eligible patients were included in the study. When compared between groups, patient's characteristics including age, body mass index, and SWL data including stone size, SWL number, total energy transmitted and duration of the procedure, were similar and there was no statistical significance. Between groups statistical significance was achieved in only VAS scores. Mean VAS scores in groups 1,2, and 3 were 6.3 ± 1.8, 4.3 ± 2.3, and 1.3 ± 1.0, respectively. No complication was seen in any of the groups. CONCLUSION: Pain relief during SWL operations is still a challenging issue for many clinicians. Our study demonstrates that, among many other anesthetic/analgesic agents and techniques described, unilateral US guided TAP block and diclofenac combination is a feasible option for pain relief during SWL procedures.

OBJECTIVO: Llevamos a cabo un estudio para evaluar la eficacia analgésica del bloqueo unilateral del plano del musculo transverso abdominal (TAP) guiado por ecografía utilizado en combinación con la administración oral de diclofenaco durante la litotricia extracorporea por ondas de choque (LEOC).MATERIAL Y MÉTODOS: Estudio clínico experimental retrospectivo llevado a cabo en un hospital universitario entre Enero de 2017 y Enero del 2018. 42 pacientes sometidos a LEOC fueron incluidos. Se dividieron en tres grupos. Grupo 1 (n=15): No recibió medicación debido a las preferencias del paciente. Grupo 2 (n=15): Recibieron 50 mg de diclofenaco oral 30 minutos antes del procedimiento; y Grupo 3 (n=12): recibieron ambos diclofenaco oral y bloqueo unilateral del plano del musculo transverso abdominal guiado por ecografía 30 minutos antes del procedimiento. Se recogieron y compararon entre los grupos las características de los pacientes, los datos de la LEOC y las puntuaciones de la escala visual analógica (EVA). RESULTADOS: Se incluyeron 44 pacientes en el estudio. En la comparación entre grupos, las características del paciente, incluyendo edad e índice de masa corporal, y los datos de la LEOC, incluyendo tamaño de la litiasis, número de ondas de choque, energía total transmitida y duración del procedimiento, fueron similares y no hubo diferencias estadísticamente significativas. En la comparación entre grupos, solo la puntuación de la EVA alcanzó significación estadística. Las puntuaciones medias de la EVA fueron 6,3 ± 1,8, 4,3 ± 2,3 y 1,3 ± 1,0, en los grupos 1, 2 y 3 respectivamente. No hubo complicaciones en ninguno de los grupos. CONCLUSIONES: El alivio del dolor durante las intervenciones de LEOC es todavía un desafío para muchos clínicos. Nuestro estudio demuestra que entre otros agentes anestésicos/analgésicos y técnicas descritas, la combinación de bloqueo unilateral del plano del musculo transverso abdominal (TAP) guiado por ecografía y diclofenaco oral es una opción factible para el alivio del dolor durante la LEOC.

Super-mini percutaneous nephrolithotomy for renal stone less than 25mm in pediatric patients: Could it be an alternative to shockwave lithotripsy? / Supermini nefrolitotomía percutánea para cálculos renales menores de 25mm en pacientes pediátricos: ¿podría ser una alternativa a la litotricia por ondas de choque?

AIM: To evaluate the efficacy of 2 different techniques: shock wave lithotripsy (SWL) vs. super-mini percutaneous nephrolithotomy (SMP), in terms of success as well as complication rates in pediatric renal stones sizing<25mm. PATIENTS AND METHODS: A total of 219 children (aging between 1-17 years) undergoing 2 different treatment modalities (SWL vs. SMP) for kidney stones<25mm were included. Depending on the type of the procedure applied, children were divided into 2 different groups: group 1 (n=108), children treated with SWL, and group 2 (n=111), children treated with SMP. All treatment related parameters (stone free rates, number of sessions, treatment duration, hospitalization, presence of the residual fragments, complications as well as the need for additional interventions) were noted and evaluated between 2 groups in a comparative manner. RESULTS: Evaluation of our data have clearly demonstrated that the percentage of residual fragments after SWL was significantly higher when compared with SMP. Although SWL required several sessions under general anesthesia in a certain per cent of the cases (54.6%), SMP was successful in one session in all of the cases. Last but not least, in addition to the similar minor complication rates observed in both group of cases, no major complication observed in any case and no case in both groups again required blood transfusion after these 2 procedures with no significant drop rates in hemoglobin levels. CONCLUSIONS: Although SWL is still the preferred treatment modality for the majority of kidney stones in children due to its safe and non-invasive nature, SMP modality may be applied as a valuable alternative in this specific patient population for its excellent stone free rates obtained in a single session and acceptable complication rates in the minimal invasive management of stones<25mm.