Abstract
Purpose
We compared the outcomes of SWL to treat distal ureter stones with regard to the conventional prone and supine positions using the transgluteal approach through the greater sciatic foramen.
Methods
A prospective, randomized, single-blind, and multicenter study was conducted between October 2014 and July 2015. The inclusion criteria were radio-opaque distal ureter stones with a maximum diameter of 0.5−2 cm as measured on a CT scan. The included 160 patients were randomly assigned to two groups: the prone group (n = 80; treated in the conventional prone position) and the transgluteal group (n = 80; treated in the supine position using a transgluteal approach). In the latter group, the focused shock wave was transmitted through the greater sciatic foramen with the head positioned at a 40° angle to the vertical. “Stone-free” was defined as the complete clearance of stone fragments, assessed using a CT scan at 2 weeks after treatment. Overall satisfaction was self-reported using a 0–5 Likert scale.
Results
The overall efficacy was 66.9%. The stone-free rate was significantly higher in the transgluteal group (72.6%) than in the prone group (54.7%; odds ratio 2.413, 95% CI 1.010−5.761, P = 0.023). No serious adverse events due to treatment were observed in either group. The satisfaction score of the transgluteal group was 4.21 ± 0.81, and 83.6% were willing to repeat the same procedure if necessary.
Conclusions
SWL using the transgluteal approach via a supine position through the greater sciatic foramen was more effective than via the conventional prone position. Furthermore, this approach provided a comparably safe and satisfactory procedure.
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Change history
11 April 2018
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References
Assimos D, Krambeck A, Miller NL, Monga M, Murad MH, Nelson CP, Pace KT, Pais VM Jr, Pearle MS, Preminger GM, Razvi H, Shah O, Matlaga BR (2016) Surgical management of stones: American Urological Association/Endourological Society guideline, part i. J Urol 196:1153–1160
Turk C, Neisius A, Petrik A, Seitz C, Skolarikos A, Tepeler A, Thomas K (2018) Guidelines on urolithiasis. European Association of Urology. http://www.uroweb.org/gls/pdf/%Urolithisis_LR.pdf. Last accessed on 05 Feb 2018
Tiselius HG, Chaussy CG (2012) Aspects on how extracorporeal shockwave lithotripsy should be carried out in order to be maximally effective. Urol Res 40:433–446
Semins MJ, Matlaga BR (2015) Strategies to optimize shock wave lithotripsy outcome: patient selection and treatment parameters. World J Nephrol 4:230–234
Hara N, Koike H, Bilim V, Takahashi K, Nishiyama T (2006) Efficacy of extracorporeal shockwave lithotripsy with patients rotated supine or rotated prone for treating ureteral stones: a case-control study. J Endourol 20:170–174
Phipps S, Stephenson C, Tolley D (2013) Extracorporeal shockwave lithotripsy to distal ureteric stones: the transgluteal approach significantly increases stone-free rates. BJU Int 112:E129–E133
Kamel M, Salem EA, Maarouf A, Abdalla M, Ragab A, Shahin AM (2015) Supine transgluteal vs prone position in extracorporeal shock wave lithotripsy of distal ureteric stones. Urology 85:51–54
Guntekin E, Kukul E, Kayacan Z, Baykara M, Sevuk M (1994) Morbidity associated with patient positioning in extracorporeal shock wave lithotripsy of distal ureteral calculi. Int Urol Nephrol 26:13–16
Lu J, Sun X, He L (2010) Sciaticum majus foramen and sciaticum minus foramen as the path of SWL in the supine position to treat distal ureteral stone. Urol Res 38:417–420
Sun X, He L, Lu J, Cong X, Shen L, Wang Y, Zhu H (2010) Greater and lesser ischiadic foramina as path of shock wave lithotripsy for distal ureteral stone in children. J Urol 184:665–668
Istanbulluoglu MO, Hoscan MB, Tekin MI, Cicek T, Ozturk B, Ozkardes H (2011) Shock wave lithotripsy for distal ureteric stones: supine or prone. Urol Res 39:177–180
Galli R, Sighinolfi MC, Micali S, Martorana E, Rosa M, Mofferdin A, Bianchi G (2017) Advantages of the supine transgluteal approach for distal ureteral stone extracorporeal shock wave lithotripsy: outcomes based on CT characteristics. Minerva Urol Nefrol 69:189–194
Eisner BH, Kambadakone A, Monga M, Anderson JK, Thoreson AA, Lee H, Dretler SP, Sahani DV (2009) Computerized tomography magnified bone windows are superior to standard soft tissue windows for accurate measurement of stone size: an in vitro and clinical study. J Urol 181:1710–1715
El-Nahas AR, El-Assmy AM, Mansour O, Sheir KZ (2007) A prospective multivariate analysis of factors predicting stone disintegration by extracorporeal shock wave lithotripsy: the value of high-resolution noncontrast computed tomography. Eur Urol 51:1688–1693 (discussion 1693−1684)
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213
Zomorrodi A, Elahian A, Ghorbani N, Tavoosi A (2006) Extracorporeal shock wave lithotripsy in prone and supine positions for patients with upper ureteral calculi. Urol J 3:130–133
Cleveland RO, McAteer JA (2012) Physics of shock-wave Lithotripsy. In: Smith AD, Badlani GH, Preminger GM, Kavoussi LR (eds) Smith’s textbook of endourology. Wiley-Blackwell, Oxford, UK, pp 527–558
Delius M, Enders G, Heine G, Stark J, Remberger K, Brendel W (1987) Biological effects of shock waves: lung hemorrhage by shock waves in dogs—pressure dependence. Ultrasound Med Biol 13:61–67
Feix B, Sturgess J (2014) Anaesthesia in the prone position. Contin Educ Anaesth Crit Care Pain. https://doi.org/10.1093/bjaceaccp/mku001
D’Addessi A, Vittori M, Racioppi M, Pinto F, Sacco E, Bassi P (2012) Complications of extracorporeal shock wave lithotripsy for urinary stones: to know and to manage them—a review. Sci World J 2012:619820. https://doi.org/10.1100/2012/619820
Rush EC, Freitas I, Plank LD (2009) Body size, body composition and fat distribution: comparative analysis of European, Maori, Pacific Island and Asian Indian adults. Br J Nutr 102:632–641
Honey RJ, Ray AA, Ghiculete D, Pace KT (2010) Shock wave lithotripsy: a randomized, double-blind trial to compare immediate versus delayed voltage escalation. Urology 75:38–43
Chung DY, Cho KS, Lee DH, Han JH, Kang DH, Jung HD, Kown JK, Ham WS, Choi YD, Lee JY (2015) Impact of colic pain as a significant factor for predicting the stone free rate of one-session shock wave lithotripsy for treating ureter stones: a Bayesian logistic regression model analysis. PLoS One 10:e0123800. https://doi.org/10.1371/journal.pone.0123800
Parr NJ, Pye SD, Ritchie AW, Tolley DA (1992) Mechanisms responsible for diminished fragmentation of ureteral calculi: an experimental and clinical study. J Urol 148:1079–1083
Funding
This research was supported by Hallym University Research Fund 2015(HURF-2015-27).
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Author contributions
MSC and SHL designed and organized this prospective multicenter study; MSC and JHH summarized and analyzed the multicenter data and wrote the manuscript; JKK, TYS, WKL and SKL were the clinicians who enrolled participants and performed the shockwave lithotripsy procedures on the distal ureter stones and recorded the data at each center.
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The authors declare that they have no conflicts of interest.
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This study was conducted according to the principles of the Declaration of Helsinki.
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Clinical Research involving Human Participants but no Animals.
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The written informed consent form was signed by each participant.
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Choo, M.S., Han, J.H., Kim, J.K. et al. The transgluteal approach to shockwave lithotripsy to treat distal ureter stones: a prospective, randomized, and multicenter study. World J Urol 36, 1299–1306 (2018). https://doi.org/10.1007/s00345-018-2244-4
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DOI: https://doi.org/10.1007/s00345-018-2244-4