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Complications and outcomes following extracorporeal shock wave lithotripsy: a prospective study of 3,241 patients

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Abstract

Extracorporeal shock wave lithotripsy (SWL) has become the least invasive treatment modality with high success rates for urinary calculi; however, its established efficacy has been associated with a number of side effects and complications. This study sought to further evaluate the incidence rate and management of the post-SWL complications and also the efficiency of procedure in a large scale of patients. During a 51-month period, 3,241 consecutive adult patients with the mean age of 38.1 years (range 15–75) and urinary calculi (≥4 mm) underwent SWL at our referral center and were followed for 3 months prospectively. Overall, 3,614 stones [kidneys (83.5%), ureters (15.8%) and bladder (0.7%)] in 3,241 patients were treated requiring 7,245 SWL sessions. Stone-free state occurred in 71.5% calculi and success rate in 79.8% patients. The re-treatment was necessary in 37.2% patients. Auxiliary procedure and efficiency quotient were 5.6% and 0.50, respectively. SWL success rate decreased as the stone size increased (P < 0.0001). The stone-free rate was correlated with the location of the stone. During the study period, 4,075 complications occurred in our patients. Colicky pain (40%) was the most frequent symptom followed by gross hematuria (32%) and steinstrasse (24.2%). Symptomatic bacteriuria developed in 9.7% patients; Escherichia coli (30.4%) was the most causative organism. In conclusion, the complication rate following SWL was high in our study; however, the majority was mild and managed conservatively or with the minimal intervention. Moreover, the management of urinary calculi in adults using SWL was proved to be safe and efficient, particularly for ureteral stones <10 mm, renal pelvic stones <20 mm, and bladder stones <30 mm.

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Acknowledgments

The authors would like to thank the nursing, secretary and administrative staff of the Urology Research Center, Sina Hospital, especially Dr. M. Rezaeidanesh, Mrs. G. Abdi, Mrs. F. Heydari and Mrs. M. Zahedikia for their excellent cooperation in the study, and also Dr. P. Khashayar and Ms. M. Tayebi for their assistance in preparation of the manuscript. Furthermore, we are grateful to Dr. B. Saboury for his consultation in the statistical analysis.

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The authors have no conflicts of interest to disclose.

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Authors and Affiliations

  1. Urology Research Center, Sina Hospital, Tehran University of Medical Sciences, Hassan-Abad Sq., 1136746911, Tehran, Iran

    Sepehr Salem, Abdolrasoul Mehrsai, Hamed Zartab, Nematollah Shahdadi & Gholamreza Pourmand

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  1. Sepehr Salem
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  2. Abdolrasoul Mehrsai
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Correspondence to Sepehr Salem.

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Salem, S., Mehrsai, A., Zartab, H. et al. Complications and outcomes following extracorporeal shock wave lithotripsy: a prospective study of 3,241 patients. Urol Res 38, 135–142 (2010). https://doi.org/10.1007/s00240-009-0247-8

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  • DOI: https://doi.org/10.1007/s00240-009-0247-8

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