Effect of stepwise voltage escalation on treatment outcomes following extracorporeal shockwave lithotripsy of renal calculi: a prospective randomized study
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AbstractOBJECTIVE:
This study aimed to assess the effects of a ramping protocol in patients receiving extracorporeal shockwave lithotripsy (SWL) for renal stones.

METHODOLOGY:
In this prospective study, patients with renal stones were randomized to receive SWL delivered using a ramping (First 1000 shocks at energy level-5, followed by 1000shocks at energy level-6 and 1000 final shocks at energy level-7; Group-1) or fixed-voltage (All 3000 shocks at energy level-7; Group-2) protocols by Modulith SLX-F2. The primary outcome was treatment success at 12weeks after a single SWL session, defined as the lack of a stone or a stone fragment <4 mm on computed tomography. Other outcomes included stone-free rate and the incidence of perinephric hematoma.

RESULTS:
300 patients (150 per group) were recruited between February 2016 and June 2018. The two groups did not differ in terms of baseline parameters. Group-1 received significantly lower energy delivered than Group-2 (14.8% less, p<0.001). The treatment success rates for Group-1 and Group-2 were 67.8% and 73.6%, respectively, and were not statistically different (crude odds ratio for Group-1: 0.753; 95% confidence interval 0.456 to 1.244; p=0.268). The stone-free rates for Group-1 and Group-2 were 36.6% and 41.9%, respectively, and did not differ between the groups. However, in Group-1 and Group-2, 23.8% and 43.8% of patients developed perinephric hematoma, respectively, and was statistically significant difference (p<0.001).

CONCLUSIONS:
The fixed-voltage SWL and ramping protocols provided similar treatment success rates for renal stones. However, ramping protocol could reduce the incidence of post-SWL perinephric hematoma.
Acceptance Date21/05/2019
All Author(s) ListNg CF, Yee CH, Teoh JY, Lau B, Leung SC, Wong CY, Tak WK, Chu WCW, Yuen J
Journal nameJournal of Urology, The
Detailed descriptionEpub ahead of print
Year2019
ISSN0022-5347
LanguagesEnglish-United States
KeywordsRamping, Renal protection, Shockwave lithotripsy, kidney stone, outcomes

Last updated on 2020-03-07 at 04:32