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

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.

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).

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
LanguagesEnglish-United States
KeywordsRamping, Renal protection, Shockwave lithotripsy, kidney stone, outcomes

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