Can a brief period of double J stenting improve the outcome of extracorporeal shock wave lithotripsy for renal calculi sized 1 to 2 cm?
Purpose: Extracorporeal shock wave lithotripsy (ESWL) is an established modality for renal calculi. Its role for large stones is being questioned. A novel model of temporary double J (DJ) stenting followed by ESWL was devised and outcomes were assessed. Materials and Methods: The study included 95...
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| Format: | Article |
| Language: | English |
| Published: |
Korean Urological Association
2017-03-01
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| Series: | Investigative and Clinical Urology |
| Subjects: | |
| Online Access: | https://www.icurology.org/Synapse/Data/PDFData/2020ICU/icu-58-103.pdf |
| _version_ | 1811257144357421056 |
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| author | Rakesh Sharma Arpan Choudhary Ranjit Kumar Das Supriya Basu Ranjan Kumar Dey Rupesh Gupta Partha Pratim Deb |
| author_facet | Rakesh Sharma Arpan Choudhary Ranjit Kumar Das Supriya Basu Ranjan Kumar Dey Rupesh Gupta Partha Pratim Deb |
| author_sort | Rakesh Sharma |
| collection | DOAJ |
| description | Purpose: Extracorporeal shock wave lithotripsy (ESWL) is an established modality for renal calculi. Its role for large stones is being
questioned. A novel model of temporary double J (DJ) stenting followed by ESWL was devised and outcomes were assessed.
Materials and Methods: The study included 95 patients with renal calculi sized 1 to 2 cm. Patients were randomized into 3
groups. Group 1 received ESWL only, whereas group 2 underwent stenting followed by ESWL. In group 3, a distinct model was applied
in which the stent was kept for 1 week and then removed, followed by ESWL. Procedural details, analgesic requirements, and
outcome were analyzed.
Results: Eighty-eight patients (male, 47; female, 41) were available for analysis. The patients’ mean age was 37.9±10.9 years. Stone
profile was similar among groups. Group 3 received fewer shocks (mean, 3,155) than did group 1 (mean, 3,859; p=0.05) or group 2
(mean, 3,872; p=0.04). The fragmentation rate was similar in group 3 (96.7%) and groups 1 (81.5%, p=0.12) and 2 (87.1%, p=0.16).
Overall clearance in group 3 was significantly improved (83.3%) compared with that in groups 1 (63.0%, p=0.02) and 2 (64.5%,
p=0.02) and was maintained even in lower pole stones. The percentage successful outcome in groups 1, 2, and 3 was 66.7%, 64.5%,
and 83.3%, respectively (p=0.21). The analgesic requirement in group 2 was higher than in the other groups (p=0.00). Group 2 patients
also had more grade IIIa (2/3) and IIIB (1/2) complications.
Conclusions: Stenting adversely affects stone clearance and also makes the later course uncomfortable. Our model of brief stenting
followed by ESWL provided better clearance, comfort, and a modest improvement in outcome with fewer sittings and steinstrasse
in selected patients with large renal calculi. |
| first_indexed | 2024-04-12T17:51:51Z |
| format | Article |
| id | doaj.art-77060c6a49a84a5e9c4dbe904794b92e |
| institution | Directory Open Access Journal |
| issn | 2466-0493 2466-054X |
| language | English |
| last_indexed | 2024-04-12T17:51:51Z |
| publishDate | 2017-03-01 |
| publisher | Korean Urological Association |
| record_format | Article |
| series | Investigative and Clinical Urology |
| spelling | doaj.art-77060c6a49a84a5e9c4dbe904794b92e2022-12-22T03:22:28ZengKorean Urological AssociationInvestigative and Clinical Urology2466-04932466-054X2017-03-0158210310810.4111/icu.2017.58.2.103Can a brief period of double J stenting improve the outcome of extracorporeal shock wave lithotripsy for renal calculi sized 1 to 2 cm?Rakesh Sharma0Arpan Choudhary1Ranjit Kumar Das2Supriya Basu3Ranjan Kumar Dey4Rupesh Gupta5Partha Pratim Deb6SMS Medical College and HospitalR G Kar Medical College and HospitalR G Kar Medical College and HospitalR G Kar Medical College and HospitalR G Kar Medical College and HospitalR G Kar Medical College and HospitalR G Kar Medical College and HospitalPurpose: Extracorporeal shock wave lithotripsy (ESWL) is an established modality for renal calculi. Its role for large stones is being questioned. A novel model of temporary double J (DJ) stenting followed by ESWL was devised and outcomes were assessed. Materials and Methods: The study included 95 patients with renal calculi sized 1 to 2 cm. Patients were randomized into 3 groups. Group 1 received ESWL only, whereas group 2 underwent stenting followed by ESWL. In group 3, a distinct model was applied in which the stent was kept for 1 week and then removed, followed by ESWL. Procedural details, analgesic requirements, and outcome were analyzed. Results: Eighty-eight patients (male, 47; female, 41) were available for analysis. The patients’ mean age was 37.9±10.9 years. Stone profile was similar among groups. Group 3 received fewer shocks (mean, 3,155) than did group 1 (mean, 3,859; p=0.05) or group 2 (mean, 3,872; p=0.04). The fragmentation rate was similar in group 3 (96.7%) and groups 1 (81.5%, p=0.12) and 2 (87.1%, p=0.16). Overall clearance in group 3 was significantly improved (83.3%) compared with that in groups 1 (63.0%, p=0.02) and 2 (64.5%, p=0.02) and was maintained even in lower pole stones. The percentage successful outcome in groups 1, 2, and 3 was 66.7%, 64.5%, and 83.3%, respectively (p=0.21). The analgesic requirement in group 2 was higher than in the other groups (p=0.00). Group 2 patients also had more grade IIIa (2/3) and IIIB (1/2) complications. Conclusions: Stenting adversely affects stone clearance and also makes the later course uncomfortable. Our model of brief stenting followed by ESWL provided better clearance, comfort, and a modest improvement in outcome with fewer sittings and steinstrasse in selected patients with large renal calculi.https://www.icurology.org/Synapse/Data/PDFData/2020ICU/icu-58-103.pdfAdult; Kidney calculi; Lithotripsy; Stents |
| spellingShingle | Rakesh Sharma Arpan Choudhary Ranjit Kumar Das Supriya Basu Ranjan Kumar Dey Rupesh Gupta Partha Pratim Deb Can a brief period of double J stenting improve the outcome of extracorporeal shock wave lithotripsy for renal calculi sized 1 to 2 cm? Investigative and Clinical Urology Adult; Kidney calculi; Lithotripsy; Stents |
| title | Can a brief period of double J stenting improve the outcome of extracorporeal shock wave lithotripsy for renal calculi sized 1 to 2 cm? |
| title_full | Can a brief period of double J stenting improve the outcome of extracorporeal shock wave lithotripsy for renal calculi sized 1 to 2 cm? |
| title_fullStr | Can a brief period of double J stenting improve the outcome of extracorporeal shock wave lithotripsy for renal calculi sized 1 to 2 cm? |
| title_full_unstemmed | Can a brief period of double J stenting improve the outcome of extracorporeal shock wave lithotripsy for renal calculi sized 1 to 2 cm? |
| title_short | Can a brief period of double J stenting improve the outcome of extracorporeal shock wave lithotripsy for renal calculi sized 1 to 2 cm? |
| title_sort | can a brief period of double j stenting improve the outcome of extracorporeal shock wave lithotripsy for renal calculi sized 1 to 2 cm |
| topic | Adult; Kidney calculi; Lithotripsy; Stents |
| url | https://www.icurology.org/Synapse/Data/PDFData/2020ICU/icu-58-103.pdf |
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