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455 Emergency extracorporeal shockwave

lithotripsy (eESWL) for acute renal colic due to
ureteral stones

Article in European Urology Supplements · March 2016

DOI: 10.1016/S1569-9056(16)60457-8

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7 authors, including:

Paolo Umari Stefano Bucci

Azienda Ospedaliero - Universitaria "Ospedali … Università degli Studi di Trieste
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Giovanni Liguori Carlo Trombetta

Università degli Studi di Trieste Università degli Studi di Trieste
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455 Emergency extracorporeal shockwave lithotripsy (eESWL) for acute renal colic due to ureteral
stones

Eur Urol Suppl 2016;15(3);e455           Print!

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Umari P., Bucci S., Rizzo M., Pavan N., Liguori G., Marega D., Trombetta C.

Azienda Ospedaliero Universitaria di Trieste, Dept. of Urology, Trieste, Italy

INTRODUCTION & OBJECTIVES: To report the results of a prospective randomized controlled study that evaluate the efficacy of
emergency treatment of obstructing ureteral stones by extracorporeal shockwave Lithotripsy (eESWL) during acute renal colic.

MATERIAL & METHODS: We prospectively studied 70 patients presenting with their first episode of ureteric colic undergoing ESWL over
14 months period. Patients were randomized to emergency ESWL within 12 hours (eESWL group) or deferred ESWL until 20 days (dESWL
group). Inclusion criteria were: acute renal colic, ureteral radiolucent or hyperechogenic stones, stone size from 5mm to 20mm, no evidence
of urinary infection or acute renal failure. Follow up included ultrasound or computed tomography scan at 24 hours, 7 days, 1 months and 3
months after treatment. When it was necessary, repeated ESWL (re-ESWL) or ureteroscopy (URS) was performed. Preoperative and
postoperative data were compared between the two groups and stone free rates and efficiency quotients were evaluated. Analyses were
performed using SAS (9.3 version) statistical software.

RESULTS: 36 patients from eESWL group and 34 patients from dESWL group were well matched for age, gender, BMI and clinical and
pathological characteristics. The mean patient age was 48.7 (range 24-81). Mean stone size was 9,83 mm (range 5-20mm). 25 stones
(35.7%) were located in the upper ureter, while 45 (64.3%) were in the distal ureter. Mean ESWL energy was 19,2 kV (range 14-24). Mean
shock waves were 2650 (range 1000-3600). ESWL treatment lasted on average 44 minutes (range 17–60 minutes). All the procedures
were conducted at the frequency of 1 Hz. No treatment was interrupted because of poor tolerance.
Patients in the dESWL group spent more time in the hospital (1.36 vs 2.21 days) and the complication rates were paragonable in both
groups (p<0.05). eESWL patients needs less auxiliary URS than dESWL patients, 11.1% vs 44.1% respectively (p<0.05) and less re-
ESWL 8.3% vs 32.4% respectively (p=0.09). The stone free rates at 24 hours were 52.8% and 11,8% in the eESWl and dESWL group
respectively (p<0.05). The stone free rates at 3 months were 94.4% and 79.4% (p=0.07) and efficiency quotients were 79.1% and 57.5% in
the eESWL and dESWL group respectively (p<0.01).

CONCLUSIONS: Rapid ESWL after the first onset of colic pain represent an effective treatment.
It delivers high stone free rates even within 24 hours from the treatment especially in <10mm stones. It accelerates the stone clearance
independently on the presence and degree of hydronephrosis and offers effective decompression of the collecting system and release from
pain. This procedure is safe and is able to reduce the number of auxiliary procedures (URS or re-ESWL) and the hospitalization. We believe
that “emergency” timing of the precedure is of remarkably importance because of development of ureteral edema and stone impactation.

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