Alcoba García MDP. et al., 2023: Is Extracorporeal Shock Wave Lithotripsy a Treatment Option for Renal Colic?
Alcoba García MDP, Bueno Serrano G, Tabares Jiménez J, González López R, Coloma Ruíz L, González Enguita C.
Department of Urology, Jiménez Díaz Foundation Hospital, 28040 Madrid, Spain.
Abstract
Background: Renal colic is characterized by sharp, intense flank pain. Nonsteroidal anti-inflammatory drugs are the treatment of choice, although extracorporeal shock wave lithotripsy (SWL) is a noninvasive alternative for pain management. The objective of our study is to present results obtained using rapid SWL to treat renal colic in our center.
Methods: We analyzed 214 patients undergoing rapid shockwave extracorporeal lithotripsy between October 2014 and June 2018: 69.63% were male, and 30.37% female, with a mean age of 47.35 years (range, 16-84). The average stone size was 6.71 mm (3-16). Stone locations were as follows: The pelviureteric junction (PUJ) (10.75%), proximal ureter (45.79%), midureter (24.77%), and distal ureter (18.69%).
Results: Pain relief was achieved in 81.31% of the patients. The rates of successful pain control according to stone location were 65.22% when the stone was located in the PUJ, 79.59% in the proximal ureter, 88.68% in the midureter, and 85.00% in the distal ureter. Complete or partial stone resolution was achieved 4 weeks postoperatively in 78.50% of cases (64.95% and 13.55%, respectively). According to the stone location, the overall rate of resolution (complete + partial) was 90.00% for distal ureteral stones, 86.80% in the midureter, 73.47% in the proximal ureter, and 60.86% in the PUJ. 44 patients (20.56%) demonstrated complications. The most common complications were persistent pain, acute renal failure and fever.
Conclusions: Immediate SWL was found to be a safe and effective treatment option for pain related to renal colic in 81% of the patients studied.
Arch Esp Urol. 2023 May;76(3):175-181. doi: 10.56434/j.arch.esp.urol.20237603.20. PMID: 37340522 FREE ARTICLE
Comments 1
Sometimes I wonder what rides authors when they quote facts from sources they obviously have not read. “In the 1990s, the use of immediate extracorporeal shock wave lithotripsy (SWL) began as a means of relieving pain caused by acute reno-ureteral colic, since then, the technique has gained popularity due to its favourable outcomes [5–7].” None of the three papers deals with SWL for colic, but with in situ SWL. Usually I stop reading the rest. But I was interested in the topic. The authors rightly state: “As there is no precise definition of rapid SWL in the literature, we have classified all treatments occurring within 72 hours of colic onset as immediate SWL.” Their description of the logistics of immediate SWL offers practical hints.
The results are convincing just as a recent metanalysis (1) has shown. Surprisingly immediate SWL to treat colic has not made it in the EAU or IUA guidelines.
1 Peng CX, et al. Efficacy of emergency extracorporeal shock wave lithotripsy in the treatment of ureteral stones: a meta-analysis. BMC Urol. 2023 Apr 4;23(1):56. doi: 10.1186/s12894-023-01226-5.
Peter Alken