The role of lithotripsy and its side effects

J. E. Lingeman, J. Woods, P. D. Toth, A. P. Evan, J. A. McAteer

Research output: Contribution to journalReview article

115 Scopus citations

Abstract

The relative roles of extracorporeal shock wave lithotripsy and percutaneous nephrostolithotomy currently are being debated. Both treatment modalities are applicable to most upper urinary tract calculi. However, there are some important implications between the 2 techniques. Over-all, extracorporeal shock wave lithotripsy is associated with significantly lower morbidity than percutaneous nephrostolithotomy but stone-free rates are lower for extracorporeal shock wave lithotripsy than for percutaneous nephrostolithotomy. This difference is slight for kidneys containing minimal stone burden but increases in direct proportion to increasing stone burden. The morbidity of extracorporeal shock wave lithotripsy also increases with increasing stone burden. When applied to the treatment of staghorn calculi the morbidity of both techniques is comparable but the stone-free rates are significantly better with percutaneous nephrostolithotomy. Treatment with extracorporeal shock wave lithotripsy produces changes in the kidney similar to that of renal trauma, consisting primarily of intraparenchymal and peripheral hemorrhage and edema. While the acute effects of extracorporeal shock wave lithotripsy are well tolerated by most patients, the long-term sequela of this form of therapy is not well established. Potential long-term adverse effects reported include loss of renal function, hypertension and an increased rate of new stone occurrence. The effect of shock waves on renal parenchyma in experimental animals is dose-dependent (number of shock waves). Magnetic resonance imaging of patients treated with extracorporeal shock wave lithotripsy demonstrates morphological abnormalities in or around the kidney in 63 to 85 per cent of the cases (average number of shock waves 1,200). Despite these observations the safe limits of extracorporeal shock wave lithotripsy in humans have yet to be established. Further study regarding this issue and the potential long-term adverse effects of extracorporeal shock wave lithotripsy is needed urgently.

Original languageEnglish (US)
Pages (from-to)793-797
Number of pages5
JournalJournal of Urology
Volume141
Issue number3 II
DOIs
StatePublished - Jan 1 1989

ASJC Scopus subject areas

  • Urology

Fingerprint Dive into the research topics of 'The role of lithotripsy and its side effects'. Together they form a unique fingerprint.

  • Cite this

    Lingeman, J. E., Woods, J., Toth, P. D., Evan, A. P., & McAteer, J. A. (1989). The role of lithotripsy and its side effects. Journal of Urology, 141(3 II), 793-797. https://doi.org/10.1016/s0022-5347(17)41012-3