Current ESWL Practice and Outcome using a Direx Electromagnetic Lithotripter-Experience from Tertiary care centre of North India

Abstract

Introduction: Forty years after its introduction, extracorporeal shockwave lithotripsy (ESWL) is still first-line treatment for selected renal and upper ureteric stones. We conducted a longitudinal descriptive study to assess the results of shock wave lithotripsy by Direx electromagnetic ESWL machine. Objective: The objective of this study isto describe overall outcome of ESWLin the treatment of renal stones and upper ureteric stonesin terms of stone clearance, complications, and stone free rates in relation to stone size. Material and methods:Case records of three hundred forty-eight patients who were treated for renal and ureteric stones in urology department of IGMC, Shimla from 2018-2020 were retrieved. Forty-six patients were excluded because they could not turn up for scheduled sessions.Mean age of patients was 40.7 years ranging from 13 years to 80 years. There were 226 (64.94%) males and 122 (35.06%) females in our study. Eighty-one patients (23.28%) presented with hydronephrosis and flank pain in emergency. Double DJ stent was inserted in 109 patients (31.32%) prior to ESWL owing to hydronephrosis or flank pain. Mean stone size was 12.75 mm ranging from 5 mm to 24 mm. Mean HU was 918 ranging from 620 to 1250. Two hundred thirty-eight patients(78.80%) had complete stone clearance on or before three sessions of ESWL. Sixty-four patients had residual stones after 3rd session of ESWL out of which forty-four (12.64%) opted for additionali.e. 4th session of ESWL. Stone free status was not achieved in 13 patients in spite of four sessions of ESWL.Thus, total of 33 patients were labelled as failure and they were planned for PCNL/RIRS. Stone free rate according to stone size was 95.2%, 71.96% and 55.55% in ≤1cm, 1.1-2 cm and >2cm stone size subgroup respectively.Twelve patients (3.45%) required DJ stenting, after ESWL, and ancillary procedure i.e. URSL and ESWL for down migrated obstructing stone fragment in ureter was required in 7 and 2 patients respectively. Moderate to severe pain was experienced during ESWL in 4.89% patients requiring medical management and reduction in intensity and frequency of shockwaves. Complications i.e.,Hematuria, Urinary tract infections associated with fever was seen in 14.86% and 8% patients respectively. Conclusion:ESWL results can be optimised by proper selection of patients and following newer technical aspects of procedure. Improvements in technique along with strict patient and stone selection criteria will help ESWL to remain a mainstay in the treatment of Renal and upper ureteric stone disease.