Ultrasound versus fluoroscopic localisation during extracorporeal shockwave lithotripsy

Czech version

Authors: Michaela Motolová ¹; Milan Král ²
Authors‘ workplace: Urologie, Barmherzige Schwestern Krankenhaus Wien ¹; Urologická klinika LF UP a FN Olomouc ²
Published in: Ces Urol 2021; 25(2): 112-119
Category: Original Articles

Overview

Motolová M, Král M. Ultrasound guidance versus flouroscopic targeting of urolithiasis by extracorporeal shock wave litotripsy.

Aim: Efficacy comparison of two localization techniques using ESWL – exclusively real time ultrasound or fluoroscopy. Demonstration of at least equivalence of both techniques. To publisize the advantages of real-time ultrasound guidance to encourage more departments in develop of this modality.

Methods: This bicentric retrospective study compares stone free rates (SFRs) in three selected groups of patients with similar characteristics. Inclusion criteria: ESWL as primary intervention for nephrolithiasis, proximal or prevesical uretherolithiasis. The definition of stone free was a patient without any residual stone or the absence of fragments ≥ 2 mm. The arm with exclusively real-time USG targeting of urolithiasis contains a group of 120 patients, using electromagnetic lithotripter – STORZ SLK between 02/2017–02/2020. The fluroscopy- arm includes two groups: 72 patients, using electroconductive lithotripters: Sonolith-i-sys (EDAP) between 04–10/2017 and 68 patients, by using electrohydraulic lithotripter Medilit 7 between 01/2016–03/2017. Simultaneus evaluation of requisite for auxiliary techniques and number of sessions for complete stone-desintegration.

Results: SFR was 90% in the USG-guided group. The avarage number of ESWL sessions was 1,3. SFR in the fluoroscopic arm: the group-Sonolith-i-sys plus the group Medilit 7 was 90%. The avarage number of ESWL sessions was 1,5. These results were not significantly different α = 0,105. The same result is shown on comparson of frequency of requirement for auxiliary techniques – DJ-stent insertion/ureterorenoscopy α = 0,453. Radiation exposure was the biggest difference between techniques, as well as analgesics requirement which were significantly lower in USG arm ( α < 0,001). The operator presence-time was significantly longer in USG – guided ESWL.

Conclusion: Our study shows efficacy equivalence of outcomes of both localization modalities. Real-time USG guidance should be primarily used to reduce radation exposure for patients undergoing ESWL.

Keywords:

Effectivity – extracorporeal shock wave lithotripsy – Radiation exposure – ultrasonography – urolithiasis

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