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Shock wave lithotripsy: a randomized, double-blind trial to compare immediate versus delayed voltage escalation
R John D'A Honey1, A Andrew Ray, Daniela Ghiculete
1Department of Urology, St. Michael's Hospital, Toronto, Ontario, Canada. honeyj@smh.toronto.on.ca
Urology
|November 10, 2009
Summary
Immediate voltage escalation during shock wave lithotripsy (SWL) demonstrated a higher success rate for kidney stone fragmentation compared to delayed escalation. This study found no significant difference in complications between the two SWL methods.
Area of Science:
- Urology
- Nephrology
- Medical Devices
Background:
- Shock wave lithotripsy (SWL) is a common procedure for kidney stone treatment.
- SWL effectiveness depends on energy settings, electrode wear, and shock wave rate.
- Preliminary evidence suggested delaying voltage escalation might improve SWL outcomes.
Purpose of the Study:
- To compare the efficacy and safety of immediate versus delayed voltage escalation in SWL for kidney stones.
- To evaluate stone-free rates and fragmentation efficiency at 3 months post-treatment.
Main Methods:
- A randomized trial involving 160 patients with kidney stones.
- Patients were assigned to either immediate or delayed voltage escalation SWL.
- Success was defined as stone-free status or fragments ≤4 mm at 3 months.
Main Results:
- The overall success rate was higher with immediate escalation (72.5%) versus delayed escalation (54.5%) (P = .021).
- Stone area decreased more rapidly with immediate escalation, particularly for smaller calculi.
- No significant differences in complications or ancillary procedures were observed between groups.
Conclusions:
- Delayed voltage escalation does not appear to offer superior stone fragmentation compared to immediate voltage escalation in SWL.
- Immediate voltage escalation may be more effective for certain stone sizes.
- SWL protocols can be optimized by considering voltage escalation timing.
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