Extracorporeal shock wave lithotripsy induces the release of prostaglandins which increase ureteric peristalsis

The aim of this study was to identify the changes in secretion of prostaglandins into the urinary tract as a result of treatment by extracorporeal shock wave lithotripsy (ESWL) and to determine their effects on ureteric motility. Sixteen patients with renal or upper ureteric calculi were studied. A peripheral blood and urine sample was collected immediately before and after ESWL, with further samples taken 24 h later. The following variables were assessed by radioimmunoassay:prostaglandin E2 (PGE2), prostaglandin F1 alpha (PGF1 alpha), and thromboxane B2 (TXB2). An in vitro canine study was then designed to study the activity of TXB2, PGF1 alpha and PGE2 on an isolated intact canine ureter model. Significant elevations of TXB2 were found immediately after ESWL in both serum and urine, which fell almost to pre-treatment levels by 24 h. PGF1 alpha levels showed significant elevations at 24 h but no immediate increase as seen with TXB2. In contrast, PGE2 levels were unchanged in the urine but significantly decreased in the serum. In vitro studies showed that both TXB2 and PGF1 alpha repeatedly produced an increased frequency of ureteric contraction. ESWL results in the release of prostaglandins from the urinary tract which are shown to cause increased ureteric peristalsis.