Optimal Frequency of Shock Wave Lithotripsy in Urolithiasis Treatment: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

No AccessJournal of UrologyAdult Urology1 Oct 2013Optimal Frequency of Shock Wave Lithotripsy in Urolithiasis Treatment: A Systematic Review and Meta-Analysis of Randomized Controlled Trials Kaiwen Li, Tianxin Lin, Caixia Zhang, Xinxiang Fan, Kewei Xu, Liangkuan Bi, Jinli Han, Hai Huang, Hao Liu, Wen Dong, Yu Duan, Min Yu, and Jian Huang Kaiwen LiKaiwen Li Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes, Sun Yat-sen University, Guangzhou, China Equal study contribution. More articles by this author , Tianxin LinTianxin Lin Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes, Sun Yat-sen University, Guangzhou, China Equal study contribution. More articles by this author , Caixia ZhangCaixia Zhang Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes, Sun Yat-sen University, Guangzhou, China Equal study contribution. More articles by this author , Xinxiang FanXinxiang Fan Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes, Sun Yat-sen University, Guangzhou, China More articles by this author , Kewei XuKewei Xu Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes, Sun Yat-sen University, Guangzhou, China More articles by this author , Liangkuan BiLiangkuan Bi Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes, Sun Yat-sen University, Guangzhou, China More articles by this author , Jinli HanJinli Han Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes, Sun Yat-sen University, Guangzhou, China More articles by this author , Hai HuangHai Huang Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes, Sun Yat-sen University, Guangzhou, China More articles by this author , Hao LiuHao Liu Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes, Sun Yat-sen University, Guangzhou, China More articles by this author , Wen DongWen Dong Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes, Sun Yat-sen University, Guangzhou, China More articles by this author , Yu DuanYu Duan Eight-year Clinical Medicine Program, Zhongshan Medical School, Sun Yat-sen University, Guangzhou, China More articles by this author , Min YuMin Yu Department of Hepatobiliary Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China More articles by this author , and Jian HuangJian Huang Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes, Sun Yat-sen University, Guangzhou, China More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.03.075AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: The optimal frequency of shock wave lithotripsy in urolithiasis has not been well determined. Materials and Methods: A search of MEDLINE®, Web of Science and the Cochrane Library was performed. All randomized controlled trials including articles and meeting abstracts that compared the effects of different frequencies (120, 90 and 60 shock waves per minute) of shock wave lithotripsy were included in analysis. The review process followed the guidelines of the Cochrane Collaboration. Results: Nine randomized controlled trials including 1,572 cases were identified. Overall success rates and success rates for large stones (greater than 10 mm) were significantly lower in the 120 vs 60 (p <0.001 and p = 0.002, respectively) and in the 120 vs 90 (p <0.001 and p = 0.02, respectively) shock waves per minute groups, but similar between the 90 and 60 shock waves per minute groups. Treatment duration was significantly shorter in the 120 vs 60, 120 vs 90 and 90 vs 60 shock waves per minute groups (all p <0.001). Success rates for small stones (less than 10 mm), complication rates and total shock waves had no significant differences among the 3 groups. Conclusions: Decreasing the frequency from 120 to 60 shock waves per minute increased overall success rates. While the treatment duration of 60 shock waves per minute was much greater, 90 shock waves per minute seemed to be optimal, especially for large stones. A frequency of 120 shock waves per minute might still be recommended for small stones. References 1 : Extracorporeal shock-wave lithotripsy (ESWL) for treatment of urolithiasis. Urology1984; 23: 59. Google Scholar 2 : Extracorporeal shock wave lithotripsy 25 years later: complications and their prevention. Eur Urol2006; 50: 981. Google Scholar 3 : Single-center experience using three shockwave lithotripters with different generator designs in management of urinary calculi. J Endourol2006; 20: 1. Google Scholar 4 : Prognostic parameters in extracorporeal lithotripsy. Arch Ital Urol Nefrol Androl1989; 61: 361. Google Scholar 5 : Does the rate of extracorporeal shock wave delivery affect stone fragmentation?. Urology1999; 54: 430. Crossref, Medline, Google Scholar 6 : The effect of rate of shock wave delivery on the efficiency of lithotripsy. Curr Opin Urol2002; 12: 291. Google Scholar 7 : Shock wave lithotripsy at 60 or 120 shocks per minute: a randomized, double-blind trial. J Urol2005; 174: 595. Link, Google Scholar 8 : Optimal frequency in extracorporeal shock wave lithotripsy: prospective randomized study. Urology2005; 66: 1160. Google Scholar 9 : Clinical predictors of stone fragmentation using slow-rate shock wave lithotripsy. Urol Int2007; 79: 124. Google Scholar 10 : A randomized, double-blind trial to compare shock wave frequencies of 60 and 120 shocks per minute for upper ureteral stones. J Urol2009; 182: 1418. Link, Google Scholar 11 : Slow versus fast shock wave lithotripsy rate for urolithiasis: a prospective randomized study. J Urol2005; 173: 127. Link, Google Scholar 12 : Does rate matter? The results of a randomized controlled trial of 60 versus 120 shocks per minute for shock wave lithotripsy of renal calculi. J Urol2006; 176: 2055. Link, Google Scholar 13 : The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ2009; 339: b2700. Google Scholar 14 : Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. [updated March 2011] : The Cochrane Collaboration2011. Google Scholar 15 Review Manager (RevMan) [Computer program]. Version 5.1. Copenhagen: The Nordic Cochrane Centre2011. Google Scholar 16 : Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol2005; 5: 13. Google Scholar 17 : Bias in meta-analysis detected by a simple, graphical test. BMJ1997; 315: 629. Google Scholar 18 : Comparison between two shock wave regimens using frequencies of 60 and 90 impulses per minute for urinary stones. Clinics (Sao Paulo)2010; 65: 961. Google Scholar 19 : Optimal frequency of shock wave lithotripsy in urolithiasis treatment; prospective randomized study. J Endourol2012; 26: A343. Google Scholar 20 : A prospective, randomized study of the clinical effects of shock wave delivery for unilateral kidney stones: 60 versus 120 shocks per minute. J Urol2012; 188: 837. Link, Google Scholar 21 : Shock wave technology and application: an update. Eur Urol2011; 59: 784. Google Scholar 22 : Effect of firing rate on the performance of shock wave lithotriptors. BJU Int2008; 102: 1681. Google Scholar 23 : Relationship between the frequency of piezoelectric shock waves and the quality of renal stone fragmentation. In vitro study and clinical implications. Eur Urol1989; 16: 41. Google Scholar 24 : Shockwave frequency affects fragmentation in a kidney stone model. J Endourol2000; 14: 547. Crossref, Medline, Google Scholar 25 : Stone fragmentation during shock wave lithotripsy is improved by slowing the shock wave rate: studies with a new animal model. J Urol2002; 168: 2211. Link, Google Scholar 26 : Renal injury during shock wave lithotripsy is significantly reduced by slowing the rate of shock wave delivery. BJU Int2007; 100: 624. Google Scholar 27 : Dynamics of bubble oscillation in constrained media and mechanisms of vessel rupture in SWL. Ultrasound Med Biol2001; 27: 119. Crossref, Medline, Google Scholar 28 : Biological effects of shock waves: kidney haemorrhage by shock waves in dogs–administration rate dependence. Ultrasound Med Biol1988; 14: 689. Google Scholar 29 : Acute and chronic bioeffects of single and multiple doses of piezoelectric shockwaves (EDAP LT. 01). J Urol1991; 145: 399. Abstract, Google Scholar 30 : The effect of shock wave rate on the outcome of shock wave lithotripsy: a meta-analysis. J Urol2008; 179: 194. Link, Google Scholar © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byNg C, Yee C, Teoh J, Lau B, Leung S, Wong C, Wong K, Chu W and Yuen J (2019) Effect of Stepwise Voltage Escalation on Treatment Outcomes following Extracorporeal Shock Wave Lithotripsy of Renal Calculi: A Prospective Randomized StudyJournal of Urology, VOL. 202, NO. 5, (986-993), Online publication date: 1-Nov-2019.Lingeman J (2015) The Era of Shock Wave Lithotripsy is Over: NoJournal of Urology, VOL. 195, NO. 1, (16-17), Online publication date: 1-Jan-2016.Nguyen D, Hnilicka S, Kiss B, Seiler R, Thalmann G and Roth B (2015) Optimization of Extracorporeal Shock Wave Lithotripsy Delivery Rates Achieves Excellent Outcomes for Ureteral Stones: Results of a Prospective Randomized TrialJournal of Urology, VOL. 194, NO. 2, (418-423), Online publication date: 1-Aug-2015.Torricelli F, Marchini G, Yamauchi F, Danilovic A, Vicentini F, Srougi M, Monga M and Mazzucchi E (2014) Impact of Renal Anatomy on Shock Wave Lithotripsy Outcomes for Lower Pole Kidney Stones: Results of a Prospective Multifactorial Analysis Controlled by Computerized TomographyJournal of Urology, VOL. 193, NO. 6, (2002-2007), Online publication date: 1-Jun-2015.Tuncer M, Sahin C, Yazici O, Kafkasli A, Turk A, Erdogan B, Faydaci G and Sarica K (2014) Does Extracorporeal Shock Wave Lithotripsy Cause Hearing Impairment in Children?Journal of Urology, VOL. 193, NO. 3, (970-974), Online publication date: 1-Mar-2015. Volume 190Issue 4October 2013Page: 1260-1267Supplementary Materials Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.Keywordsreviewurolithiasismeta-analysislithotripsyhigh-energy shock wavesMetrics Author Information Kaiwen Li Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes, Sun Yat-sen University, Guangzhou, China Equal study contribution. More articles by this author Tianxin Lin Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes, Sun Yat-sen University, Guangzhou, China Equal study contribution. More articles by this author Caixia Zhang Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes, Sun Yat-sen University, Guangzhou, China Equal study contribution. More articles by this author Xinxiang Fan Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes, Sun Yat-sen University, Guangzhou, China More articles by this author Kewei Xu Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes, Sun Yat-sen University, Guangzhou, China More articles by this author Liangkuan Bi Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes, Sun Yat-sen University, Guangzhou, China More articles by this author Jinli Han Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes, Sun Yat-sen University, Guangzhou, China More articles by this author Hai Huang Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes, Sun Yat-sen University, Guangzhou, China More articles by this author Hao Liu Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes, Sun Yat-sen University, Guangzhou, China More articles by this author Wen Dong Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes, Sun Yat-sen University, Guangzhou, China More articles by this author Yu Duan Eight-year Clinical Medicine Program, Zhongshan Medical School, Sun Yat-sen University, Guangzhou, China More articles by this author Min Yu Department of Hepatobiliary Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China More articles by this author Jian Huang Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes, Sun Yat-sen University, Guangzhou, China More articles by this author Expand All Advertisement PDF downloadLoading ...