Comparison of ultrasonography and fluoroscopy as guides for extracorporeal shock wave lithotripsy in nephrolithiasis patients: a systematic review

  • Gede Wirya Kusuma Duarsa Department of Urology, Faculty of Medical and Health Science, Universitas Udayana, Sanglah General Hospital, Denpasar, Indonesia
  • Christian Nurtanto Putra Faculty of Medical and Health Science, Universitas Udayana, Denpasar, Indonesia
  • Kevin Ivandi Faculty of Medical and Health Science, Universitas Udayana, Denpasar, Indonesia
  • Kadek Adit Wiryadana Faculty of Medical and Health Science, Universitas Udayana, Denpasar, Indonesia
  • Pande Made Wisnu Tirtayasa Department of Urology, Faculty of Medical and Health Science, Universitas Udayana, Sanglah General Hospital, Denpasar, Indonesia
  • Firman Pribadi Faculty of Medical and Health Science, Universitas Muhammadiyah Yogyakarta, Yogyakarta, Indonesia
Keywords: complications, ESWL, fluoroscopy, nephrolithiasis, treatment outcome, ultrasonography
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Abstract

BACKGROUND Extracorporeal shock wave lithotripsy (ESWL) is one of the first-line treatment options for patients with renal stones <2 cm. The large variability in ESWL results may be due to the stone visualization methods using ultrasonography (USG), fluoroscopy, or a combination of both. This study aimed to review the efficacy and safety of the stone visualization method on the stone-free rate (SFR) and postprocedural complications in nephrolithiasis patients.

METHODS We conducted a systematic review of USG and fluoroscopy on ESWL until July 2022, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We assessed and collected summaries of the screened papers. The main outcomes assessed were the SFR of renal stones and postprocedural complications between imaging modalities.

RESULTS A total of 7 studies were assessed, including 6 comparative assessments of USG versus fluoroscopy and 1 comparative assessment of USG and fluoroscopy versus fluoroscopy only. Although all studies showed that USG had a higher SFR than fluoroscopy, only 1 study showed a significant difference (p = 0.008). Additionally, superior results were obtained using a combination of USG and fluoroscopy compared with fluoroscopy only. Most studies agreed that USG was not inferior in post-ESWL complication results.

CONCLUSIONS Overall, the use of USG is comparable to fluoroscopy because it does not provide a significant difference in the SFR and complications. In most cases, USG is preferred because of the absence of radiation. The combination of fluoroscopy and USG also provides more promising results than a single modality.

References

  1. Sorokin I, Mamoulakis C, Miyazawa K, Rodgers A, Talati J, Lotan Y. Epidemiology of stone disease across the world. World J Urol. 2017;35(9):1301-20. https://doi.org/10.1007/s00345-017-2008-6

  2. Türk C, Skolarikos A, Neisius A, Petrik A, Seitz C, Thomas K, et al. EAU guidelines on urolithiasis. European Association of Urology; 2019.

  3. Goren MR, Goren V, Ozer C. Ultrasound-guided shockwave lithotripsy reduces radiation exposure and has better outcomes for pediatric cystine stones. Urol Int. 2017;98(4):429-35. https://doi.org/10.1159/000446220

  4. Chang TH, Lin WR, Tsai WK, Chiang PK, Chen M, Tseng JS, et al. Comparison of ultrasound-assisted and pure fluoroscopy-guided extracorporeal shockwave lithotripsy for renal stones. BMC Urol. 2020;20(1):183. https://doi.org/10.1186/s12894-020-00756-6

  5. D'Addessi A, Vittori M, Racioppi M, Pinto F, Sacco E, Bassi P. Complications of extracorporeal shock wave lithotripsy for urinary stones: to know and to manage them-a review. Sci World J. 2012;2012:619820. https://doi.org/10.1100/2012/619820

  6. Nasu Y, Kurashige T, Kumon H. Common and uncommon complications related to ESWL. In: Akimoto M, Higashihara E, Kumon H, Masaki Z, Orikasa S, editors. Treatment of urolithiasis. Recent Advances in Endourology, vol 3. Tokyo: Springer; 2001. https://doi.org/10.1007/978-4-431-68517-3_12

  7. Van Besien J, Uvin P, Hermie I, Tailly T, Merckx L. Ultrasonography is not inferior to fluoroscopy to guide extracorporeal shock waves during treatment of renal and upper ureteric calculi: a randomized prospective study. Biomed Res Int. 2017;2017:7802672. https://doi.org/10.1155/2017/7802672

  8. Ozkaya F. Comparison of the results of shock wave lithotripsy with ultrasonic and fluoroscopic focus in pediatric age group; fluoroscopic focusing how much is needed? Ann Med Res. 2021;26(11):2502-6. https://doi.org/10.5455/annalsmedres.2019.10.600

  9. Reynolds LF, Kroczak T, Pace KT. Indications and contraindications for shock wave lithotripsy and how to improve outcomes. Asian J Urol. 2018;5(4):256-63. https://doi.org/10.1016/j.ajur.2018.08.006

  10. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. https://doi.org/10.1136/bmj.n71

  11. Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016;355:i4919. https://doi.org/10.1136/bmj.i4919

  12. Motolová M, Král M. [Ultrasound versus fluoroscopic localisation during extracorporeal shockwave lithotripsy]. Ces Urol. 2021;25(2):112-9. Czech.

  13. Arunagiri A. Comparative study of efficacy of localization and fragmentation of renal stone by USG and fluoroscopy guided ESWL [master's thesis]. Chennai: Kilpauk Medical College; 2010.

  14. Smith HE, Bryant DA, KooNg J, Chapman RA, Lewis G. Extracorporeal shockwave lithotripsy without radiation: ultrasound localization is as effective as fluoroscopy. Urol Ann. 2016;8(4):454-7. https://doi.org/10.4103/0974-7796.192104

  15. Shehata A, Ayman K, Gamal S. Ultrasound guided extracorporeal shock wave lithotripsy for renal calculi in children. New York Sci J. 2016;9(12):156-61.

  16. Grabsky A, Tsaturyan A, Musheghyan L, Minasyan G, Khachatryan Y, Shadyan G, et al. Effectiveness of ultrasound-guided shockwave lithotripsy and predictors of its success rate in pediatric population: a report from a national reference center. J Pediatr Urol. 2021;17(1):78.e1-7. https://doi.org/10.1016/j.jpurol.2020.10.014

  17. Abid N, Ravier E, Codas R, Crouzet S, Martin X. [New ultrasound navigational system in extracorporeal lithotripsy: decreased fluoroscopy and radiation]. Prog Urol. 2013;23(10):856-60. French.

  18. Musa AA. Use of double-J stents prior to extracorporeal shock wave lithotripsy is not beneficial: results of a prospective randomized study. Int Urol Nephrol. 2008;40(1):19-22. https://doi.org/10.1007/s11255-006-9030-8

  19. Kirkali Z, Esen AA, Akan G. Place of double-J stents in extracorporeal shock wave lithotripsy. Eur Urol. 1993;23(4):460-2. https://doi.org/10.1159/000474653

Published
2022-10-05
How to Cite
1.
Duarsa GWK, Putra CN, Ivandi K, Wiryadana KA, Tirtayasa PMW, Pribadi F. Comparison of ultrasonography and fluoroscopy as guides for extracorporeal shock wave lithotripsy in nephrolithiasis patients: a systematic review. Med J Indones [Internet]. 2022Oct.5 [cited 2022Dec.4];1(1). Available from: https://mji.ui.ac.id/journal/index.php/mji/article/view/6140
Section
Clinical Research