Immediate Shock Wave Lithotripsy

In the setting of partially obstructing stones, shock wave lithotripsy (SWL) has also been performed as immediate treatment (Kravchick et al. 2005; Doublet et al. 1997; Tligui et al. 2003; Joshi et al. 1999). While SWL in this situation would be less invasive, one theoretical concern would be treating a stone with SWL in the set ting of unrecognized infection. SWL would provide little opportunity to diagnose an unsuspected infection and thereby alter treatment plans. Nonetheless, in the absence of indications for urgent upper tract decompression, some authors have acutely utilized SWL. In a recent report, Kravchick and colleagues reported a prospective randomized trial of emergent SWL vs scheduled SWL (treatment within 30 days of diagnosis) for upper urinary tract stones associated with acute renal colic (Kravchick et al. 2005). None of the patients had presenting indications that warranted a temporary drainage procedure. Emergent SWL was associated with a higher success rate (72%) than delayed treatment (64%). In addition, scheduled (delayed) treatment was associated with significantly prolonged hos-pitalizations and recovery at home. Other groups have noted favorable experiences with emergency SWL. For instance, Doublet and associates found a significant relationship between stone location and stone-free rates after emergent SWL (Doublet et al. 1997). In their report, proximal stone treatment was associated with a 65 % success rate.

More controversial is the use of emergency shock wave lithotripsy (SWL) for immediate definitive management of completely obstructing stones (Joshi et al. 1999). Among 82 consecutive patients with completely obstructing stones treated by Joshi and co-workers, 26 patients underwent percutaneous nephrostomy tube placement followed by scheduled SWL, 40 patients underwent retrograde stent placement followed by scheduled SWL, and 16 patients underwent urgent in situ SWL alone without prior drainage procedures (Joshi et al. 1999). All SWL procedures were performed on a Siemens Lithostar Multiline or Lithostar Plus lithotripter. The mean stone size was 8.98 mm (range, 4-25 mm) and stone size was not significantly different among treatment groups. Infectious complications related to urgent in situ SWL were not observed. Urgent in situ SWL was associated with an overall success rate of 81 % compared to a 70% success rate in the stent + SWL group and 54% success rate in the nephrostomy tube + SWL group. Success rates were highest for in situ SWL performed on proximal ureteral stones. While Joshi and colleagues report favorable results, additional clinical evaluation appears warranted before urgent SWL can be recommended for emergent treatment of completely obstructed stones. Indeed, the presence of completely obstructing stones would traditionally mandate the use of a temporary drainage technique prior to delayed definitive treatment.

Baby Sleeping

Baby Sleeping

Everything You Need To Know About Baby Sleeping. Your baby is going to be sleeping a lot. During the first few months, your baby will sleep for most of theday. You may not get any real interaction, or reactions other than sleep and crying.

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