ESWL for Distal Ureteric Stone: Supine Versus Prone

  • STATUS
    Recruiting
  • End date
    Nov 26, 2027
  • participants needed
    130
  • sponsor
    Queen Mary Hospital, Hong Kong
Updated on 26 January 2021
chronic obstructive pulmonary disease (copd)
lithotripsy
ureterolithiasis
kub x-ray

Summary

Extracorporeal shockwave lithotripsy (ESWL) for urinary stone is common and widespread nowadays. Approximately 80% of urinary stones are treated by ESWL. Traditionally distal ureteric stones are treated with ESWL in the prone position. However, as some patients cannot tolerate lying in the prone due to medical illness such as chronic obstructive pulmonary disease (COPD), some authors have reported using the supine approach of ESWL for treatment of distal ureter stones. No serious complications had developed in the patients who underwent supine approach. Only minor complications such as self-limiting blood in the urine, painful passage of urine, or local pain that had responded to oral painkillers. There were no serious complications encountered in children as well. In the most recent retrospective review by Tolley et al, they had revealed that patients who had underwent supine ESWL for distal ureteric stones had an improved stone-free rate compared with the traditional prone approach.

Patient with radio-opaque distal ureteric stones (stones below the sacroiliac joint) on KUB X-ray, who have opted for ESWL treatment, are randomized into two groups: one undergoing ESWL in the supine position and the other undergoing ESWL in the prone position. Patients will be observed for two hours after ESWL before being discharged. Oral painkillers as necessary will be provided to the patient. The patients will have a KUB Xray at 2 weeks post-ESWL, and then monthly afterwards if required. If there are residual stones at the 2-week follow-up, the patient will be offered ESWL again. Patients are free to withdraw from the study at any time and will continue to be managed as per usual.

The investigators aim to have 130 patients, with 65 patients in each group with an interim analyses to be performed when 66 patients have been recruited (33 patients in each group).

Description

Previous authors have reported using the greater and lesser sciatic foramina as a pathway for the shockwaves to reach the distal ureter. No serious complications had developed in the patients who underwent transgluteal approach. Only minor complications such as self-limiting hematuria, dysuria, or pain that had responded to oral analgesics. There were no serious complications encountered in children as well. In the most recent retrospective review by Tolley et al, they had revealed that patients who had underwent transgluteal ESWL for distal ureteric stones had an improved stone-free rate of 78% in the transgluteal group versus 40% in the prone group after one session of shockwave lithotripsy and a stone-free rate of 92% versus 63% respectively after two sessions of shockwave lithotripsy. This has been speculated to be due to the presence of bowel gas attenuating the shockwaves as well as a long skin-to-stone distance in the prone position.

Details
Condition Urolithiasis, Urinary calculus
Treatment Supine ESWL, Prone ESWL, Extracorporeal Shockwave Lithotripsy (ESWL)
Clinical Study IdentifierNCT02298465
SponsorQueen Mary Hospital, Hong Kong
Last Modified on26 January 2021

Eligibility

Yes No Not Sure

Inclusion Criteria

Is your age greater than or equal to 18 yrs?
Gender: Male or Female
Do you have Urinary calculus?
Do you have any of these conditions: Urinary calculus or Urolithiasis?
All patients, over 18 years of age, with distal ureteric stones with stone size of 3mm on kidney-ureter-bladder (KUB) X-ray who opted for ESWL treatment

Exclusion Criteria

Patients who are unable to provide consent
radiolucent stones
active urinary tract infections
pregnancy
uncontrolled hypertension
uncontrolled bleeding tendencies
severe skeletal malformations
arterial aneurysms within the vicinity of the stone (such as iliac artery aneurysms)
unable to assume the appropriate position (prone or supine) for ESWL
solitary kidneys
transplanted kidneys
presence of ureteric stents
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