1462 ANALGESIA DURING EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY USING DORNIER (ALPHA COMPACT) LITHOTRIPTOR: A PROSPECTIVE RANDOMIZED DOUBLE BLIND CLINICAL TRIAL

Vol. 183, No. 4, Supplement, Tuesday, June 1, 2010

1461 STONE ATTENUATION VALUE AND CROSS-SECTIONAL AREA ON COMPUTED TOMOGRAPHY PREDICT THE SUCCESS OF SHOCK WAVE LITHOTRIPSY Michio Tanaka*, Eisuke Yokota, Yoichiro Toyonaga, Yoshiyuki Ishii, Saitama, Koshigaya City, Japan; Fumitaka Shimizu, Makoto Fujime, Bunkyo-ku, Tokyo, Japan INTRODUCTION AND OBJECTIVES: Noncontrast computed tomography (CT) offers valuable clinical information in the evaluation of urolithiasis. Some reports have suggested that stone attenuation value on CT is an independent parameter of clinical outcome after shock wave lithotripsy (SWL). We attempted to determine which radiographic parameters on CT were the most predictive of SWL success. METHODS: We reviewed the records of 75 patients who underwent SWL with a Dornier Compact S lithotripter for urinary calculi measuring 5 to 20 mm. Using noncontrast CT images archived to a POP-Net Server (ImageONE Co., Ltd.), we estimated the largest stone cross-sectional area and contoured the inner edge of the stone. Using these parameters, the stone area and the stone attenuation values could be calculated. Using follow-up imaging, clinical outcome was classified as successful (patients that were stone-free or had fragments less than 4 mm in diameter) or failed (patients with stone fragments measuring 4 mm or more). The impact of preoperative parameters, ie, stone length, location, average stone attenuation value, stone crosssectional area, and distance from stone to skin, were evaluated by univariate and multivariate analysis. RESULTS: Of 75 patients, 27 (36.0%) had a renal stone and 48 (64.0%) had a ureteral stone. Clinical outcomes were assessed after an average follow-up of 61.8⫾34.6 days. The overall success rate was 73.3%. Average stone attenuation value, stone length, and stone cross-sectional area for the success and failure groups were 627.4⫾166.5 vs 788.1⫾233.9 HU (p⬍0.01), 11.7⫾3.8 vs 14.2⫾3.6 cm (p⫽0.01), and 0.31⫾0.17 vs 0.57⫾0.41 cm2 (p⬍0.01), respectively. Univariate analysis showed that average stone attenuation value, stone length, and stone cross-sectional area were associated with SWL success (p⬍0.05). However, on multivariate analysis, stone attenuation value was the only independent predictor of SWL success (p⬍0.05), although stone cross-sectional area had a tendency to be associated with SWL success (p⫽0.05). Patients were then classified as group 1: attenuation ⱕ850 HU and cross-sectional area ⱕ0.4 cm2; group 2: ⱕ850 HU and ⬎0.4 cm2; group 3: ⬎850 HU and ⱕ0.4 cm2; and group 4: ⬎850 HU and ⬎0.4 cm2. Group 1 was more than 10.7 times as likely to have a successful result on SWL, as compared with all other groups (OR, 10.7; 95% CI, 3.3-42.1; p⬍0.01). CONCLUSIONS: Stone attenuation value and stone crosssectional area, as determined by noncontrast CT, are good predictors of extracorporeal SWL outcome. Source of Funding: None

1462 ANALGESIA DURING EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY USING DORNIER (ALPHA COMPACT) LITHOTRIPTOR: A PROSPECTIVE RANDOMIZED DOUBLE BLIND CLINICAL TRIAL Anup Kumar*, Manoj Jain, Sanjay Prakash, Nayan Mohanty, Delhi, India INTRODUCTION AND OBJECTIVES: To evaluate the role of oral ketorolac with occlusive dressing of Eutectic Mixture Of Local Anaesthesia (EMLA), oral alprazolam with occlusive dressing of EMLA and a combination of oral ketorolac,alprazolam with occlusive dressing of EMLA,as three analgesic regimens for pre-medication prior to SWL, to investigate their their efficacy, adverse effects, need for supplemental analgesia, and assess patients’ satisfaction and overall treatment outcome.

THE JOURNAL OF UROLOGY姞

e563

METHODS: 150 consecutive patients with urolithiasis scheduled for SWL between May 2008 and December 2008 were randomized equally into 3 groups that were treated using the following protocols: Group A – oral tablet ketorolac 60 min prior to SWL (dosage: 30 mg for body weight ⬍70 Kg, 60 mg for ⬎70 Kg) along with occlusive dressing of a combination of lignocaine and prilocaine (EMLA) 5 gm, applied on a skin area of approximately 30 cm2, corresponding to entry site of the shock waves, 60 min prior to SWL; Group B – oral tablet alprazolam 60 min prior to SWL (dosage: 0.25 mg for body weight ⬍70 Kg, 0.5 mg for ⬎70 Kg) along with occlusive dressing of a combination of lignocaine and prilocaine (EMLA) 5 gm, applied on a skin area of approximately 30 cm2, corresponding to entry site of the shock waves, 60 min prior to SWL; Group C – combination of oral ketorolac, oral alprazolam with occlusive dressing of EMLA, in dosage described above for first two regimens. A Visual Analog Scale (VAS) was used for the subjective evaluation of pain. The various parameters were recorded and analyzed statistically. RESULTS: The total number of shock waves delivered, the maximum voltage used and SWL duration were statistically greater in Group C (p ⬍0.001). The VAS scores at 15 min, 30 min, 45 min, 60 min and 120 min, and the supplemental analgesia requirement were statistically lesser in Group C( p ⬍0.001). The stone fragmentation rate, stone free rate at 3 months (89.2%) and modified Efficiency Quotient (0.67) were statistically greater in Group C (p ⬍0.001). The post SWL auxiliary procedure rate and Steinstrasse rates were statistically lesser in Group C. ly greater in Group C (p ⬍0.001). The post SWL auxiliary procedure rate and Steinstrasse rates were statistically lesser in Group C. CONCLUSIONS: The use of a combination of oral ketorolac,alprazolam and an occlusive dressing of EMLA cream during SWL provides adequate analgesia with minimal morbidity, avoids the need for parenteral analgesics and their side effects and additionally improves the success rate of SWL. Source of Funding: None

1463 A PROSPECTIVE RANDOMIZED COMPARISON BETWEEN EARLY(< 48 HOURS OF ONSET OF COLICKY PAIN) VERSUS DELAYED SHOCK WAVE LITHOTRIPSY FOR SYMPTOMATIC UPPER URETERIC CALCULI:A SINGLE CENTRE EXPERIENCE Anup Kumar*, Manoj Jain, Sanjay Prakash, Nayan Mohanty, Delhi, India INTRODUCTION AND OBJECTIVES: We have performed a prospective randomized comparison between early(⬍ 48 hours) versus delayed (⬎ 48 hours)shock wave lithotripsy for symptomatic upper ureteric stones less than 1 cm to evaluate the feasibility,safety and efficacy of early SWL in these patients METHODS: 160 consecutive patients with a single radioopaque upper ureteric stone ⬍ 1 cm, presenting with an episode of colicky pain,undergoing treatment between July 2008 and June 2009 in our department were included. The patients were hospitalized and randomized into 2 groups – Group A: SWL was performed within 48 hours of onset of colicky pain(early SWL) using the electromagnetic lithotripter (Dornier Alpha Compact)along with analgesics and hydration therapy; Group B: SWL was performed after 48 hours(delayed SWL) along with analgesics and hydration therapy. The statistical analysis was performed in 2 groups regarding patient demographic profile,presence of hydronephrosis, time to stone clearance,success rates, no. of sessions required, auxiliary procedures, modified efficiency quotient(EQ)and complications. RESULTS: 80 patients were enrolled in each group. The mean stone size was 7.3 mm in group A vs. 7.5 mm in group B (p⫽ 0.52).The stone fragmentation rate was 88.75% in group A vs 91.2% in group B(p ⫽ 0.35). The overall 3 month stone free rate was (69/80)86.3% for