呂謹亨1 郭俊逸1,2,3 林子平1,2,3 范玉華1,2,3 林志杰1,2,3 鍾孝仁1,2,3 吳宏豪1,2,3 黃逸修1,2,3
黃志賢1, 2, 3 張延驊1,2,3林登龍1,2,3 陳光國1,2,3
台北榮民總醫院 外科部 泌尿科1 國立陽明大學醫學院 泌尿學科2 書田泌尿科學研究中心3
Clinical analysis of 48 hours emergency department visit post outpatient extracorporeal shock wave lithotripsy for urolithiasis
Chin Heng Lu1, Junne Yih Kuo 1,2,3, Tzu-Ping Lin1,2,3, Y.H. Fan1,2,3, Chih-Chieh Lin1,2,3, Hsiao-Jen Chung1,2,3, Howard H.H Wu1,2,3, Yi-Hsiu Huang1,2,3, William J.S. Huang1, 2, 3, Yen-Hua Chang1,2,3, Alex Tong-Long Lin1,2,3, Kuang-Kuo Chen1,2,3
1Division of Urology, Department of Surgery, Taipei Veterans General Hospital
2Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
3Shutien Urological Science Research Center, Taipei, Taiwan
Purpose: To assess the safety of outpatient extracorporeal shock wave lithotripsy (ESWL) in the management of patients with renal and ureteral stones.
Materials and Methods: Between February 2012 and November 2014, 844 outpatients were treated with Outpatient ESWL at Taipei Veterans General Hospital. 22 patients visited emergency department (ED) within 48 hours. Stone size, stone shape (long to short axis ratio), location, total pulse of shockwaves, stone management and urine analysis data and date before ESWL, complications and treatment at ER and admission rate was investigated. Chi-Square and Logistic Regression analyses were used, with p<0.05 set as the level of significance.
Results: Of the 844 initial consecutive patients who underwent ESWL, 1095 times of ESWL was performed totally. There were 22(2%) patients visited ED within 48 hours after ESWL. Mean Age was 54.3±12.6 years old; BMI was 25.9±3.2; pre-ESWL Cr was 0.89±2.54 mg/ml; post-ESWL Cr was 1.04±0.23 mg/ml; stone height/width ratio was 1.80±0.57. The mean renal stone size was 12.2±5.9 mm;. The mean ureteral stone size was 6.1±0.2 mm. 8 (8/379=2.1%) patients had right side stone, 14 (14/465=3.0%) patients had left side stones. 16 patients received ESWL for renal stone, 5 patients for ureter stone and 1 patient for both. The most common complication was flank pain include 16 patients (72.7%). Other complication includes hematuria (5 patients, all from renal stone), fever (4 patients, all from renal stone), acute urinary retention and nausea with vomiting (1 patient each). There were 12 patient received EWSL, PCNL, or URSL before. In 22 patient back to ER, 7 patients admitted to ward and 1 patient back to ER twice continuously. All patients received medical treatment without ESWL or surgical management.
Conclusions: The 48 hours Emergency Department Visiting rate was 2%. There was no severe morbidity or mortality case. The tendency risk factors according to our study include renal stone, large stone height/width ratio, pre-ESWL stone management. The conclusion showed the outpatient ESWL is safe for treating renal and ureteral stones.