Beware! Shock wave lithotripsy (SWL) for renal calculi patients may increase the risk of hypertension and diabetes in long-term follow-up.
This landmark paper is a fitting tribute to this icon in endourology, Joe Segura. The death, this month, of this venerable clinician, researcher, and educator, who has contributed a wealth of knowledge to stone disease management, will leave a huge void in the Endourologic community.
This study compared 288 patients undergoing SWL for renal stone disease to a cohort stone patient group with no surgery for renal stones matched by age, sex, and year of presentation. At 19 years of follow-up, hypertension was more prevalent in the SWL group and this was related primarily to bilateral treatment of renal stones. In addition, in the SWL group 16.8% of the patients developed diabetes mellitus and this was statistically higher than in the controlled group. Most interestingly even by controlling for change in body mass index, there still was a persistent risk of diabetes mellitus in the SWL group compared to the non-surgical renal stone group. Diabetes mellitus was related to the number of administered shocks and treatment intensity, but not the side treated.
This study was based on the HM3 lithotripter which is considered the goal standard for SWL. Further studies with other lithotripters and review of patients treated with SWL for pancreatic stones should be undertaken. However, SWL is not a benign treatment and the patient should be advised with regards to the importance of blood pressure monitoring and follow-up, particularly for bilateral SWL.
By Elspeth M. McDougall, MD
J Urol 175: 1742-1747, 2006
AE Krambeck, MT Gettman, AL Rohlinger, CM Lohse, BE Patterson, and JW Segura
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