Shock Wave Lithotripsy Case Study

open surgery was the mainstay of treatment for urolithiasis, but it has now been supplanted by less invasive treatments:
Shock wave lithotripsy, the introduction of shock wave lithotripsy in the early 1980s revolutionized the treatment of nephrolithiasis. A shock wave is generated by a source external to the patient that propagates through the body before being focused on a kidney stone. Shock waves cause stone fragmentation directly by producing mechanical stresses or indirectly by the collapse of cavitation bubbles (61).
Although shock wave lithotripsy is the most common treatment for urolithiasis, it can have side effects,it can cause acute renal injury (62).
Computed tomography and magnetic resonance imaging have demonstrated renal injury in 63-85% of patients treated with shock wave lithotripsy (63).
A recent retrospective case study with 19 year follow-up noted an association between shock wave lithotripsy and the development of hypertension and diabetes mellitus. In the lithotripsy group, diabetes developed in 16.8% of patients versus 6.6% of controls (64).
Ureteroscopy, it involves retrograde visualisation of the collecting system using a rigid, semi-rigid, or flexible endoscope.
Improved fibreoptics and deflectability and the reduced size of ureteroscopes have expanded the use of ureteroscopy for stones in the upper urinary tract. The ureteroscope has a working channel that allows the introduction of a variety of instruments for stone fragmentation and removal. A retrospective study showed that ureteroscopy is useful when lithotripsy fails; when complex or lower pole renal calculi are present; or when patient factors such as pregnancy, coagulopathy, or morbid obesity preclude lithotripsy
(65). One disadvantage of ureteroscopy is that a ureteral stent, which causes considerable discomfort in some patients, is often necessary to prevent obstruction from ureteral oedema or stone fragments (26).
Percutaneous nephrolithotomy , it involves creating an access tract into the renal collecting system through which nephroscopy can be performed. The nephroscope has a working channel through which an intra- corporeal lithotripsy device (lithotrite or laser) can be introduced. Stone fragments are removed using suction, graspers, or basket extraction. The technique enables stones to be retrieved for analysis, and all stone material can be removed so that the patient does not have to pass any fragments, as is common with shock wave lithotripsy and ureteroscopy. Although percutaneous nephrolithotomy is thought to be more invasive than other treatments, a large meta-analysis has demonstrated its safety and efficacy, particularly when stones are large, multiple, or complex (66).