SWL literature
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Reviewer's Choice 

Van Besien J et al, 2017: Ultrasonography Is Not Inferior to Fluoroscopy to Guide Extracorporeal Shock Waves during Treatment of Renal and Upper Ureteric Calculi: A Randomized Prospective Study.

Van Besien J, Uvin P, Hermie I, Tailly T, Merckx L.
Department of Urology, AZ Sint-Lucas, Ghent, Belgium.
Department of Radiology, AZ Sint-Jan, Bruges, Belgium.
Department of Urology, University Hospitals, Ghent, Belgium.

Abstract

Objective: To investigate whether the visualization modality (ultrasound or fluoroscopy) used during shockwave lithotripsy (SWL) affects the clinical outcome in those instances where both imaging modalities are optional.
Methods: Between November 2014 and July 2016, 114 patients with radiopaque upper urinary tract calculi were randomly assigned to an ultrasound- or fluoroscopy-guided SWL group in a prospective, open-label, single-center study. A standardized SWL protocol was used. The stone-free rate and the positive outcome rate (stone-free or asymptomatic residual fragments ≤ 4 mm) were compared.
Results: The stone-free rate was 52% in the ultrasound-guided group compared to 42% in the fluoroscopy-guided group (𝑝 = 0.06) and the positive outcome rate was 79% in the ultrasound-guided group compared to 70% in the fluoroscopy-guided group (𝑝 = 0.28). These results were not significantly different but proved to be noninferior based on a Wilson confidence interval of independent proportions (noninferiority limit 10%). The mean number of SWL sessions was not significantly different (𝑝 = 0.4).
Conclusion: Our study demonstrated that the clinical results of ultrasound-guided SWL were not inferior to the results of fluoroscopy-guided SWL, while no ionizing radiation is needed.

Biomed Res Int. 2017;2017:7802672. doi: 10.1155/2017/7802672. Epub 2017 May 15

 

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Comments 1

Peter Alken on Monday, 06 November 2017 08:05

I expected the ultrasonography group outcomes to be much better than those of the fluoroscopy group. After all continuous real-time targeting was used in the sonography group patients and patients were repositioned statistically significant more often - 8 vs. 6 - than those of the fluoroscopy group.
Maybe the fact that both patient groups were treated by two experienced practitioners also abolished the differences. It is the statistical design of the study which only allowed the conclusion that ultrasound-guided SWL is not inferior to the results of fluoroscopy-guided SWL.
This manuscript is a recreation area for a frequent reader. Everything from material and methods to results and conclusion is detailed in a precise, clear and unambiguous manner. Therefore this is one of my reviewers choices.

I expected the ultrasonography group outcomes to be much better than those of the fluoroscopy group. After all continuous real-time targeting was used in the sonography group patients and patients were repositioned statistically significant more often - 8 vs. 6 - than those of the fluoroscopy group. Maybe the fact that both patient groups were treated by two experienced practitioners also abolished the differences. It is the statistical design of the study which only allowed the conclusion that ultrasound-guided SWL is not inferior to the results of fluoroscopy-guided SWL. This manuscript is a recreation area for a frequent reader. Everything from material and methods to results and conclusion is detailed in a precise, clear and unambiguous manner. Therefore this is one of my reviewers choices.
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Sunday, 17 November 2019
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