Analgesia in piezoelectric SWL: Comparative study of kidney and upper ureter treatments

Background: The development of newer-generation lithotripters has reduced t he pain associated with SWL, but many patients still require some form of s edation. We prospectively compared the analgesic requirements for kidney an d upper ureteral treatments. Predictive factors for pain during piezoelectr ic SWL were also studied. Patients and Methods: A total of 102 consecutive patients without any previ ous experience of SWL were treated for renal (N = 70) or upper ureteral (N = 32) calculi using the EDAP LT02 lithotripter. The stones' largest diamete r ranged from 4 to 30 mm (mean 9 mm), Patients were given an oral dose of 6 0 mg of dextropropoxyphene hydrochloride and 800 mg of paracetamol associat ed with 100 mg of ketoprofene per rectum 30 minutes before treatment, The S WL session was begun at low intensity and increased to the maximal range of energy as rapidly as could be tolerated by the patient, The amount of pain during treatment was recorded according to a visual analogue scale (VAS), Further analgesia using intravenous alfentanil was given as required by the severity of the pain. Visual analog pain scores, additional sedation requi rements, and success rates after one session were analyzed. Results: The VAS scores and intravenous sedation requirements were signific antly lower for patients with upper ureteral stones than for those with ren al calculi (P < 0.01). The stone-free rates after one session were, respect ively, 90% and 73% (P < 0.05), On the other hand, SWL tolerance was signifi cantly lower for women presenting with renal stones (P < 0.05). Conclusion: Piezoelectric SWL without intravenous sedation is suitable for the treatment of upper ureteral calculi, However, such an approach is less efficient in the management of kidney stones, especially for female patient s.