Shock Wave Lithotripsy For Renal Stones Is Not Associated With Hypertension And Diabetes Mellitus

Main Category: Urology / Nephrology
Also Included In: Diabetes;  Hypertension
Article Date: 31 Jul 2008 - 1:00 PDT

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UroToday.com - In 2006, a worrisome paper regarding the long-term effects of HM-3 shock wave lithotripsy was published by the Mayo Clinic.

In that study of 578 treated patients (288 responded to the questionnaire), with 19 year follow-up matched to a control population with untreated urinary stones, a statistically significant increase in hypertension, 36% vs. 28% - and in diabetes mellitus, 17% vs. 7% was reported.1 The present study is not confirmatory. It comprises more than twice as many respondents (772 renal and 505 ureteral stone patients) all of whom had HM-3 shock wave lithotripsy between 1984 and 1994. In contrast to the Mayo Clinic findings, the incidence of new onset hypertension (22.8% vs. 20.0% in men and 23.1% vs. 20.5% in women) and diabetes (7.4% vs. 11.0% in men and 8.7% vs. 8.7% in women) was similar - with a follow-up period of more than a decade in all cases, and an average of 17 years overall.

The authors surmised that if renal lithotripsy were problematic then the rate of both hypertension and diabetes should have been higher since the control ureteral stone patients would have less chance of a shock wave effect on the pancreas or the kidney.

Confused???? Me too..

However, the answer may lay in more investigation. Could the group at the Mayo Clinic or the investigators in Sapporo go back and duplicate each other's control group; specifically, examining the ureteral SWL patient population in Rochester or the stone patients without treatment in Sapporo? The cynic would say that none of this is relevant since the HM-3 is now almost completely abandoned across the world and this massive study would have to be done for each of the second and third generation lithotriptors currently in use in order to discern whether any of the current modes of extracorporeal lithotripsy place patients at risk for either hypertension or diabetes. But at the end of the day, isn't that exactly what we owe our patients now that the clarion call has been sounded? How is this different from the recall of an automobile or a pharmaceutical when a problem has been identified and needs further study? Each lithotriptor currently on the market, in my mind, needs to be clearly evaluated in this regard. When the cure of one disease becomes the cause of another, who gains?

1 Krambeck, A., E., Gettman, M. T., Rohlinger, A. L., Lohse, C. M., et al.: Diabetes Mellitus and Hypertension Associated with Shock Wave Lithotripsy of Renal and Proximal Ureteral Stones at 19 Years of Follow-up. J. Urol. 175: 1742, 2006.

Sato Y, Tanda H, Kato S, Ohnishi S, Nakajima H, Nanbu A, Nitta T, Koroku M, Akagashi K, Hanzawa T
Urology. 2008 Apr;71(4):586-91
doi:10.1016/j.urology.2007.10.072

Reported by UroToday.com Medical Editor Ralph V. Clayman, MD

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