Effects of altering ESWL stone treatment protocol on kidney biomarkers
Research type
Research Study
Full title
The role of modified ESWL protocols on selective inflammatory and renal biomarkers and their association with clinical outcome measures
IRAS ID
288236
Contact name
David K Jones
Contact email
Sponsor organisation
University of Chester
Duration of Study in the UK
2 years, 0 months, 1 days
Research summary
In the United Kingdom (UK) urological problems impose an enormous social and economic burden on our society. This ultimately causes huge financial restraints and increasing problems to our National Health Service (NHS).
Extra Corporeal Shockwave Lithotripsy (ESWL) is the first line minimally invasive treatment, employing shockwaves for the fragmentation kidney stones negating the need for alternative, and often invasive surgical intervention. All adults with kidney stones up to 20mm in size on an outpatient basis, would be eligible for treatment excluding general contraindications and exclusion criteria.
The use of Lithotripsy (ESWL) for stone management should always be performed to highest safety and efficacy standards, hence any study that demonstrates improvement in both standards must always be as the result of well-designed and robust study, adhering to highest ethics.
The energy and pressure of the shockwaves can cause endothelial cells within inner surface layer of the kidney structure to rupture causing blood loss during urination. Another adverse side effect is that some patients may develop urinary infections due to increased release of bacteria from fissures and cracks within kidney stone treated.
There is evidence in altering protocol to support ramping of power from the lithotripter for encouraging the priming phenomena, causing vasoconstriction whilst also lessening the degree of bleeding and consequent renal damage.
The other treatment variable of reducing the frequency of shockwave output can also have the desired effect of altering presence of secondary cavitation and consequent possible decrease in renal damage, whilst improving fragmentation effect.
Blood samples will be taken from all patients who consent to be part of the study prior to treatment, and post treatment at 30-minute, 120 minute and 240-minute intervals. The samples will be analysed for various inflammatory and renal injury biomarkers at the NWCRC laboratory in Wrexham Technology Park.
The effect of reducing frequency and employing voltage ramping can potentially increase fragmentation, reduce renal injury and allow the decrease in the number of shockwaves in a modified treatment protocol.REC name
South West - Cornwall & Plymouth Research Ethics Committee
REC reference
22/SW/0059
Date of REC Opinion
10 Jun 2022
REC opinion
Further Information Favourable Opinion