Conclusion This series of investigations demonstrated how we can apply our knowledge to improve the treatment outcome of ESWL. Based on clinical information, such as age, suitable candidates for ESWL can be identified, and hence better application of ESWL can be achieved. With an understanding of the benefits and limitations of imaging (NCCT and intravenous urography), treatment success can be predicted, and better treatment plans for patients can be formulated. A policy of more liberal use of analgesia during ESWL can also help to improve the treatment outcomes of patients. Finally, with the use of different assessment methods, the true impact of various new technologies or treatment protocols can be assessed, and the results can lead to better understanding of ESWL and also improvement in the treatment outcomes. / Materials and Methods In a retrospective review of treatment information of 2192 patients, the effect of age on stone-free rates after ESWL was assessed. Next, in a prospective study, the role of stone parameter, measured using non-contrast computerized tomography (NCCT), in predicting the treatment outcomes of upper ureteric stones was examined. The general applicability of caliceal pelvic height (CPH) in determining the treatment outcomes for lower caliceal stones for three different lithotriptors was assessed in the third study. In another retrospective comparative study, the effect on treatment outcomes of additional usage of intravenous analgesic during ESWL, as compared to oral analgesic premedication alone, was analyzed. Finally, the feasibility of the use of two statistical methods, logistic regression and matched-pair analysis, in comparing the treatment results of different lithotriptors was investigated. / Objectives Despite the initial success of extracorporeal shock wave lithotripsy (ESWL), the performance of the contemporary machines has never been as good as that of the first-generation machine. Therefore, a series of studies was conducted to advance the current knowledge of ESWL and investigate possible ways to further optimize the treatment outcomes. / Results We found that the stone-free rate after ESWL for older patients with renal stones, but not for those with ureteric stones, was significantly lower than that of younger patients. Stone parameters measured using NCCT, namely, mean stone density, stone volume, and skin-to-stone distance, were significant predictive factors for successful ESWL for upper ureteric stones. However, caliceal pelvic height, measured by intravenous urography, was a significant predictor of treatment outcomes of lower caliceal stones for only the Piezolith 2300 lithotriptor, and not the other two types of lithotriptors. The additional usage of intravenous analgesic improved the effectiveness quotient and hence treatment outcomes of ESWL. Finally, both logistic regression and matched-pair analysis were found to be feasible approaches for the comparison of the performance of different lithotriptors. / Chi-Fai Ng. / Source: Dissertation Abstracts International, Volume: 73-02, Section: B, page: . / Thesis (M.D.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 224-243). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
| Identifer | oai:union.ndltd.org:cuhk.edu.hk/oai:cuhk-dr:cuhk_344662 |
| Date | January 2010 |
| Contributors | Ng, Chi-Fai, Chinese University of Hong Kong Graduate School. Division of Surgery. |
| Source Sets | The Chinese University of Hong Kong |
| Language | English |
| Detected Language | English |
| Type | Text, theses |
| Format | electronic resource, microform, microfiche, 1 online resource (249 leaves : ill.) |
| Rights | Use of this resource is governed by the terms and conditions of the Creative Commons “Attribution-NonCommercial-NoDerivatives 4.0 International” License (http://creativecommons.org/licenses/by-nc-nd/4.0/) |
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