“Second-look” extracorporeal shock wave lithotripsy after percutaneous nephrolithotomy

Dear Editor,

We read with interest the study by Zareian Baghdadabad et al. ¹ titled “Evaluation of the analgesic effect of a combination of oral acetaminophen and oxycodone after extracorporeal shock wave lithotripsy (SWL)” and we commend the authors for their valuable and well-executed study. The study’s design and thorough methodology provide important insights into the analgesic strategies available to clinicians treating patients with renal stones. The focus of this research on Extracorporeal Shock Wave Lithotripsy (ESWL) is particularly important, given the procedure’s resurgence in recent years. ² As the authors have noted, ESWL is experiencing a revival,^3,4 primarily due to the challenges faced by healthcare systems globally in securing timely operating room access for retrograde intrarenal surgery (RIRS). ⁵ Many hospitals and clinics are struggling to meet the growing demand for RIRS procedures, which often results in prolonged waiting list times for patients. This issue has been exacerbated by various resource constraints, particularly in public healthcare systems, and especially after COVID-19 pandemic. ⁶

In light of these difficulties, ESWL has become a valuable alternative, ⁷ offering patients an effective treatment option that can be delivered in a non-invasive manner without requiring the extended use of operating room resources. At our center, we have similarly reintroduced ESWL in recent years as part of a broader strategy to reduce the burden on RIRS and to minimize waiting list times for patients requiring intervention for renal stones. This reintroduction of ESWL has significantly enhanced our ability to manage patient flow and provide timely care. We have also implemented ESWL as a “second look” procedure, few weeks after percutaneous nephrolithotomy (PCNL) in cases where patients have residual stones. The early results of this approach have been promising, with 63.3% of patients experiencing significant improvement in stone-free status following this additional treatment.

Furthermore, the study highlights the importance of patient satisfaction in managing post-procedural pain as well as to a “minimally-invasive” anesthesia and analgesia also for endourological procedures also during postoperative period. ⁸ Given the complexity and potential discomfort associated with urological procedures such as ESWL, ensuring adequate pain control is critical to improving patient outcomes. The findings provide valuable evidence that can help guide clinical decision-making, particularly in settings where resources are limited, and timely access to surgery may be challenging.