Extracorporeal shock wave lithotripsy as monotherapy for vesical calculi

Extracorporeal shock wave lithotripsy (ESWL) is a well-established non-surgical treatment of urolithiasis. ESWL as a monotherapy to treat vesical calculi is still unfamiliar among many urologists, despite its early introduction in the 1990’s. ESWL monotherapy for vesical calculi was performed in our study in a unique fashion in supine position with full bladder unlike any other previous reported studies. We aimed this study to report our experience with ESWL as a monotherapy in treating urinary bladder stones with a unique technique. A total of 29 patients with vesical calculi were treated with ESWL monotherapy from May 2021 to January 2023 using Dornier delta lithotripter in the supine position with the full bladder without per urethral catheterisation. Patients with stone size > 2.5cm or Hounsfield units > 1200 were excluded. Stone clearance was assessed with the help of fluoroscopy and ultrasonography on a second visit on day 7 after the procedure. Patients were followed up for 3 months. The mean size of vesical calculus was 1.6 cm (SD 0.32), and the mean Hounsfield unit was 940 HU (SD 86.61). None of the study subjects required surgical intervention. The stone clearance was obtained in 93.1% after a single session. The remaining two patients (6.9%) required one more session of ESWL following which stone clearance was obtained. One patient had acute urinary retention, and five (17.2%) patients had mild haematuria. ESWL monotherapy is a safe and effective treatment option for vesical calculi, with minimal or no patient discomfort, when done in supine position without routine per urethral catheterisation as described in the study. It should be considered more often by practicing urologists for vesical calculi.